By Steve Syre
LTSS Center researchers track insurance coverage, health improvements among adults age 50-64.
One of the many grim lessons of the coronavirus pandemic is that people of any age face a greater risk if they are already living with other health problems.
LTSS Center researchers had that in mind when they looked at the impact of the decade-old Affordable Care Act (ACA) on the health status of adults age 50 to 64. They found that this pre-Medicare population had significantly improved medical care coverage and entered the COVID-19 age in better health, by many measures.
“The impact of the ACA on lowering the health and mortality risk of the pre-Medicare population should not be underestimated—especially now that we are in the midst of a pandemic that threatens greater numbers of people as they age,” said Marc Cohen, co-director of the LTSS Center. “It is simply not debatable that the law has put the pre-Medicare population in a better position to handle health risks during the pandemic.”
HOW MEDICAL INSURANCE COVERAGE IMPROVED
In a recent paper, Cohen and LTSS Center Fellow Jane Tavares noted that people in the 50-64 age group had faced significant health insurance coverage problems before the ACA was enacted. About 8.9 million people in that age category were uninsured and insurance companies had rejected 1 in 5 of their applications for coverage.
After passage of the ACA, 5.6 million people aged 50-64—roughly 9% of the estimated 62 million Americans in that age category—now buy health coverage on their own in the non-group insurance market. Between 2013 and 2018, the rate of uninsured people in the age group declined from over 14% to less than 9%.
TRACKING EVIDENCE OF BETTER HEALTH
Cohen and Tavares tracked health status changes for those pre-Medicare adults over a comparable period, using longitudinal data from the Health and Retirement Study collected in 2010 and 2016. The population of people aged 50-64 reported significant health gains by a wide range of measures.
For example, a greater percentage of people in this age group said their health had improved over the previous 2 years and a smaller percentage reported that their health had declined over the same period. A smaller percentage reported incidence of depression.
During the same period, rates of hospital stays over the previous 2 years declined from 20.5% to 17.7%. The number of people who said they had stayed at a nursing home at some point over the previous 2 years declined from 1.7% in 2010 to 0.6% in 2016.
The change in rate of nursing home utilization translates into 284,000 fewer admissions on an annualized basis. The authors estimated that the reduction could be associated with as many as 8,520 fewer COVID-19 deaths in nursing home settings.
IMPROVED INSURANCE COVERAGE LOWERED OUT-OF-POCKET EXPENSES
Generally better health was accompanied by a decline in out-of-pocket medical expenses from 2010 to 2016, when a greater percentage of 50-64-year-old adults report at least some government insurance coverage and some private insurance. Those expenses declined by 11% during a period when medical inflation increased by more than 25%.
“Our findings suggest a continued need, not only to safeguard the ACA, but to strengthen it—and keep millions of vulnerable Americans safe and healthy,” said Cohen.
“The Trump Administration’s recent ill-considered move to overturn the ACA, particularly during this extraordinary time, will only add to our current challenges and most certainly lead to more sickness and death,” he continued. “It is that simple.”