ACA Repeal Economic Impact on Cook County

Preliminary Economic Impact of Affordable Care Act Repeal on Cook County

If Congress repeals health coverage for over 1 million Illinoisans under the Affordable Care Act (ACA) and does not replace it, preliminary estimates are that, statewide, Illinois would sustain a potential loss of $11.6 billion to $13.1 billion in annual economic activity, which translates to a potential loss of 84,000 to 95,000 jobs.

In addition, Illinois hospitals have already experienced over $1 billion in Medicare payment cuts to help pay for ACA coverage. For 2016-2025, these hospital cuts will approximate another $10 billion.


  • Illinois hospitals strongly support ensuring continued access to healthcare coverage.
  • Any repeal of ACA coverage should not take effect until the replacement plan takes effect.
  • If Congress does not make repeal of coverage contingent on adoption of a replacement plan, then Congress should also repeal the hospital payment cuts that help pay for ACA coverage.

Cook County Region – Estimated Economic Impact

Congressional Districts 1, 2, 3, 4, 5, 7, 8, and 9

  • $1.50 billion in lost spending for coverage of Medicaid ACA population
  • $867 million in lost spending for coverage of Marketplace ACA population
  • $5.92 billion in lost economic impact with indirect ripple effect
  • 42,800 jobs lost
  • $630 million in hospital Medicare payment cuts incurred 2010-15
  • $1.61 billion in additional hospital Medicare payment cuts 2016-20
  • $6.59 billion in total hospital Medicare payment cuts 2010-25

Cook County Region – Estimated Enrollment Data

Congressional Districts 1, 2, 3, 4, 5, 7, 8, and 9

  • 319,000 Medicaid expansion enrollees
  • 1.55 million total Medicaid enrollees
  • 197,000 ACA Marketplace enrollees


  • Illinois Department of Healthcare and Family Services (HFS) Medicaid ACA Enrollment by Congressional District, June 2016. Note: HFS classified some enrollees as unknown so these enrollees are not included in any congressional district.
  • HFS CY2016 MCO Rate Certification for ACA population, July 2016.
  • U.S. Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE) Plan Selections in Health Insurance Marketplace, March 2016. Mapping by zip codes results in some zip codes allocated to multiple congressional districts.
  • ASPE Office of Health Policy Research Brief, Health Plan Choice and Premiums in the 2017 Health Insurance Marketplace, October 2016.
  • IHA estimate of percentage of Marketplace beneficiaries who would obtain alternate coverage.
  • Centers for Medicare & Medicaid Services payment rule Impact Files, Medicare Cost Reports (2012-2014) and Medicare Claims data (2014). All impacts reflect Medicare FFS payments. Medicare impact analysis prepared by DataGen, subsidiary of Hospital Association of New York State, February 2016.

Economic impact estimates are based on Regional Input-Output Modeling System II (RIMS II), U.S. Bureau of Economic Analysis (BEA). The Final Demand Multipliers, obtained from BEA RIMS-II, were applied to estimated cost of Medicaid and Marketplace coverage to obtain the total economic impact, including “ripple effect,” of jobs and spending at risk throughout the state.