ObamaCare versus RomneyCare versus RomneyCandidate Care
A National and State-by-State Analysis
A report from Families USA, a 501(c)(4) organization, September 2012

The development of this report was aided by Stuart Altman, the Sol C. Chaikin Professor of National Health Policy at the Heller School for Social Policy and Management at Brandeis University; Jonathan Gruber, Professor of Economics at the Massachusetts Institute of Technology; and John McDonough, Professor of Practice at the Harvard School of Public Health and Director of the Harvard School of Public Health’s Center for Public Health Leadership.

Key Findings (see the full report for tables)

• Help with the Cost of Health Insurance Premiums in 2016
• Health Care Spending by Families with Private Health Insurance in 2016
• Uninsured Americans in 2016
• Uninsured Americans in 2022
• Medicare Preventive Health Care Services
• Medicare Prescription Drug Coverage
• Summary of Sources for Key Findings

Help with the Cost of Health Insurance Premiums in 2016  

Nationally

• Although both ObamaCare and RomneyCandidateCare provide help with health insurance premiums through the federal tax system, the former does it through tax credits and the latter through tax deductions. As a result, not only does ObamaCare provide help to more than twice as many people, but the average amount of help provided to each person is also much larger (Table 2).
• Under ObamaCare, 20.3 million Americans purchasing individual health coverage would receive help with the cost of health insurance premiums in 2016 through tax credits (Table 2).
• Under RomneyCandidateCare, fewer than half as many Americans (fewer than 10.1 million people) would receive help with premiums through tax deductions (Table 2).
• Under ObamaCare, the average amount of help with premiums would be $4,231 in 2016 (Table 2).
• Under RomneyCandidateCare, the average amount of help with premiums would be $2,490 in 2016 (Table 2).
• As a result, the size of the average premium tax credit would be 70 percent higher under ObamaCare than it would be under RomneyCandidateCare.

By State (Table 2)

In Colorado

• Under ObamaCare, 340,000 people would receive an average of $4,572 in premium help in 2016.
• Under RomneyCandidateCare, 250,000 people would receive an average of $1,995 in premium help in 2016.

In Florida

• Under ObamaCare, 1,620,000 people would receive an average of $4,216 in premium help in 2016.
• Under RomneyCandidateCare, 800,000 people would receive an average of $3,174 in premium help in 2016.

In Iowa

• Under ObamaCare, 170,000 people would receive an average of $5,256 in premium help in 2016.
• Under RomneyCandidateCare, 100,000 people would receive an average of $2,637 in premium help in 2016.

In Michigan

• Under ObamaCare, 650,000 people would receive an average of $4,674 in premium help in 2016.
• Under RomneyCandidateCare, 240,000 people would receive an average of $3,604 in premium help in 2016.

In Nevada

• Under ObamaCare, 190,000 people would receive an average of $3,731 in premium help in 2016.
• Under RomneyCandidateCare, 110,000 people would receive an average of $2,758 in premium help in 2016.

In New Hampshire

• Under ObamaCare, 80,000 people would receive an average of $4,256 in premium help in 2016.
• Under RomneyCandidateCare, 50,000 people would receive an average of $2,031 in premium help in 2016.

In North Carolina

• Under ObamaCare, 750,000 people would receive an average of $4,170 in premium help in 2016.
• Under RomneyCandidateCare, 290,000 people would receive an average of $2,138 in premium help in 2016.

In Ohio

• Under ObamaCare, 750,000 people would receive an average of $4,646 in premium help in 2016.
• Under RomneyCandidateCare, 350,000 people would receive an average of $1,977 in premium help in 2016.

In Pennsylvania

• Under ObamaCare, 570,000 people would receive an average of $4,466 in premium help in 2016.
• Under RomneyCandidateCare, 320,000 people would receive an average of $3,035 in premium help in 2016.

In Virginia

• Under ObamaCare, 470,000 people would receive an average of $3,700 in premium help in 2016.
• Under RomneyCandidateCare, 240,000 people would receive an average of $1,919 in premium help in 2016.

In Wisconsin

• Under ObamaCare, 300,000 people would receive an average of $4,333 in premium help in 2016.
• Under RomneyCandidateCare, 130,000 people would receive an average of $1,858 in premium help in 2016.

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Health Care Spending by Families with Private Health Insurance in 2016  

Nationally

• As a result of the difference in the amount of help available with premiums and in the quality of insurance plans, middle-class families who purchase health insurance on their own (non-group coverage) would spend considerably more out of pocket in 2016 under RomneyCandidateCare than they would under ObamaCare.
• Under ObamaCare, the average spending on health care (including premiums and out-of-pocket costs) would be $5,985 (Table 3).
• Under RomneyCandidateCare, the average spending on health care (including premiums and out-of-pocket costs) would be $11,481 (Table 3).
• Accordingly, under RomneyCandidateCare, average health care spending by a household would be 92 percent higher than under ObamaCare (Table 3).

By State (Table 3)

In Colorado

• Under ObamaCare, the average spending on health care would be $5,998 in 2016.
• Under RomneyCandidateCare, the average spending on health care would be $9,069 in 2016.

In Florida

• Under ObamaCare, the average spending on health care would be $5,651 in 2016.
• Under RomneyCandidateCare, the average spending on health care would be $10,543 in 2016.

In Iowa

• Under ObamaCare, the average spending on health care would be $7,021 in 2016.
• Under RomneyCandidateCare, the average spending on health care would be $11,163 in 2016.

In Michigan

• Under ObamaCare, the average spending on health care would be $5,043 in 2016.
• Under RomneyCandidateCare, the average spending on health care would be $14,200 in 2016.

In Nevada

• Under ObamaCare, the average spending on health care would be $7,778 in 2016.
• Under RomneyCandidateCare, the average spending on health care would be $12,306 in 2016.

In New Hampshire

• Under ObamaCare, the average spending on health care would be $6,206 in 2016.
• Under RomneyCandidateCare, the average spending on health care would be $8,516 in 2016.

In North Carolina

• Under ObamaCare, the average spending on health care would be $4,908 in 2016.
• Under RomneyCandidateCare, the average spending on health care would be $14,658 in 2016.

In Ohio

• Under ObamaCare, the average spending on health care would be $5,098 in 2016.
• Under RomneyCandidateCare, the average spending on health care would be $10,096 in 2016.

In Pennsylvania

• Under ObamaCare, the average spending on health care would be $7,941 in 2016.
• Under RomneyCandidateCare, the average spending on health care would be $13,820 in 2016.

In Virginia

• Under ObamaCare, the average spending on health care would be $5,583 in 2016.
• Under RomneyCandidateCare, the average spending on health care would be $10,130 in 2016.

In Wisconsin

• Under ObamaCare, the average spending on health care would be $6,006 in 2016.
• Under RomneyCandidateCare, the average spending on health care would be $10,044 in 2016.

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Uninsured Americans in 2016  

Nationally

• In the absence of ObamaCare or RomneyCandidateCare, the number of uninsured Americans under the age of 65 is projected to rise to 56.0 million by 2016 (Table 4).
• Under ObamaCare, the number of uninsured Americans would decrease significantly, falling by 30.7 million by 2016 (Table 4).
• In sharp contrast, under RomneyCandidateCare, the number of uninsured Americans would actually increase, rising by 11.2 million to 67.2 million by 2016 (Table 5).
• Under RomneyCandidateCare, there would be 41.9 million more uninsured people in 2016 than under ObamaCare (Table 5).

By State (Table 4)

In Colorado

• Under ObamaCare, 390,000 people would gain health coverage by 2016.
• Under RomneyCandidateCare, 190,000 people would lose health coverage by 2016.

In Florida

• Under ObamaCare, 2,480,000 people would gain health coverage by 2016.
• Under RomneyCandidateCare, 490,000 people would lose health coverage by 2016.

In Iowa

• Under ObamaCare, 210,000 people would gain health coverage by 2016.
• Under RomneyCandidateCare, 120,000 people would lose health coverage by 2016.

In Michigan

• Under ObamaCare, 890,000 people would gain health coverage by 2016.
• Under RomneyCandidateCare, 370,000 people would lose health coverage by 2016.

In Nevada

• Under ObamaCare, 310,000 people would gain health coverage by 2016.
• Under RomneyCandidateCare, 60,000 people would lose health coverage by 2016.

In New Hampshire

• Under ObamaCare, 80,000 people would gain health coverage by 2016.
• Under RomneyCandidateCare, 40,000 people would lose health coverage by 2016.

In North Carolina

• Under ObamaCare, 940,000 people would gain health coverage by 2016.
• Under RomneyCandidateCare, 240,000 people would lose health coverage by 2016.

In Ohio

• Under ObamaCare, 1,030,000 people would gain health coverage by 2016.
• Under RomneyCandidateCare, 490,000 people would lose health coverage by 2016.

In Pennsylvania

• Under ObamaCare, 830,000 people would gain health coverage by 2016.
• Under RomneyCandidateCare, 450,000 people would lose health coverage by 2016.

In Virginia

• Under ObamaCare, 740,000 people would gain health coverage by 2016.
• Under RomneyCandidateCare, 150,000 people would lose health coverage by 2016.

In Wisconsin

• Under ObamaCare, 340,000 people would gain health coverage by 2016.
• Under RomneyCandidateCare, 250,000 people would lose health coverage by 2016.

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Uninsured Americans in 2022  

Nationally

• In the absence of ObamaCare or RomneyCandidateCare, the number of uninsured Americans under the age of 65 is projected to rise to more than 60.0 million by 2022 (Table 6).
• Under ObamaCare, the number of uninsured Americans would decrease significantly, falling by 32.9 million by 2022 (Table 6).
• In sharp contrast, under RomneyCandidateCare, the number of uninsured Americans would actually increase, rising by nearly 18.0 million to 78.0 million by 2022 (Table 7).
• Under RomneyCandidateCare, in 2022, there would be nearly 50.9 million more uninsured people than under ObamaCare (Table 7).

By State (Table 6)

In Colorado

• Under ObamaCare, 410,000 people would gain health coverage by 2022.
• Under RomneyCandidateCare, 290,000 people would lose health coverage by 2022.

In Florida

• Under ObamaCare, 2,640,000 people would gain health coverage by 2022.
• Under RomneyCandidateCare, 930,000 people would lose health coverage by 2022.

In Iowa

• Under ObamaCare, 230,000 people would gain health coverage by 2022.
• Under RomneyCandidateCare, 170,000 people would lose health coverage by 2022.

In Michigan

• Under ObamaCare, 960,000 people would gain health coverage by 2022.
• Under RomneyCandidateCare, 620,000 people would lose health coverage by 2022.

In Nevada

• Under ObamaCare, 330,000 people would gain health coverage by 2022.
• Under RomneyCandidateCare, 110,000 people would lose health coverage by 2022.

In New Hampshire

• Under ObamaCare, 80,000 people would gain health coverage by 2022.
• Under RomneyCandidateCare, 50,000 people would lose health coverage by 2022.

In North Carolina

• Under ObamaCare, 1,030,000 people would gain health coverage by 2022.
• Under RomneyCandidateCare, 480,000 people would lose health coverage by 2022).

In Ohio

• Under ObamaCare, 1,110,000 people would gain health coverage by 2022.
• Under RomneyCandidateCare, 810,000 people would lose health coverage by 2022.

In Pennsylvania

• Under ObamaCare, 910,000 people would gain health coverage by 2022.
• Under RomneyCandidateCare, 790,000 people would lose health coverage by 2022.

In Virginia

• Under ObamaCare, 820,000 people would gain health coverage by 2022.
• Under RomneyCandidateCare, 250,000 people would lose health coverage by 2022.

In Wisconsin

• Under ObamaCare, 370,000 people would gain health coverage by 2022.
• Under RomneyCandidateCare, 400,000 people would lose health coverage by 2022.

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Medicare Preventive Health Care Services  

• ObamaCare provides free preventive health care services, such as colonoscopies and mammograms, to seniors and people with disabilities enrolled in Medicare. In 2011, 25.7 million beneficiaries who were enrolled in traditional Medicare (fee-for-service Medicare) received one or more free preventive services (Table 8).
• Under RomneyCandidateCare, Medicare would no longer provide preventive services for free, and cost-sharing would be reinstated. The millions of seniors and people with disabilities who currently receive free services would have to pay cost-sharing, such as copayments and co-insurance, for such care.
• By state, the number of seniors and people with disabilities who received free Medicare preventive care services in 2011 under ObamaCare and who would lose them under RomneyCandidateCare are as follows (Table 8):
• • In Colorado, 281,800 seniors and people with disabilities.
  • In Florida, 1,824,700 seniors and people with disabilities.
  • In Iowa, 348,400 seniors and people with disabilities.
  • In Michigan, 983,300 seniors and people with disabilities.
  • In Nevada, 161,000 seniors and people with disabilities.
  • In New Hampshire, 155,000 seniors and people with disabilities.
  • In North Carolina, 980,900 seniors and people with disabilities.
  • In Ohio, 922,400 seniors and people with disabilities.
  • In Pennsylvania, 1,014,400 seniors and people with disabilities.
  • In Virginia, 737,000 seniors and people with disabilities.
  • In Wisconsin, 477,800 seniors and people with disabilities.

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Medicare Prescription Drug Coverage  

• Prior to ObamaCare, Medicare’s prescription drug benefit had a huge coverage gap that is euphemistically called the doughnut hole. In 2012, that coverage gap begins once a Medicare beneficiary reaches $2,930 in drug expenses, and it continues until that beneficiary reaches $6,657.50 in drug expenses—a gap of $3,727.50. With each passing year, that gap grows.
• Under ObamaCare, this coverage gap is being phased out, and people enrolled in Medicare drug coverage are already being helped today:
• • Since 2010, when help with the doughnut hole began, ObamaCare has saved seniors and people with disabilities enrolled in Medicare more than $4.1 billion.⁶
  • In 2011, nearly 3.8 million Medicare beneficiaries received discounts of 50 percent on the cost of brand-name drugs while in the doughnut hole, an average of $613 per person (Table 9).
  • By 2020, under ObamaCare, the drug coverage gap will be entirely eliminated.⁷
• Under RomneyCandidateCare, seniors and people with disabilities in Medicare would no longer receive help with prescription drug costs while in the doughnut hole. The millions of people who currently receive help with high drug costs would lose that help.
• By state, the number of people who fell into the doughnut hole in 2011, who received help under ObamaCare but who would lose it under RomneyCandidateCare, are as follows (Table 9):
• • In Colorado, 41,800 seniors and people with disabilities received drug discounts.
  • In Florida, 253,000 seniors and people with disabilities received drug discounts.
  • In Iowa, 44,500 seniors and people with disabilities received drug discounts.
  • In Michigan, 87,900 seniors and people with disabilities received drug discounts.
  • In Nevada, 23,500 seniors and people with disabilities received drug discounts.
  • In New Hampshire, 13,900 seniors and people with disabilities received drug discounts.
  • In North Carolina, 113,300 seniors and people with disabilities received drug discounts.
  • In Ohio, 197,100 seniors and people with disabilities received drug discounts.
  • In Pennsylvania, 242,900 seniors and people with disabilities received drug discounts.
  • In Virginia, 86,000 seniors and people with disabilities received drug discounts.
  • In Wisconsin, 62,800 seniors and people with disabilities received drug discounts.

Summary of Sources for Key Findings  

In order to compare ObamaCare, RomneyCare, and RomneyCandidateCare, Families USA commissioned the work of Dr. Jonathan Gruber, Professor of Economics at the Massachusetts Institute of Technology. Dr. Gruber’s economic model, built on publicly available data, allowed us to generate unique new estimates of the impact of each of these three policy approaches on the following: the number of people eligible for help with the cost of health insurance premiums and the value of that help, the average amount of money spent on health care by people with private insurance, and the number of uninsured people. (A detailed Methodology is available upon request.) For our analysis of the new prevention and prescription drug benefits for Medicare enrollees that are part of the Affordable Care Act, we relied on the most recent annual Medicare data from the Centers for Medicare and Medicaid Services. These data are based on Medicare claims data for 2011. State-level data on the Medicare prevention and prescription drug benefits are available on the federal government’s website at www.HealthCare.gov.

Endnotes

⁶ Department of Health and Human Services, News Release: People with Medicare Save More than $4.1 Billion on Prescription
Drugs (Washington: HHS, August 20, 2012), available online at http://www.hhs.gov/news/press/2012pres/08/20120820a.html.  
⁷ Health Care and Education Reconciliation Act of 2010, Public Law 111-152 (March 30, 2012), Title I, Subtitle B, Section 1101,
amending the Patient Protection and Affordable Care Act, Public Law 111-148 (March 23, 2010).  

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