“Obamacare in Pictures: Visualizing the Effects of the Patient Protection and Affordable Care Act” shows in detail the impact of the sweeping health care law for Americans.

1. Obamacare
in Pictures
VISUALIZING THE EFFECTS OF THE PATIENT PROTECTION
AND AFFORDABLE CARE ACT
Spring 2014

2. 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
327
1,100
5.4
90
WY
WV
WI
WA
VT
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
73MD
21DC
MA
LA
KYKS
INIL
ID
IA
HI
GA
FL
12DE
66CT
CO
CA
AZ
AR
AK
AL
Data not available
Cancelled plans
switched automatically
0–10
10–100
100–200
200+

3. 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

4. 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/a
75%
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
VA
UT
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%MD
1%DC
n/aMA
LA
KYKS
INIL
ID
IA
HI
GA
FL
100%DE
64%CT
CO
CA
AZ
AR
AK
AL
CHANGE IN PREMIUMS
FOR 27–YEAR–OLDS
Down 1% to 30%
Up 0%–50%
Up 51% to 100%
Up 100%+

5. 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 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/a
26%
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
VA
UT
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%MD
53%DC
n/aMA
LA
KYKS
INIL
ID
IA
HI
GA
FL
65%DE
75%CT
CO
CA
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.

6. 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/a
7%
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
VA
UT
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%MD
15%DC
n/aMA
LA
KYKS
INIL
ID
IA
HI
GA
FL
19%DE
23%CT
CO
CA
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.

7. 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-
sponsored
insurance
$6,346
$4,617
$2,756
$1,203
$390
$1,135

8. 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%)

9. $2
trillion
$898
billion
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 Office, 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

10. heritage.orgObamacare in PicturesSources: Heritage Foundation calculations based on data from the Congressional
Budget Office, 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
$326
U.S. total:
$41.9 billion
$583
$1,389
$156
$9,011
$2,805 $364
$63
$368
WY
WV
WI
WA VT
VA
UT
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
CO
CA
AZ
AR
AK
AL
$30–$99
$100–$499
$500–$999
$1,000–$1,999
$2,000–$9,100

11. heritage.orgObamacare in PicturesSource: Congressional Budget Office, 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
DOWN
25
UP 13
UP 24
56
31
34
47
24
million
million
million
million
million
Without
Obamacare
With
Obamacare
Without
Obamacare
With
Obamacare
Without
Obamacare
With
Obamacare
million
million
million

12. heritage.orgObamacare in PicturesSources: Heritage Foundation calculations based on data from Congressional
Budget Office, 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.

13. heritage.orgObamacare in PicturesSource: Congressional Budget Office, 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%
BELOW
400% FPL
ABOVE
400% FPL
31%
69%
Below Poverty Line
10%
100%–200% FPL
21%
200%–300% FPL
20%
300%–400% FPL
18%
400%–500% FPL
11%
More Than
500% FPL
20%

14. heritage.orgObamacare in PicturesSource: Congressional Budget Office, 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

15. 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

16. 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