Visualizing the Effects of the Patient Protection and Affordable Care Act Fall 2012
expands dependence on government health care dumps millions into Medicaid and creates new federal subsidies for government-approved coverage. As a result, by the end of the decade most Americans will receive health coverage through government programs. Health Care Enrollment in 2020 Exchange Subsidies: 7.3% Medicare: 18.3% Medicaid and CHIP: 25.1% Government 50.7% 50% 40% 30% 20% 10% 0% Other 49.3% Source: Centers for Medicare and Medicaid Services, Office of the Actuary, January 2012 report.
Millions remain uninsured under President Obama promised near-universal coverage under his health care overhaul. However, even with, millions of Americans will remain uninsured. Those who do gain coverage will do so primarily through government exchanges or Medicaid. Health Coverage, With and Without (2022) UNINSURED 56 million ( 26 million) 30 million MEDICAID (+11 million) 32 million 43 million GOVERNMENT EXCHANGES (+25 million) 25 million n/a Note: Figures have been rounded. Without With Without With Without With Source: Congressional Budget Office, March 2012 and July 2012 reports.
If you like your health care, can you really keep it? President Obama promised that reform would not affect existing coverage. While it remains uncertain exactly how many Americans will lose employer-sponsored plans under, studies show that it will be millions. Congressional Budget Office CMS Office of the Actuary The Lewin Group American Action Forum Estimated Loss of Employer Coverage After Full Implementation 17.2 million 20 million 14 million Sources: Congressional Budget Office and Joint Committee on Taxation, March 2012; CMS Office of the Actuary, April 2010; The Lewin Group, June 2010; and the American Action Forum, May 2010. 35 million
Premiums continue to rise under President Obama promised that premiums would fall under his health law, but that has yet to happen. Even when the law is in full effect, premiums will likely continue to rise. Average Annual Cost of Employer-Based Health Insurance $15,000 $12,000 $9,000 $6,000 $3,000 $13,770 $15,745 +14.3% $5,049 $5,615 +11.2% $0 2010 2012 2010 2012 Family Policy Individual Policy Source: Kaiser Family Foundation and Health Research and Educational Trust, Employer Health Benefits 2012 Annual Survey.
A Medicaid monster If the states expand their Medicaid programs to the new level, enrollment in the low-quality, low-access Medicaid program would increase by 17 million Americans. WA VT NH 22.8% 11.2% 24.3% MT ND 43.4% OR 32.5% 49.5% MN ID 21.1% 35.8% SD WI NY WY 28% 17.7% MI 17.3% 32.3% 23.5% NV IA PA NE 17.6% 65.6% 36.1% 22.3% UT IL OH IN 24.7% 34.5% CO 24.7% 25.7% WV CA 44.2% 23.9% VA 30% KS MO KY 39.6% 40.7% 30.8% 31.4% NC AZ OK TN 25.1% 36.8% 36.4% NM AR 34.5% 30.7% 28.3% SC MS 36.1% 36.3% AL GA 26.2% 41.1% TX 56.7% LA AK 29.5% 34.3% HI 13.1% U.S. total: 30.4% FL 42.6% ME 12.1% MA 8.7% RI 21.8% CT 21.0% NJ 42.8% DE 18.1% MD 30.9% DC 13.3% Increase in Medicaid Population Under by 2014 0% to 20% 20.1% to 30% 30.1% to 40% 40.1% to 70% Sources: Heritage Foundation calculations based on data from the Centers for Medicare and Medicaid Services and the Kaiser Family Foundation s statehealthfacts.org.
Medicaid expansion burdens state budgets If states choose to accept s huge expansion of Medicaid, it would burden both federal and state budgets. States are already struggling to afford the program. WA VT NH $547 $134 $42 MT ND $57 OR $55 $343 MN ID $724 $61 SD WI NY WY $61 $843 MI $7,694 $22 $883 NV NE IA PA $1,374 $138 $157 $287 UT IL OH IN $1,194 $231 CO $2,338 CA $444 WV $156 VA $9,011 KS MO KY $176 $284 $85 $515 $370 NC AZ OK TN $777 $891 $2,805 NM AR $331 $319 $364 SC MS $820 $312 AL GA $368 $583 TX $1,402 LA AK $685 $63 HI $326 U.S. total: $41.9 billion FL $1,389 ME $332 MA $923 RI $107 CT $335 NJ $5 DE $164 MD $289 DC $119 Estimated State Costs for Medicaid Expansion, 2014 2022 (millions) $30 $99 $100 $499 $500 $999 $1,000 $1,999 $2,000 $9,100 Sources: Heritage Foundation calculations based on data from the Congressional Budget Office and Medicaid and CHIP Payment and Access Commission.
Did slow private-sector recovery? Between the recession s low point in January 2009 and April 2010, net private-sector job growth improved at a rate of 66,800 jobs per month. After Obama signed his health care legislation into law at the end of March 2010, the improvement stalled. Over the next 29 months, private-sector job growth improved at a rate of just 300 jobs per month. Month-to-Month Net Change in Private-Sector Jobs 600,000 400,000 200,000 0,000 200,000 400,000 600,000 800,000 1,000,000 Jan. 2009 BEFORE OBAMACARE Monthly improvement in job-growth rates: +66,800 jobs/month Trend Actual Jan. 2010 AFTER OBAMACARE Monthly improvement in job-growth rates: +300 jobs/month Jan. 2011 Jan. 2012 Sept. 2012 Source: Heritage Foundation calculations based on data from the U.S. Department of Labor, Bureau of Labor Statistics, Establishment Survey/Haver Analytics.
18 new taxes and penalties totaling $836 billion To pay for new government spending under, the law includes 18 new taxes and penalties that will affect every American, costing taxpayers $836 billion through 2022. BEGINNING 2013 Increase in Medicare hospital insurance tax and extension to investment income for high-income earners. $318 billion BEGINNING 2014 Employer mandate to offer coverage to workers. $106 billion Annual fee on health insurance providers. $102 billion Individual mandate to buy health insurance. $55 billion* BEGINNING 2018 Excise tax on Cadillac employer health plans. $111 billion 13 other taxes, 2013 2022 $144 billion $120 billion $90 $60 $30 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 $0 * Individual mandate begins in 2014, with revenue beginning in 2015. Sources: Congressional Budget Office and Joint Committee on Taxation.
Who will pay the individual mandate tax? President Obama has promised not to raise taxes on the middle class, but nearly 70 percent of those who will pay the individual mandate tax earn less than 400 percent of the federal poverty level (FPL), and 10 percent live in poverty. This chart shows the share of total payers of the tax by income group. LOWEST EARNERS 69% 300% 400% FPL 18% 200% 300% FPL 20% 100% 200% FPL 21% Below Poverty Line 10% HIGHEST EARNERS 31% More Than 500% FPL 20% 400% 500% FPL 11% 75% 50% 25% 0% Source: Congressional Budget Office.
raids Medicare to pay for other new programs Projected Medicare savings from don t improve the program. Instead, they pay for other new programs created under the law that aren t even for seniors. By slashing reimbursement rates instead of introducing real reform, the health law jeopardizes seniors access to providers. Cuts in Medicare Due to, 2013 2022 Hospital services Payment rates in Medicare Advantage DSH* payments and other Medicare provisions Home health services Skilled nursing services All other services Hospice services $156 billion $145 billion $66 billion $39 billion $33 billion $17 billion $260 billion cuts $716 billion from Medicare $0 $50 $100 $150 $200 $250 billion * Disproportionate Share Hospital, meaning payments that go to hospitals that serve a large number of low-income patients. Source: Congressional Budget Office.
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