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Donald Trump and Congressional leaders have stated their intent to repeal the Patient Protection and Affordable Care Act (ACA or Obamacare). This report examines the consequences of repealing two key elements: (1) federal premium tax credits that help low and middle income Americans afford insurance policies bought through the Health Insurance Marketplaces (exchanges) and (2) federal payments to states for expansions of Medicaid eligibility for low-income adults. Congress passed similar legislation (H.R. 3762) in late 2015, which President Obama vetoed.

This report analyzes how the repeal of these policies could affect state-level employment, economies and fiscal conditions. If tax credits and Medicaid expansions end in 2019, repeal would cut a projected $61 billion in premium tax credits and $78.5 billion in grants to states for Medicaid expansions in a single year, a total of $140 billion in health insurance and health service subsidies that help millions of low and middle income Americans.

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