THE COMMONWEALTH FUND

1. THE COMMONWEALTH FUND Realizing Health Reform’s Potential: Adults Ages 50-64 and the Affordable Care Act of 2010 Sara R. Collins, Ph.D. Vice President, Affordable Health Insurance Michelle M. Doty, Ph.D. Assistant Vice President, Director of Survey Research The Commonwealth Fund Media Teleconference December 13, 2010

2. Exhibit 1. Importance of Health Reform For Baby Boomers • 57 million 50-64 year olds in U.S.: 29 m women, 28 m men • 8.6 million older adults uninsured in 2009, up 1.1 million over 2008: 4.2 m uninsured women, 4.3 m uninsured men • 9.7 million older adults with insurance have such high out-of-pocket costs relative to income that they are underinsured • 2.2 million ages 55+ were unemployed in Nov. • Average weeks unemployed: 45 weeks, longest of any age group • 35 million, or 64% of older adults have at least one chronic condition

3. 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 Source: The Commonwealth Fund Biennial Health Insurance Survey (2007).

4. 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: The Commonwealth Fund Biennial Health Insurance Survey (2007).

5. Exhibit 4. Affordable Care Act Implementation Timeline:Provisions Benefiting Adults Ages 50–64 • Pre-Existing Condition Insurance Plans • Early retiree reinsurance for adults who have retired but do not yet qualify for Medicare • Preventive services coverage without cost-sharing • Ban on lifetime benefit caps and rescissions • Phased-in ban on annual limits • Medicaid expansion • State insurance exchanges • Insurance market reforms, including no rating on health, limits on age rating • Essential benefit standard • Premium and cost-sharing credits for exchange plans • Individual requirement to have insurance • Employer shared responsibility payments • CLASS Act • Establishment of CLASS Program (2011) • Designation of CLASS Benefit Plan (2012) • Phased-in ban on annual limits 2010 2011–2013 2014 Source: Commonwealth Fund Health Reform Resource Center: What’s In the Affordable Care Act? (Public Law 111-148 and 111-152), www.commonwealthfund.org/Health-Reform/Health-Reform-Resource.aspx.

6. Exhibit 5. Early Provisions of the Affordable Care Act That Will Benefit Baby 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 6 months • Ban on lifetime coverage limits/phase out of annual limits, ban on rescissions (2010): About 102 million people have health plans with lifetime limits,18 million have plans with annual limits, older adults at higher risk of reaching limits, having coverage rescinded • Employers and insurers must cover recommended preventive services without cost-sharing (2010): Including colorectal cancer screening, mammograms, flu and pneumonia vaccines • Early retiree reinsurance program (2010):$5 billion temporary program to pay part of early retiree health costs; 3600 private and public employers have enrolled in program • Long term care insurance (2012): Voluntary long term care insurance program available through workplace or other mechanism for self-employed; premiums based on age at enrollment but not health and can be paid through payroll deductions. Cash benefits of at least $50 day for those enrolled at least 60 months and with functional limitation lasting for 90 days+

7. Exhibit 6. Provisions of the Affordable Care Act That Will Benefit Baby Boomers, 2014+ • Expansion in Medicaid eligibility to cover adults with incomes under 133% poverty ($14,000 individual; $29,000 for family of four): 3.3 million currently uninsured would be covered • 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: 3.5 million currently uninsured would be covered by premium subsidies • 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 levels of benefits – bronze, silver, gold, platinum – that will vary only by cost sharing, benefits are the same at each level, and will be similar to employer plans: 8.6 million currently uninsured and 9.7 million underinsured would benefit • Restrictions on insurance carriers from denying coverage or charging higher premiums on the basis of health or age: 8.6 million currently uninsured and 9.7 million underinsured would benefit

8. Exhibit 7. Most of the 8.6 Million Currently Uninsured Adults Ages 50–64 Will Gain Coverage Beginning in 2014 Subsidized private insurance with consumer protections 3.5 million 41% Medicaid 3.3 million 38% Nonsubsidized private insurance with consumer protections 1.4 million 17% Undocumented 376,889 4% 8.6 Million Uninsured Adults Ages 50–64 in 2009 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.

9. Exhibit 8. Adults Ages 50–64 in 16 States with Uninsured Rates Higher Than the National Average Will Particularly Benefit from the Health Reform Law States with uninsured rate higher than national average of 14.2%, adults ages 50–64, 2008–2009 AK 16.5% NH WA VT ME MT 15.3% ND MN OR NY WI MA SD ID WY 17.2% MI RI PA CT IA NJ NE OH DE NV 16.6% IL IN MD UT WV VA CO DC CA 17.6% MO KS KY NC 14.3% TN 15.3% OK 15.9% SC 14.5% AZ 17.7% NM 20.1% AR MS 15.8% GA 18.2% AL HI LA 15.4% TX 22.5% FL 20.6% 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.