Association for Public Policy Analysis & Management

This study examines health insurance coverage among individuals ages 55 through 64 before and after the implementation of the major coverage provisions of the Affordable Care Act in 2014. We compare trends in coverage (Medicaid, private non-group, employer-sponsored, and none) for older Americans in states that did and did not expand Medicaid under the ACA in January 2014. We also present results for subgroups defined by income, employment, and health status. Data are from the American Community Survey and the Health and Retirement Survey. Overall, the fraction of older Americans without coverage dropped from 13.4 percent in 2013 to 7.9 percent in 2015. Medicaid and private non-group coverage increased significantly in both Medicaid expansion and non-expansion states, with no evidence of an accelerating decline in employer-sponsored coverage. Gains were largest for groups that had the lowest rates of coverage to begin with, including non-workers and individuals with very low income, particularly in Medicaid expansion states. There, the gap in coverage between individuals below and just above the Federal Poverty Level was eliminated. In contrast, in non-expansion states there was little change in the income gradient for insurance coverage. Overall, the ACA significantly reduced the fraction of older Americans without coverage. If ACA coverage provisions are repealed without a replacement, approximately 1.8 million Americans between the ages of 55 and 64, the majority of whom have at least one chronic condition, would lose insurance coverage.