By Mark Gruenberg
PAI Staff Writer

An independent study for the non-profit Commonwealth Fund calculates the Senate Republicans’ “replacement” for the seven-year-old Affordable Care Act could cost 919,000 jobs in health care alone by 2026 – and 1.45 million jobs overall that year.

And Michigan would be first in line, as the sole state to lose jobs overall next year (-2,200), because the GOP-run Legislature expanded Medicaid coverage but on the condition that if Congress repealed that expansion, the state would drop it, too, cutting patients and jobs. By 2026, Michigan would be among the top five states in job losses if the legislation becomes law, losing an estimated 51,000 jobs.

Across the U.S., health care jobs would start to shrink immediately: losing 30,000 jobs in 2018 and 111,000 jobs the year after that, the study said. They’d accelerate to a 347,000-job loss in 2020 with rising losses afterwards.

The study concedes that if the Senate GOP’s health care bill becomes law, combined overall jobs in health care - combined with those tied to the health care industry - would increase the first two years, but with a smaller increase in 2019. But then, those fields start shedding jobs in 2020, from 13,000 lost that year to 350,000 lost in 2021, with expanding declines beyond that. 

The study adds to the weight of evidence against the Republicans’ replacement bill, pushed by Senate Majority Leader Mitch McConnell. The measure would throw 22 million people off of health insurance in a decade, with two-thirds of them losing it next year.

Unions and their allies have emphasized loss of health insurance coverage in their campaigns against repealing the ACA and replacing it with the GOP measure, called the “Better Care Reconciliation Act.” But they also are aware of the job losses among workers. Sheila Lindsay of the American Nurses Association, whose staff is unionized, says her group is planning to ramp up its campaign among its members. 

National Nurses United Communications Director Charles Idelson says NNU “is more concerned about the impact on patients, why the Dems are so reluctant to admit the weaknesses of the ACA that led to this and why they don’t do more to promote the real fix, single-payer” government-run Medicare for All. That’s a top NNU cause.

At least one Senate Democrat, Oregon’s Jeff Merkley, reported July 11 that even Republicans are telling him at home that they back single-payer. And Sen. Bernie Sanders, Ind.-Vt., has pushed single-payer for years.

The Commonwealth Fund study also reported states would lose $162 billion in gross (state) domestic product value in 2026 if the GOP legislation passed, and $265 billion in business output that year. In both areas, the states gained money – but in declining numbers – from 2018-20, then ran in the red starting in 2021. 

“Coverage and spending-related policies are directly related to funding for health services e.g., Medicaid, premium tax credits, and high-risk pools,” wrote the study’s five co-authors, all with masters’ degrees in health policy and employed by the health policy research center at George Washington University in D.C.

“The reductions directly affect the health sector — hospitals, doctors’ offices, or pharmacies — but then flow out to other sectors. Thus, almost half of jobs lost due to coverage policies are in the health sector while the rest are in other sectors,” they explained.

The study explains things will worsen after 2026 because the GOP is considering its replacement for the ACA at a time of low inflation and low unemployment – in other words, at the peak of a business cycle. And the way the GOP bill is structured, the study warns, would only worsen a subsequent slide.

“The combination of more uninsured and more unemployed people will increase the demand for social assistance, but weaker state economies and federal reductions in Medicaid spending will make it more difficult for states to respond to those needs. States will confront painful choices between raising taxes or slashing services,” the study's authors predict.