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Study: Medicaid expansion helps cut rate of older, uninsured adults

By Michelle Andrews, KAISER HEALTH NEWS | May 22, 2015

The Affordable Care Act’s expansion of Medicaid coverage to adults with incomes over the poverty line was key to reducing the uninsured rate among 50- to 64-year-olds from nearly 12 percent in 2013 to 8 percent in 2014, according to a new analysis.

“Clearly most of the gains in coverage were in Medicaid or non-group coverage,” said study co-author Jane Sung, a senior strategic policy adviser at the AARP Public Policy Institute, which conducted the study with the Urban Institute.

Under the health reform law, adults with incomes up to 138 percent of the federal poverty level ($16,105 for one person) are eligible for Medicaid if a state decides to expand coverage. Twenty-seven states had done so by the end of 2014.

The study found the uninsured rate for people age 50 to 64 who live in states that haven’t expanded Medicaid was twice as high — 11 percent — as for those who live in states that have done so. Kansas is among the states that have not expanded eligibility for Medicaid.

More than 2 million people age 50 to 64 gained coverage between December 2013 and December 2014, according to the study.

The figures are based on the Urban Institute’s quarterly Internet-based Health Reform Monitoring Survey, which includes 8,000 adults age 50 to 64.

During the same period, the uninsured rate among all adults age 18 to 64 fell from 17.5 percent to 12.8 percent, said Laura Skopec, a research associate at the Urban Institute who co-authored the study. Other studies that have looked at the population overall also have shown deeper cuts in the uninsured rate in states that expanded Medicaid.

Many people in the older 50-to-64 age group have employer-sponsored insurance, Skopec said. But until the health law passed, “those who didn’t have access to employer-sponsored coverage didn’t have very good options.”

In addition to expanding Medicaid coverage, the health law prohibits insurers from charging older people premiums that are more than three times higher than those for younger people. The law’s prohibition against insurers refusing to cover people because they have pre-existing medical conditions also has helped many older people gain coverage, Skopec said.