Estimates of the Increase in Uninsured by Congressional District Under the Senate GOP Tax Bill
Last week, the Senate dealt a blow to health care by repealing the individual coverage mandate as part of its tax bill. The Congressional Budget Office (CBO) has estimated that repeal of the mandate will result in millions more uninsured over the next decade, even if Congress approves a market stabilization package. A major portion of the newly uninsured would come from the individual market, where mandate repeal would raise premiums and drive some people out of coverage altogether.
The CBO projects that 4 million fewer people would have coverage in 2019 and 13 million fewer would be covered by 2025. As a result, the share of the nonelderly population that is uninsured would swell to 16 percent by 2025, compared with about 10 percentcurrently. By simply allocating the 13 million proportionally across states, the Center for American Progress estimates that, on average, about 29,800 more people would be uninsured in each congressional district by 2025 under the Senate Republican tax bill. CAP previously published state-level estimates of coverage reductions due to mandate repeal here.
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Mandate repeal has two effects on the individual market. First, some healthy enrollees would drop out of ACA-compliant plans and become uninsured or underinsured. Second, because the remaining enrollees in the risk pool would be sicker on average, insurance companies would need to raise rates about 10 percent to cover the increased average cost. The resulting higher premiums would discourage even more people from obtaining coverage through the individual market.
Repeal of the mandate would spur healthy people to avoid purchasing coverage until they need it. Without the mandate, the millions who would become uninsured instead of being covered by Medicaid, employer-sponsored plans, or nongroup insurance would no longer have financial protection against catastrophic medical costs and would be more likely to forgo needed care due to cost.
California estimates by district, excerpted from 50-state table
| Net reduction in health insurance coverage in 2025 due to individual mandate repeal, by congressional district and coverage type |
| STATE | REPRESENTATIVE | TOTAL COVERAGE REDUCTION | MEDICAID REDUCTION | INDIVIDUAL MARKET REDUCTION | EMPLOYER-SPONSORED REDUCTION |
| California | Doug LaMalfa (CA-1) | 16,200 | 13,100 | 1,800 | 1,300 |
| California | Jared Huffman (CA-2) | 35,500 | 13,700 | 20,200 | 1,600 |
| California | John Garamendi (CA-3) | 19,100 | 15,100 | 2,400 | 1,600 |
| California | Tom McClintock (CA-4) | 32,900 | 14,100 | 16,600 | 2,200 |
| California | Mike Thompson (CA-5) | 18,700 | 14,800 | 2,300 | 1,700 |
| California | Doris O. Matsui (CA-6) | 34,000 | 16,200 | 2,200 | 15,600 |
| California | Ami Bera (CA-7) | 18,900 | 15,100 | 1,400 | 2,300 |
| California | Paul Cook (CA-8) | 17,400 | 14,900 | 1,000 | 1,500 |
| California | Jerry McNerney (CA-9) | 19,800 | 16,000 | 1,700 | 2,200 |
| California | Jeff Denham (CA-10) | 19,300 | 15,800 | 1,600 | 1,900 |
| California | Mark DeSaulnier (CA-11) | 43,800 | 15,300 | 26,300 | 2,100 |
| California | Nancy Pelosi (CA-12) | 33,000 | 15,600 | 3,000 | 14,400 |
| California | Barbara Lee (CA-13) | 36,100 | 15,700 | 4,000 | 16,400 |
| California | Jackie Speier (CA-14) | 40,400 | 15,400 | 2,400 | 22,600 |
| California | Eric Swalwell (CA-15) | 46,300 | 16,200 | 2,000 | 28,100 |
| California | Jim Costa (CA-16) | 17,200 | 15,700 | 1,400 | 100 |
| California | Ro Khanna (CA-17) | 68,700 | 16,600 | 24,000 | 28,000 |
| California | Anna G. Eshoo (CA-18) | 66,400 | 15,200 | 23,700 | 27,600 |
| California | Zoe Lofgren (CA-19) | 40,500 | 16,200 | 2,300 | 21,900 |
| California | Jimmy Panetta (CA-20) | 19,700 | 15,300 | 2,800 | 1,600 |
| California | David G. Valadao (CA-21) | 16,300 | 15,200 | 1,000 | 100 |
| California | Devin Nunes (CA-22) | 19,700 | 16,000 | 1,700 | 2,100 |
| California | Kevin McCarthy (CA-23) | 18,500 | 15,000 | 1,500 | 1,900 |
| California | Salud O. Carbajal (CA-24) | 32,700 | 14,700 | 3,200 | 14,700 |
| California | Stephen Knight (CA-25) | 33,900 | 15,500 | 16,100 | 2,300 |
| California | Julia Brownley (CA-26) | 37,400 | 14,900 | 20,600 | 1,900 |
| California | Judy Chu (CA-27) | 50,500 | 14,400 | 34,500 | 1,600 |
| California | Adam B. Schiff (CA-28) | 59,100 | 14,500 | 43,400 | 1,200 |
| California | Tony Cárdenas (CA-29) | 19,300 | 15,800 | 2,400 | 1,100 |
| California | Brad Sherman (CA-30) | 53,400 | 15,600 | 36,000 | 1,900 |
| California | Pete Aguilar (CA-31) | 18,800 | 15,800 | 1,300 | 1,700 |
| California | Grace F. Napolitano (CA-32) | 18,700 | 15,100 | 2,200 | 1,500 |
| California | Ted Lieu (CA-33) | 84,000 | 14,300 | 50,000 | 19,700 |
| California | Jimmy Gomez (CA-34) | 18,900 | 16,100 | 2,700 | 100 |
| California | Norma J. Torres (CA-35) | 19,300 | 16,000 | 1,800 | 1,500 |
| California | Raul Ruiz (CA-36) | 16,300 | 14,100 | 1,000 | 1,100 |
| California | Karen Bass (CA-37) | 59,500 | 15,400 | 42,900 | 1,200 |
| California | Linda T. Sánchez (CA-38) | 18,500 | 14,800 | 1,700 | 1,900 |
| California | Edward R. Royce (CA-39) | 48,700 | 15,100 | 31,700 | 1,900 |
| California | Lucille Roybal-Allard (CA-40) | 17,100 | 16,000 | 1,000 | 100 |
| California | Mark Takano (CA-41) | 36,000 | 16,700 | 1,800 | 17,500 |
| California | Ken Calvert (CA-42) | 39,000 | 16,800 | 19,700 | 2,400 |
| California | Maxine Waters (CA-43) | 19,000 | 15,500 | 2,000 | 1,500 |
| California | Nanette Diaz Barragán (CA-44) | 17,900 | 15,600 | 900 | 1,400 |
| California | Mimi Walters (CA-45) | 79,800 | 16,100 | 38,100 | 25,600 |
| California | J. Luis Correa (CA-46) | 18,800 | 16,000 | 1,600 | 1,300 |
| California | Alan S. Lowenthal (CA-47) | 19,200 | 15,100 | 2,300 | 1,700 |
| California | Dana Rohrabacher (CA-48) | 45,600 | 14,600 | 29,300 | 1,700 |
| California | Darrell E. Issa (CA-49) | 37,700 | 14,600 | 21,000 | 2,100 |
| California | Duncan Hunter (CA-50) | 39,800 | 15,500 | 22,600 | 1,700 |
| California | Juan Vargas (CA-51) | 17,800 | 15,300 | 1,400 | 1,200 |
| California | Scott H. Peters (CA-52) | 69,600 | 15,000 | 34,200 | 20,300 |