Where do the beneficiaries of the Affordable Care Act live?

The three interactive graphics below detail the most salient points about where the beneficiaries of the Affordable Care Act live, by state and county, in terms of access to expanded Medicaid coverage, new subsidies for health insurance, and how a ruling by the Supreme Court in the case of King vs. Burwell against the Obama Administration would affect ACA coverage.

The first map contains estimates for the relative rank of counties by the share of families eligible for Medicaid. Families making less than 138 percent of the Federal Poverty Level—about $33,000 for a family of four—are eligible for Medicaid if their state has elected to expand the program. The states opting out of the Affordable Care Act’s Medicaid expansion (those on the tan spectrum) are among those that would benefit the most. The counties in darker green are greatly benefiting from the expansion of Medicaid. Many of the counties that either are or would be major beneficiaries of Medicaid expansion are rural. (See Figure 1.)

Figure 1

The second map contains estimates for the relative rank of counties by the share of families in the income range that qualifies them for subsidies on the exchange. Families making between 138 percent and 400 percent of the Federal Poverty Level—between $33,000 and $97,000 for a family of four—are eligible for exchange subsidies if they do not have access to employer coverage. The beneficiaries of the subsidies are spread across the country with higher concentrations in suburban and middle-income counties. (See Figure 2.)

Figure 2

The third map contains estimates for the relative rank of counties by the share of families in the income range that qualifies them for subsidies on the exchange. Families making between 138 percent and 400 percent of the Federal Poverty Level are eligible for exchange subsidies if they do not have access to employer coverage. If the Supreme Court rules in the King vs Burwell case that states using a federally run exchange are ineligible for subsidies, then families in those states on the tan spectrum will lose their subsidies while those in gray will be largely unaffected. The counties that would be hurt the most from the loss of subsidies are disproportionately in the South. (See Figure 3.)

Figure 3

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