Photo: Flickr user Elvert Barnes.

A lot, according to new estimates.

With Texas leading the charge to repeal the Affordable Care Act, also nicknamed Obamacare, in the courts, millions of Americans stand to lose their health insurance if the courts decide to ultimately uphold the December 2018 decision of a district court judge. Some 20 million Americans could be uninsured if that happens, according to the Urban Institute with new estimates from the Center for American Progress offering a glimpse of how that breaks down by congressional district.

With an estimated 65 percent increase in the non-elderly uninsured population across the country, some states would see bigger changes than others. In states like Texas that did not expand Medicaid, for example, or had low enrollment under the Marketplace, were estimated to experience smaller increases in the number of uninsured people as well as smaller declines in federal health care spending. Still, the Urban Institute estimated that the non-elderly uninsured population of Texas would increase by 1.7 million people, or 37 percent, with a full repeal of the ACA and renewed Medicaid coverage expansion waivers.

Source: Urban Institute.

Using those state-wide estimates, the Center for American Progress projected those across each congressional district. 

In Rep. Sylvia Garcia's district, an estimated 62,000 residents could be uninsured, with another 61,000 in Rep. Al Green's district, 54,000 in Rep. Sheila Jackson Lee's district, 38,000 in Rep. Lizzie Fletcher's district and 31,000 in Rep. Dan Crenshaw's district. 

Source: State of Texas.

The liberal policy think tank generated the estimates by assuming "that each district’s coverage loss would be proportional to the size of insurance coverage gains that have occurred since the implementation of the ACA’s major coverage provisions, as measured through U.S. Census Bureau data."

The analysis found that on average, 45,600 people in each congressional district, as well as Washington, D.C., who would be uninsured if Texas and the other conservative states behind the lawsuit succeed.

"If the Supreme Court ultimately sides with partisan judges and conservative activists by striking down the entire ACA, the effects would be immediate and devastating," wrote Emily Gee, a health economist with the Center for American Progress, and Charles Gaba, a health care analyst.

The impacts would extend beyond individuals who buy insurance on their own, the authors note, to include people with preexisting conditions who might lose critical protections under the ACA. 

The case was taken up Tuesday by a federal appeals court in New Orleans but could potentially find its way to the United States Supreme Court, which has already upheld the healthcare law in two other cases.

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