Repeal of the Affordable Care Act is already the topicof controversy for many reasons: how many people could end upuninsured, depending on how the ACA is repealed; how muchpeople will end up paying for coverage; what might replace it inproviding coverage; and how effective the replacement might be.

But there's another aspect of the dispute that hasn't gotten alot of attention yet: how many jobs the repeal will cost.

And according to a report from the Economic PolicyInstitute, in 2019 the tally will be 1.2 million in every state inthe country. The report looks at the effects of cuts to bothspending and taxes that would occur under a full repeal, whichwould include cuts in federal spending nationwide by roughly $109billion in 2019 and in taxes by roughly $70 billion in 2019.

States with the highest proportion of low- and middle-incomefamilies would see the most economic damage from the $109 billionin spending cuts, along with states that took up the ACA Medicaidexpansion.

The $70 billion in tax cuts, on the other hand, woulddisproportionately benefit states with the most households in thetop 1 percent.

The Tax Policy Center has estimated the distributional impact oftax cuts related to ACA repeal at the national level, and indicatedthat “an extraordinary 57.4 percent of these tax cuts would accrueto the top 1 percent, with over a third accruing to the top 0.1percent alone,” the report said.

The combination of tax and spending cuts would reduce nationaljob growth by almost 1.2 million in 2019, all else equal, accordingto the report, since low- and moderate-income households tend tospend a much higher share of marginal increases in disposableincome while wealthier households save a significant proportion ofincome increases.

As a result, the spending cuts would hurt job growth more thanthe tax cuts would help it, with the overall effect ofan ACA repeal being less spending and slowerdemand growth across all states, according to Josh Bivens, authorof the report and research director at EPI.

In a statement, Bivens said, “If the ACA is repealed, workingpeoples' purchasing power will be significantly reduced, whichmeans they will spend less on goods and services in the localeconomy.” He added, “Job growth will be constrained due to thisdecrease in spending. Any spending boost from lower taxes as aresult of ACA repeal would be swamped by spending cutbacks low- andmiddle-income families would have to undertake after losing accessto Medicaid or subsidies in insurance exchanges.”

“The most important reason to oppose repealing the ACA is the 20million Americans who would lose health insurance,” Bivens added.“But layered on top of this loss is a potential macroeconomic shockthat would likely significantly affect job growth.”

Lost jobs would not be solely in health care, either; studies ofjobs gained through Medicaid expansions in the American Recoveryand Reinvestment Act (ARRA) indicate that more than 75 percent ofthe jobs gained were not in the health care sector.

And every state would lose jobs, with the extent depending onhow much a state expanded spending (and thus will lose) and whatportion of a state's households fall within the groups getting thelargest tax cuts (and thus will gain).

Eighteen states would see employment losses greater than 0.5percent of their current state under-65 population, and the studysaid, “The top 15 job-losing states, as measured by jobs lost as ashare of both the total employment and the share of residents underage 65, are Arizona, Colorado, Kentucky, Louisiana, Maryland,Montana, Nevada, New Jersey, New Mexico, North Carolina, Oregon,Rhode Island, Vermont, Washington and West Virginia.”

States that didn't expand Medicaid would stand to lose theleast, as would states with the largest share of households in thetop 1 percent. They would benefit disproportionately from theinsurance premium and cost-sharing subsidies of the ACA, the studysaid, pointing out that overall, insurance premium and cost-sharingsubsidies amount to approximately 0.4 percent of non-expansionstates' gross domestic product, although in expansion states thosesubsidies equal roughly 0.15 percent of GDP.

In addition, while there are claims that any ACA job losseswould be neutralized by countervailing Federal Reserve policy, thestudy said, “[m]onetary policy is unlikely to be able to provide anexpansionary boost to economic activity anywhere near large enoughto counteract the significant fiscal contraction posed by ACArepeal, even in 2019.”

In addition, a Huffington Post report cited Politicohealth care writer Dan Diamond as pointing out numeroustimes that “private sector employment has risen every single monthsince March 2010, when President Barack Obama signed the AffordableCare Act into law. Meanwhile, the Affordable Care Act has made iteasier for aspiring entrepreneurs to leave large companies andstart their own businesses, since the self-employed no longer haveto worry about insurers denying coverage for preexistingconditions.”

If the provision of the ACA that forbids denial of coverage dueto preexisting conditions is eliminated, that too will then weighon employment.