Obamacare in Pictures: Visualizing the Effects of the Patient Protection and Affordable Care Act
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Obamacarein PicturesVISUALIZING THE EFFECTS OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT
Spring 2014
heritage.orgObamacare in PicturesSource: Associated Press, December 26, 2013.
At least 4.7 million health care plans in the individual market have been discontinued due to new Obamacare rules.
If you like your health care plan, can you really keep it?
POLICIES SCHEDULED FOR CANCELLATION (THOUSANDS)
3.2
290
60
250
135
100
25
26
22
47
184
0.5
140
225
93
130
108185
105
1
400
333
3271,100
5.4
90
WY
WV
WI
WAVT
VA
UT
TX
TN
SD
SC
RI
PA
OR
OK
OH
NY
NV
NM
150NJ
NH
NE
ND
NC
MT
MS
MO
MN
MI
ME
73MD21DC
MA
LA
KYKS
INIL
ID
IA
HI
GA
FL
12DE
66CT
COCA
AZ AR
AK
AL
Data not availableCancelled plansswitched automatically
0–1010–100100–200200+
heritage.orgObamacare in PicturesSource: Towers Watson/NBGH Employer Survey on Purchasing Value in Health Care, 2013.
Those with employer coverage might not be able to keep their existing plans either. The vast majority of businesses expect to make changes to their health care plans to comply with Obamacare’s regulations, and more than half of those anticipate the changes to be significant or drastic.
BUSINESSES ANTICIPATING CHANGES TO THEIR EMPLOYER-SPONSORED HEALTH CARE BY 2018
Obamacare will require employers to make changes to their health care plans
0%
10%
20%
30%
40%
50%
3%
44% 45%
8%
No change or small change
Modest change
Significant change
Complete transformation
heritage.orgObamacare in PicturesSource: Heritage Foundation calculations using data from healthcare.gov and state-run exchanges, October 2013.
Notes: Data for KY, HI, and MA unavailable at time of analysis. VA figure not available due to possible errors.
Buying individual health insurance in the exchanges is generally more expensive than it was before Obamacare, especially for young adults. In 11 states, 27–year–olds will see premiums double or more.
Premiums are higher in Obamacare exchanges: Age 27
26%
7%
99%
73% 144%
n/a75%
100%
59%
94%
20%
32%
55%
58%
–2%
–29%
2%
80%
1%
71%
113%
91%
43%
31%
54%
15%
118%
26%
106%
n/a129%
34%114%
86%
12%
n/a
168%
75%
–30%24%
157% 171%
73%
31%
WY
WV
WI
WA VT
VAUT
TX
TN
SD
SC
–28%RI
PA
OR
OK
OH
NY
NV
NM
–3%NJ
NH
NE
ND
NC
MT
MS
MO
MN
MI
ME
10%MD1%DC
n/aMA
LA
KYKS
INIL
ID
IA
HI
GA
FL
100%DE
64%CT
COCA
AZ AR
AK
AL
CHANGE IN PREMIUMS FOR 27–YEAR–OLDS
Down 1% to 30%Up 0%–50%Up 51% to 100%Up 100%+
heritage.orgObamacare in PicturesSource: Heritage Foundation calculations using data from healthcare.gov and state-run exchanges, October 2013.
Buying individual health insurance in the exchanges is generally more expensive than it was beforeObamacare. In 13 states, 50–year–olds will see premiums rise by 50 percent or more.
Premiums are higher in Obamacare exchanges: Age 50
15%
9%
64%
13% 61%
n/a26%
91%
32%
73%
33%
29%
7%
22%
–2%
–29%
50%
12%
5%
22%
96%
21%
31%
37%
39%
23%
43%
4%
44%
n/a72%
81%43%
34%
13%
n/a
71%
75%
–26%13%
42% 79%
46%
29%
WY
WV
WI
WA VT
VAUT
TX
TN
SD
SC
–16%RI
PA
OR
OK
OH
NY
NV
NM
–1%NJ
NH
NE
ND
NC
MT
MS
MO
MN
MI
ME
13%MD53%DC
n/aMA
LA
KYKS
INIL
ID
IA
HI
GA
FL
65%DE
75%CT
COCA
AZ AR
AK
AL
CHANGE IN PREMIUMS FOR 50–YEAR–OLDS
Down 1% to 30%Up 0%–25%Up 26% to 50%Up 50%+
Notes: Data for KY, HI, and MA unavailable at time of analysis. VA figure not available due to possible errors.
heritage.orgObamacare in PicturesSource: Heritage Foundation calculations using data from healthcare.gov and state-run exchanges, October 2013.
Buying individual health insurance in the exchanges is generally more expensive than it was before Obamacare. In 19 states, premiums for a family of four will increase by more than 10 percent.
Premiums are higher in Obamacare exchanges: Family of four
4%
2%
19%
3% 18%
n/a7%
30%
9%
22%
9%
8%
2%
6%
–0.4%
–7%
0.8%
3%
1.3%
6%
32%
5%
8%
10%
11%
6%
12%
0.9%
12%
n/a22%
26%12%
9%
7%
n/a
21%
23%
–6%3%
12% 25%
13%
8%
WY
WV
WI
WA VT
VAUT
TX
TN
SD
SC
–4%RI
PA
OR
OK
OH
NY
NV
NM
–0.3%NJ
NH
NE
ND
NC
MT
MS
MO
MN
MI
ME
3%MD15%DC
n/aMA
LA
KYKS
INIL
ID
IA
HI
GA
FL
19%DE
23%CT
COCA
AZ AR
AK
AL
CHANGE IN PREMIUMS FOR A FAMILY OF FOUR
Down 1% to 10%Up 0%–10%Up 11% to 20%Up 21%+
Notes: Data for KY, HI, and MA unavailable at time of analysis. VA figure not available due to possible errors.
heritage.orgObamacare in PicturesSources: Heritage Foundation calculations based on data from HHS and Kaiser Family Foundation Employer Health Benefits 2013 Annual Survey.
Note: Those with incomes between 100% and 250% of FPL who purchase silver plans qualify for a separate cost-sharing reduction subsidy that reduces their deductible and other out-of-pocket expenses.
In addition to premium costs, individuals must meet an annual deductible before coverage kicks in. Average individual deductibles in the 36 states with a federally run exchange are much higher than the average individual deductible for employer- sponsored plans in 2013.
AVERAGE DEDUCTIBLE
Many Obamacare exchange plans come with higher deductibles
Catastrophic Bronze Silver(Standard)
Gold Platinum Employer-sponsoredinsurance
$6,346
$4,617
$2,756
$1,203
$390
$1,135
heritage.orgObamacare in PicturesSources: Heritage Foundation calculations using data from healthcare.gov and state-run exchanges, November 2013.
More than half of U.S. counties have only one or two insurance carriers selling coverage in the Obamacare exchanges. This lack of competition means less choice for consumers and less market pressure to keep prices down.
COUNTIES WITH LITTLE OR NO COMPETITION IN OBAMACARE EXCHANGES (% OF ALL COUNTIES)
Lack of competition in Obamacare exchanges
■ Only 1 carrier (17%)■ Only 2 carriers (35%)
$2 trillion
$898billion
March 2010 estimate(six years of spending
over 10 years)
February 2014 estimate(10 years of spending
over 10 years)
heritage.orgObamacare in PicturesSource: Congressional Budget Oce, March 2010 and February 2014.
Initial estimates for Obamacare’s spending on the Medicaid expansion and exchange subsidies counted only six years of spending. A full 10–year cost reveals nearly $2 trillion in new spending by 2024.
Obamacare’s new spending continues to grow
heritage.orgObamacare in PicturesSources: Heritage Foundation calculations based on data from the Congressional Budget O�ce, March 2012, and Medicaid and CHIP Payment Access Commission.
In the vast majority of states, adopting the Medicaid expansion would require additional state spending.Obamacare’s Medicaid expansion burdens state budgets
ESTIMATED STATE COSTS FOR MEDICAID EXPANSION, 2014–2022 (MILLIONS)
$22
$176
$843
$547 $134
$284$231
$1,402
$777
$61
$820
$1,374
$343
$319
$1,194
$7,694
$138
$331
$42
$157
$55
$891
$57
$312
$515
$724
$883
$332
$685
$370$85
$444$2,338
$61
$287
$326U.S. total:
$41.9 billion
$583
$1,389
$156$9,011
$2,805 $364
$63
$368
WY
WV
WI
WA VT
VAUT
TX
TN
SD
SC
$107RI
PA
OR
OK
OH
NY
NV
NM
$5NJ
NH
NE
ND
NC
MT
MS
MO
MN
MI
ME
$289MD$119DC
$923MA
LA
KYKS
INIL
ID
IA
HI
GA
FL
$164DE
$335CT
COCA
AZ AR
AK
AL
$30–$99$100–$499$500–$999$1,000–$1,999$2,000–$9,100
heritage.orgObamacare in PicturesSource: Congressional Budget Oce, February 2014.
In 2024, after 10 years of full implementation and nearly $2 trillion in new spending, 31 million people will likely remain uninsured. Those who do gain coverage will do so primarily through Obamacare exchanges or Medicaid.
HEALTH COVERAGE IN 2024, WITH AND WITHOUT OBAMACAREMillions will remain uninsured under Obamacare
Note: Figures have been rounded.
UNINSURED MEDICAID OBAMACARE EXCHANGES
n/a
DOWN25
UP 13
UP 24
56
3134
47
24
million
millionmillion
million
million
Without Obamacare
With Obamacare
Without Obamacare
With Obamacare
Without Obamacare
With Obamacare
millionmillion
million
heritage.orgObamacare in PicturesSources: Heritage Foundation calculations based on data from Congressional Budget O�ce, May 2013, and Joint Committee on Taxation, June 2012.
Obamacare includes 18 new taxes, fees, and penalties, costing taxpayers an estimated $771 billion by 2022.
OBAMACARE TAXES IN BILLIONS OF NOMINAL DOLLARS
Obamacare’s 18 new taxes and penalties
$0
$20
$40
$60
$80
$100
$120
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
Increase in Medicare payroll tax and application to investment income for high earners
Individual and employer mandates
Health insurance tax
Tax on “Cadillac” plans
Fee on pharmaceutical companies
Fee on medical device manufacturers
All other taxes
Note: The total amount of tax revenue collected from the individual mandate, employer mandate (excluding collections in 2015 because of the July 2013 delay), and 40 percent excise tax on high-cost health plans are from the CBO’s May 2013 estimates. For the remaining taxes, the revenue projections are from the Joint Committee on Taxation’s 2012 estimates.
heritage.orgObamacare in PicturesSource: Congressional Budget Oce, June 2012.
Nearly 70 percent of those projected to pay the Obamacare individual mandate tax earn less than 400 percent of the federal poverty level (FPL) ($45,960 for a single individual in 2013), and 10 percent live in poverty.
Who pays the Obamacare individual mandate tax?
0%
25%
50%
75%
BELOW400% FPL
ABOVE400% FPL
31%
69%
Below Poverty Line10%
100%–200% FPL21%
200%–300% FPL20%
300%–400% FPL18%
400%–500% FPL11%
More Than500% FPL20%
heritage.orgObamacare in PicturesSource: Congressional Budget Oce, July 2012.
Projected Medicare savings from Obamacare do not improve the program’s long-term solvency. Most of the savings are redirected to fund new Obamacare spending.
CUTS IN MEDICARE DUE TO OBAMACARE, 2013–2022Obamacare cuts Medicare payments to fund other new programs
* Disproportionate Share Hospital, meaning supplemental payments that go to hospitals that serve a large number of low-income patients.
$0 $50 $100 $150 $200 $250 billion
Hospital services
Payment rates in Medicare Advantage
DSH* payments, other Medicare provisions
Home health services
Skilled nursing services
All other services
Hospice services
$260 billion
$156 billion
$145 billion
$66 billion
$39 billion
$33 billion
$17 billion
Obamacare cuts$716 billion
from Medicare
PERCENTAGE OF HOSPITALS, SKILLED NURSING FACILITIES, AND HOME HEALTH AGENCIES PROJECTED TO OPERATE AT A LOSS
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
15%
25%
40%
2019 2030 2050
heritage.orgObamacare in PicturesSource: Medicare trustees 2013 report.
By cutting Medicare payments instead of introducing real reform, the health care law jeopardizes seniors’ access to providers. According to the Medicare trustees, Obamacare’s scheduled reductions to provider payments will cause Medicare’s payments for health services to fall further below providers’ costs. This will cause providers to either withdraw from serving Medicare beneficiaries or shift more costs to their patients with private coverage.
Obamacare’s Medicare cuts will result in severe access problems for seniors
heritage.orgObamacare in PicturesNote: Figures shown are the first poll average in each month.Source: Real Clear Politics, “Public Approval of Health Care Law,” March 2014.
Opposition to Obamacare has hovered around 50 percent since early 2010. Over the past year, the law has grown even more unpopular.
POLL AVERAGE, BY MONTH
Obamacare remains unpopular
30%
40%
50%
60%
AGAINST/OPPOSE
FOR/FAVOR
Jan.2010
Jan.2011
Jan.2012
Jan.2013
Jan.2014
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