The consequences of repealing the Affordable Care Act would be dire, warns a new study from the Urban Institute, a liberal-leaning think-tank.

The study comes in light of a lawsuit, brought by a number of states, that seeks to overturn the law in court. The suit, Texas v. U.S., argues that the repeal of the individual mandate as part of the 2017 tax bill invalidated the rest of the ACA.

In December U.S. District Judge Reed O'Connor agreed with the plaintiffs and ruled that the ACA is unconstitutional. However, O'Connor immediately granted a stay, allowing the law to remain in effect while the ruling was appealed. The case is currently being considered by the U.S. Court of Appeals for the 5th Circuit.

Scrapping the landmark law would result in 20 million people losing health care coverage and the uninsured rate among those under 65 would climb from 11 percent to 18 percent. Just over 50 million people nationally would lack insurance.

The impact would be greatest among the 34 states that have expanded Medicaid to those up to 138 percent of the federal poverty line. The uninsured population would nearly double in those states. In states that have still not expanded Medicaid, the uninsured population would grow by 34 percent.

In other words, things would largely revert to the pre-ACA reality.

“Eliminating the ACA would be a major step backward for the millions of people who gained affordable healthcare coverage this decade,” said John Holahan, Institute Fellow at the Urban Institute. “Without access to the ACA's health and financial benefits, more low- and middle-income people would face higher financial burdens and less access to necessary medical care.”

During the two years when they controlled both chambers of Congress, Republicans could not agree on a way to repeal the ACA. Challenging the party's nine-year-old promise to repeal is the fact that the law has become increasingly popular. Polls now consistently show majority support for keeping it in place.

The Trump administration is supporting the lawsuit, and has written a brief in support of the O'Connor's ruling. Meanwhile, the Democratic-controlled House of Representatives has signed on to defend the law.

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20 million would lose coverage if ACA is repealed

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