By Kimerly Amadeo, Balance, updated 2018.
Three million to 5 million people lost their employment-based health insurance. Many businesses found it more cost-effective to pay the penalty and let their employees purchase insurance plans on the exchanges. Other small businesses find they can get better plans through the state-run exchanges.
Thirty million people never had company plans and relied on private health insurance. Insurance companies canceled many of their plans because their policies didn't cover the ACA's 10 essential benefits. For those who lost those cut-rate plans, the costs of replacing them are high. The ACA requires services that many people don't need, like maternity care.
Increased coverage raised overall health care costs in the short term. That's because many people received preventive care and testing for the first time. It was expensive to treat illnesses that had been ignored for decades. The ACA taxed those who didn't purchase insurance. But many avoided the tax through an ever-expanding list of exemptions. Four million people chose to pay the tax rather than pay for coverage.
The Congressional Budget Office estimated they paid $54 billion. In 2013, the ACA raised the income tax rate for 1 million individuals with incomes above $200,000. It also raised taxes for 4 million couples filing joint returns on incomes exceeding $250,000. The rate increased from 1.45 percent to 2.35 percent on income above the threshold. They also pay an additional 3.8 percent Medicare tax. That applies to the lesser of income from dividends, capital gains, rent and royalties or income above the threshold.
Starting in 2013, medical device manufacturers and importers paid a 2.3 percent excise tax. Note: This tax was suspended for 2016-2018. Indoor tanning services paid a 10 percent excise tax. This might discourage those businesses from hiring new employees. Starting in 2013, families could deduct medical expenses that exceeded 10 percent of income. Before, they could deduct any expenses that exceeded 7.5 percent of income. The Tax Cut and Jobs Act restored the deduction to the 7.5 percent limit for 2018 and 2019.
Pharmaceutical companies pay an extra $84.8 billion in fees between 2013 and 2023. That pays for closing the "doughnut hole" in Medicare Part D. Drug costs could rise if the companies pass this onto consumers.
In 2022, insurance companies will be assessed a 40 percent excise tax on "Cadillac" health plans. These are plans with annual premiums exceeding $10,200 for individuals or $27,500 for families. Many of these plans are for people in high-risk pools, such as older workers or those with dangerous jobs. Most of the tax will be passed onto the companies and employees, raising premiums and deductibles. (Sources: "Federal Budget Bill to Delay ACA’s Cadillac Tax & Suspend Two Other Taxes," Kistler Tiffany Benefits, December 21, 2015. "Cadillac Tax Explained," Kaiser Health News, March 18, 2010. "What Obamacare Means for Taxes," Smart Money, June 28, 2012.)