THE COMMONWEALTH

FUND

Adults Ages 50-64 and the Affordable Care Act

Sara R. Collins, Ph.D.Vice President, Affordable Health Insurance

AARP and Alliance For Health Reform Briefing: Boomers Come of Age

January 24, 2011

THE COMMONWEALTH

FUND

Exhibit 1. 8.6 Million Uninsured Adults Ages 50–64 in 2009,Up by 1.1 Million in Last Year

Millions uninsured, adults ages 50–64

5.5 5.76.1 6.4

6.06.6

7.1 7.17.5

8.6

0

2

4

6

8

10

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Source: S. Collins, M. Doty, T. Garber, Realizing Health Reform’s Potential: Adults Ages 50-64 and the Affordable Care Act o 2010, The Commonwealth Fund, December 2010; Analysis of the 2001–2010 Current Population Surveys by N. Tilipman and B. Sampat of Columbia University for The Commonwealth Fund.

THE COMMONWEALTH

FUND

Exhibit 2. Two of Five Adults Ages 50–64 Who Have or Tried to Buy Individual Insurance Were Turned Down, Charged a Higher Price,

or Excluded Because of a Preexisting Condition

AdultsAges 50–64

Adults who have individual coverage or tried to buy it in past three years who:

Found it very difficult or impossible to find coverage they needed

45%

Found it very difficult or impossible to find affordable coverage

61

Turned down, charged a higher price or excluded because of a preexisting condition

39

Never bought a plan 69

Source: S. Collins, M. Doty, T. Garber, Realizing Health Reform’s Potential: Adults Ages 50-64 and the Affordable Care Act o 2010, The Commonwealth Fund, December 2010; The Commonwealth Fund Biennial Health Insurance Survey (2007).

THE COMMONWEALTH

FUND

232024

8

24

60

68

78

69

54

75

46

0

20

40

60

80

100

Spent 10% or more ofincome on out-of-

pocket costs annually

Any medical billproblems or

outstanding debt

Any cost-relatedaccess problem

Delayed or did not getpreventive screening

due to costs

Insured, not underinsured Underinsured Uninsured during year

Exhibit 3. Seventy Five Percent of Uninsured AdultsAges 50-64 Reported a Cost-Related Problem Getting Needed Care

Percent of adults ages 50–64

Source: S. Collins, M. Doty, T. Garber, Realizing Health Reform’s Potential: Adults Ages 50-64 and the Affordable Care Act of 2010, The Commonwealth Fund, December 2010; The Commonwealth Fund Biennial Health Insurance Survey (2007).

THE COMMONWEALTH

FUND

Exhibit 4. Early Provisions of the Affordable Care Act That Will Benefit Boomers, 2010–2013

• Preexisting condition insurance plans (2010): Enrollment underway in all 50 states/DC for people with health problems who have been uninsured for at least six months.

• Ban on lifetime coverage limits/phase-out of annual limits, ban on rescissions (2010): Older adults at higher risk of reaching limits, having coverage rescinded.

• Employers and insurers must cover recommended preventive services without cost-sharing (2010): Includes colorectal cancer screening, mammograms, flu and pneumonia vaccines.

• Early retiree reinsurance program (2010): A $5 billion temporary program to pay part of early retiree health costs; 3,600 private and public employers have enrolled.

• Long-term care insurance (2012): Voluntary program available through workplace or other mechanism for self-employed

Source: Commonwealth Fund Health Reform Resource Center: What’s in the Affordable Care Act? (PL 111-148 and 111-152), www.commonwealthfund.org/Health-Reform/Health-Reform-Resource.aspx

THE COMMONWEALTH

FUND

Exhibit 5. Provisions of the Affordable Care Act That Will Benefit Boomers, 2014+

• Expansion in Medicaid eligibility to cover adults with incomes under 133% poverty ($14,000 individual, $29,000 for family of four).

• New state insurance exchanges with premium and cost-sharing tax credits up to 400% poverty ($43,000 individual, $88,000 family of four). Premiums capped at 3%-9.5% of income between 133-400% poverty; spending capped at 6%-27% of total spending between 133-250% poverty.

• Essential health benefit standards and limits on cost-sharing for plans sold in insurance exchanges and in the individual and small group markets: Four different standardized levels of benefits—bronze, silver, gold, platinum—that will vary only by cost sharing; essential benefits are similar to employer plans.

• Restrictions on insurance carriers from denying coverage or charging higher premiums on the basis of health or age.

Source: Commonwealth Fund Health Reform Resource Center: What’s in the Affordable Care Act? (PL 111-148 and 111-152), www.commonwealthfund.org/Health-Reform/Health-Reform-Resource.aspx

THE COMMONWEALTH

FUND

Exhibit 6. Most of the 8.6 Million Currently Uninsured Adults Ages 50–64 Will Gain Coverage Beginning in 2014

Source: Analysis of the March 2010 Current Population Survey by N. Tilipman and B. Sampat of Columbia University for The Commonwealth Fund; estimates of undocumented uninsured adults by Jonathan Gruber and Ian Perry of MIT using the Gruber Microsimulation Model for The Commonwealth Fund.

Medicaid 3.3 million

38%

Subsidized private insurance with

consumer protections 3.5 million

41%

Nonsubsidized private insurance with

consumer protections 1.4 million

17%

Undocumented 376,889

4%

8.6 Million Uninsured Adults Ages 50–64 in 2009

THE COMMONWEALTH

FUND

TX

22.5% FL

20.6%

NM

20.1%GA

18.2%

AZ

17.7%

CA

17.6%

WY

17.2%

NV

16.6%

AK

OK

15.9%MS

15.8%LA

15.4%

MT

15.3%

TN 15.3%

Exhibit 7. Adults Ages 50–64 in 16 States with Uninsured Rates Higher Than the National Average Will Particularly Benefit from

the Health Reform Law

Note: Uninsured rates are two-year averages, 2008–2009.Source: Analysis of the March 2009 and 2010 Current Population Survey by N. Tilipman and B. Sampat of Columbia University for The Commonwealth Fund.

WA

OR

ID

UTCO

KS

NE

SD

ND

MNWI

MI

IA

MO

AR

IL INOH

KY

WVVA

NC 14.3%

SC 14.5%

AL

PA

NY

ME

DCMD

DE

NJCT

RIMA

NHVT

HI

States with uninsured rate higher than national average of 14.2%, adults ages 50–64, 2008–2009

16.5%