18.3 million baby boomers could benefit from the Affordable Care Act

18.3 million men and women ages 50 to 64 stand to benefit from provisions in the Affordable Care Act that expand access to affordable health insurance, assure that all health insurance provides a standard comprehensive benefit, prevent insurers from denying coverage or charging higher premiums to people with pre-existing conditions, and eliminate lifetime and annual limits in health insurance policies, according to a new Commonwealth Fund report released today.

Adults ages 50-64 are currently suffering the highest rates of longtime unemployment among working-age adults, and millions are without health benefits. Of the 8.6 million currently uninsured in this age group—4.3 million men and 4.2 million women—3.3 million with incomes under $29,000 for a family of four will gain Medicaid coverage, 3.5 million with incomes up to $88,000 for a family of four will be able to gain subsidized private coverage through the new health insurance exchanges, and 1.4 million with higher incomes will gain new coverage with consumer protections.

In addition, an estimated 9.7 million older adults who have health insurance but have such high out-of-pocket costs relative to their income that they are effectively underinsured, will gain improved coverage through the implementation of essential benefit standards, limits on out-of-pocket spending, and elimination of lifetime benefit limits.

Uninsured adults in this age group face serious difficulty with access to needed care: three-quarters (75 %) report forgoing needed health care and medications because of costs and nearly half (46%) report not getting recommended preventive care. More than half of uninsured women in this age group had not had a mammogram within the past two years. Nearly 70 percent of uninsured and underinsured baby boomers report that they have problems paying medical bills or are paying off medical debt.

“A loss of employer health benefits can be devastating to men and women in this age group since their older age and higher rates of chronic health problems places them at risk of facing exorbitant premiums, having a condition excluded from their coverage, or being denied insurance altogether if they try to buy it on their own,” said Commonwealth Fund Vice President Sara Collins, lead author of the report. “The Affordable Care Act will change all of that. Once its provisions are in full effect, older adults who lose their employer health insurance will have access to affordable and comprehensive health benefits regardless of their age or health.”

The report, Realizing Health Reform's Potential: Adults Ages 50-64 and the Affordable Care Act of 2010, finds that the biggest gains for older adults will come in 2014 when everyone will have access to comprehensive health insurance through a substantial expansion in Medicaid and subsidized private health insurance through new health insurance exchanges. However, millions of older adults and their families have already benefitted from provisions in the Affordable Care Act that went into effect this year, like the phasing out of lifetime and annual limits on benefits, and insurance plans for people with pre-existing conditions.

“This report paints a picture of a baby boomer generation whose health and financial security are in jeopardy because of rising health care costs and declining health insurance coverage,” said Commonwealth Fund President Karen Davis. “The good news is that the Affordable Care Act is already making a difference for them, as lifetime and annual limits are phased out and pre-existing condition insurance plans get up and running. Things will only continue to improve as states and the federal government move toward fully implementing the law and we enter a new era in American health care, in which everyone has access to affordable, comprehensive health insurance.”

Baby boomers living in the 16 states with uninsured rates for this age group higher than the national average of 14.2 percent—primarily in the south and southwest—stand to benefit the most from the Affordable Care Act. In Florida, New Mexico, and Texas, 20.1 percent to 22.5 percent of adults ages 50 to 64 were uninsured in 2008 and 2009, and in Alaska, Arizona, California, Georgia, Nevada, and Wyoming, 16.5 percent to 18.2 percent of those 50 to 64 were uninsured.

New consumer protections in the health insurance marketplace will provide some of the biggest benefits for baby boomers: 64 percent have at least one chronic condition like heart disease or diabetes, making it difficult or impossible for them to find affordable coverage on the individual market. Seven of 10 adults ages 50 to 64 who looked into buying individual insurance coverage never bought a plan because of high cost or coverage limits, or because they were turned down completely. In addition, changes that limit how much more insurers can charge based on age will benefit adults in this age group, who currently pay much higher premiums than their younger counterparts pay: the new law restricts variation in premiums based on age to no more than three to one.

Additional Benefits for Baby Boomers in the Affordable Care Act

The Affordable Care Act includes many additional features that will improve health insurance coverage for adults ages 50 to 64:

Beginning in 2010, adults in this age group with chronic health problems who have been uninsured for more than six months can join new plans for people with pre-existing conditions.

A ban on lifetime limits on insurance benefits beginning in 2010 will help an estimated 102 million people who currently have these limits on their plans; older adults are at greater risk than younger adults of exceeding their limits and being saddled with a crushing debt load as a result.

Requiring coverage of preventive care and immunizations without cost-sharing will assure access to services such as mammograms and colorectal cancer screenings for baby boomers beginning in 2010.

Requiring health plans to insure all who apply, preventing health plans from charging higher premiums to sicker people, and limiting how much premiums can rise by age will remove many of the barriers baby boomers face when they have to buy coverage on their own beginning in 2014.

Two lesser-known ACA provisions will also provide significant benefits to baby boomers, the report finds:

The Early Retiree Health Benefits Reinsurance Program for Employers helps public and private sector employers pay for health benefits for employees who retire before age 65. This $5 billion temporary program has already enrolled 3,600 employers and will run through 2014, when people who retire before age 65 will be eligible to purchase health insurance through the new insurance exchanges.

The Community Living Assistance Services and Supports (CLASS) Program will provide employers and their workers as well as self-employed individuals the option of participating in a national long-term care insurance program aimed at providing better access to affordable long-term care insurance.

This report is part of a series of Fund issue briefs that examines the way the Affordable Care Act of 2010 will benefit different populations and groups, as well as improve insurance coverage and change the delivery of care. For more information, please visit: http://www.commonwealthfund.org/Content/Publications/Issue-Briefs/2010/Sep/A-New-Series-of-Briefs-on-the-Affordable-Care-Act.aspx

The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.