A Project of The Annenberg Public Policy Center

ACA ‘Hurting’ Families

Party Lines Red InsertThe Line: The Affordable Care Act is hurting families.

The Party: Republican

Several ads attacking the Affordable Care Act make the general claim that the law is “hurting” families. It’s true that some who bought their own insurance on the individual market could end up paying more. But millions of uninsured families will gain coverage under the law, many of them through free or low-cost Medicaid or Children’s Health Insurance Program coverage. And millions of insured families will get federal subsidies to help pay for coverage.

The “hurting families” claim has been a tagline on several Americans for Prosperity ads, including ones against Rep. Gary Peters of Michigan and Rep. Bruce Braley in Iowa. A March ad from Republican Sen. Thad Cochran in Mississippi also says, “Sen. Thad Cochran understands Obamacare hurts our families.” An ad from Senate candidate Sid Dinsdale in Nebraska features a small-business owner saying of Dinsdale: “He understands how Obamacare and regulations hurt our families.”

In January, an Americans for Prosperity ad attacking Arizona Rep. Ron Barber said the ACA “means higher costs for struggling families.” And in another version of the struggling-families theme, Senate candidate Paul Hollis attacked Sen. Mary Landrieu in Louisiana in an ad, saying that families in the state deserve better than “the high premiums, large deductibles and canceled policies of Obamacare.”


As we’ve explained before, some Americans who buy their own insurance will pay more, and some will pay less, depending on the individual. So, some families could be “hurt” or “struggling,” while others are helped with lower costs. How many? We don’t know.

But we do know that millions of uninsured families will gain coverage under the law — the nonpartisan Congressional Budget Office estimates that there will be 25 million fewer uninsured Americans due to the ACA as early as 2016. And many — 12 million — will gain free or low-cost Medicaid or Children’s Health Insurance Program coverage. (Research by the Urban Institute and RAND Corp. indicates that millions of the previously uninsured have already gained coverage.)

Those with adult children also could benefit from the law’s provision allowing dependents up to age 26 to be on their parents’ plan (the administration estimates 3 million young adults have gained coverage because of that requirement). Others will save money on insurance through subsidies, which are available to a family of four buying its own coverage and earning between $23,850 and $95,400 (that’s between 100 percent and 400 percent of the poverty level).

For instance, in Arizona, where the AFP ad said that “struggling families” were facing “higher costs,” the Medicaid expansion would provide insurance to an additional 240,000 Arizonans, as estimated by Republican Gov. Jan Brewer, and enable the state to continue Medicaid coverage for 50,000 adults without children in their homes. An additional 210,000 residents who were previously eligible for Medicaid are expected to sign up now, prompted by the law, as estimated by the Kaiser Family Foundation.

The expansion makes Medicaid available to those earning up to 138 percent of the federal poverty level, which is $32,913 for a family of four. The eligibility level pre-ACA varied by state.

Louisiana, Mississippi and Nebraska are among the 19 states that have decided not to expand Medicaid under the law. But even there, KFF estimates that 58,000, 57,000 and 20,000 residents, respectively, would newly join Medicaid. These folks would have been eligible previously but will now sign up, likely prompted by news of the law and the individual mandate to have insurance or pay a fine. If the states do decide to expand Medicaid, KFF estimates 398,000 would be added to the rolls in Louisiana, 231,000 in Mississippi, and 88,000 in Nebraska. More than half of the uninsured in Louisiana and Mississippi earn 138 percent of the poverty level or less. In Nebraska, 26 percent to 47 percent of the uninsured are in that category.

Those who qualify for subsidies in 2014 to buy their own coverage on the exchanges include an estimated 313,000 in Arizona, 344,000 in Louisiana, 204,000 in Mississippi, and 122,000 in Nebraska, according to KFF estimates. Qualifying for subsidies, however, doesn’t necessarily mean their costs would be lower than what they had been paying for insurance before. The subsidies are on a sliding scale, and are based on a maximum percentage of income that individuals would pay for a benchmark plan where they live.

For instance, those earning 100 percent of the poverty level would pay a maximum of 2 percent of their income for insurance, with subsidies making up the difference, while those earning up to 400 percent of the poverty level pay a maximum of 9.5 percent of their income. The Kaiser Family Foundation further explains: “If the premium that a person or family faces for the benchmark plan in their area is higher than the maximum percent of income defined in the law for their income, they are eligible for a tax credit and the tax credit is equal to the difference between the premium for the benchmark plan and the defined percent of their income. The benchmark plan is the second-lowest-cost plan in the silver cost-sharing tier offered through the marketplace for the area where they live.”

It’s a bit complicated. A family of four earning $90,000, then, would pay a maximum of $8,550 for the year for the second-cheapest “silver” plan, or $713 per month. On HealthCare.gov, we found cheaper insurance — $562 per month — for a bronze-level plan for a hypothetical family of four (nonsmokers) living in Adams County in southwest Mississippi. The second-lowest-cost silver plan, with a lower deductible, was $715 per month, after subsidies. (The KFF subsidy calculator showed similar results.)

Whether any of that is a good deal depends on the family and various individual factors — such as health status and the coverage it had before. It’s just one example of how blanket statements about “struggling” or “hurting” families attempt to paint the law in black and white when reality isn’t so clear-cut.

One more example: We recently fact-checked another AFP ad in which a Michigan mother says that her family’s “new plan is not affordable at all” and that the law is “destroying the middle class.” But we found her situation is an example of how families can benefit from the law. The Michigan family of seven could have selected a cheaper exchange plan, as opposed to the unsubsidized private plan it chose, but the family did not want the children to be on the Children’s Health Insurance Program.

— Lori Robertson