Adhering to the health insurance coverage requirements of the Patient Protection and Affordable Care Act no doubt costs the business community billions in additional coverage and compliance expenses each year. But that bill could be even higher if the ACA is repealed, a new report suggests.

The report from the Urban Institute and funded by the Robert Wood Johnson Foundation says repealing the ACA would increase uncompensated-care costs by nearly $1.1 trillion over 10 years starting in 2019. Uncompensated care is the combination of charity care, which is care provided with no expectation of payment, and bad debt, which is care provided for which payment was expected but not received.

The additional $1.1 trillion in uncompensated-care costs would come from individuals losing their health insurance benefits under the ACA but continuing to seek care from hospitals, doctors, pharmacies and other health care providers. A previous report from the Urban Institute estimated that the number of uninsured Americans would rise by 29.8 million people to 58.7 million people by 2019 from a repeal of the ACA.

“The additional financial burden of uncompensated care is likely to fall hardest on health care providers,” the new report said. “Partial ACA repeal could lead to a fourfold increase in the amount of uncompensated care providers finance themselves compared to current levels.”

What the report doesn’t say is that providers may try to make up the difference by charging higher prices for care to patients covered by commercial health insurance plans, including employer-sponsored health plans. That could translate into higher health care costs for employers and their workers.

In Minnesota, an ACA repeal would ignite a $24.5 billion jump in uncompensated care from 2019 to 2028, according to the Urban Institute report. Of that:
 

• $6.8 billion would fall on hospitals
• $5 billion would come from free or discounted prescription drugs
• $3.2 billion would fall on doctors
• $9.5 billion would come from other health care services

Hospitals’ uncompensated-care costs in Minnesota reached an eight-year low of $268 million in 2015, according to a report released last October by the Minnesota Department of Health. The department attributed the decline to an increase in the number of Minnesotans with health insurance—an increase largely driven by the individual and employer insurance coverage mandates of the ACA.