Obamacare in Pictures: Visualizing the Effects of the Patient Protection and Affordable Care Act

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%+


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%+



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%+


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

Obamacare in Pictures: Visualizing the Effects of the Patient Protection and Affordable Care Act

Health & Medicine

congressional

heritage foundation

joint committee

vast majority

remain uninsured

va gure

ma unavailable

run exchanges