How Did Health Insurance Coverage Changes Affect Older Adults? Two Studies Take a Look

With lawmakers in Washington, D.C. and state houses getting ready to make major health policy decisions, a pair of new University of Michigan studies shows how past policy decisions have affected older Americans with modest or low incomes.

The new findings could also help inform upcoming decisions about health insurance programs that are currently open to people with incomes under about $60,000 per person, and programs aimed at those living in or near poverty.

One study, just published in JAMA Health Forum, looks at people who turned 65 in the time since the Affordable Care Act’s (ACA) insurance provisions took effect in 2014, compared with those who turned 65 before the ACA.

It shows that the more recent group have lower out-of-pocket health costs and have had fewer hospitalizations as they aged into Medicare eligibility. This has implications for overall Medicare spending as they continue to age.

The study focused on people whose incomes were up to four times the poverty level, making them potentially eligible for help paying for health insurance if they needed to buy it when they were in their pre-Medicare years. It also looked at the subgroup who were eligible for Medicaid depending on their income and whether they lived in a state that expanded Medicaid under the ACA.

The other study, also published in JAMA Health Forum, shows that half of people who are both old enough for Medicare and have incomes low enough to qualify for Medicaid did not know that they had to renew their Medicaid coverage every year.

This requirement had been in place before the COVID-19 pandemic, but temporarily stopped from 2020 to 2024. The reinstatement of annual renewals happened through a process called “unwinding.”

In all, the study finds that 12% of these “dual eligible” individuals lost their Medicaid coverage during the unwinding. Half of them said they had gotten it back, but they were the most likely to say they had gone without care they needed because of the cost.

“We hope evidence in these studies informs upcoming decisions related to funding, requirements, eligibility or cost supports for Medicaid, ACA, and related insurance programs,” said Renuka Tipirneni, M.D., M.S., the lead author of both studies and an associate professor of internal medicine at the U-M Medical School. “It will also be important to continue to study the health, health care use and health costs of those who have yet to age into Medicare since the ACA went into effect.”

More about the first study:

For the study of people who aged into Medicare before and after the ACA’s insurance cost supports and Medicaid expansions took effect in 2014, Tipirneni and her colleagues used data from the Health and Retirement Study^[1].

Those who entered Medicare after the ACA took effect had lower out-of-pocket health costs by an average of $417 per year, compared with the pre-ACA group, and had fewer hospitalizations each year. There were no differences between the groups in their total Medicare costs, their health status or their use of outpatient or emergency care.

More about the second study:

For the study of dual-eligible individuals, Tipirneni and her colleagues carried out a survey through a polling organization. They questioned 843 people age 65 and older who had had both Medicare and Medicaid coverage in the past year, and incomes less than the federal poverty level, which is about $15,000 for an individual^[2]

In all, 16% said they had heard a lot about the return of annual Medicaid renewal requirements, and 35% had heard a little. But 49% of the group had heard nothing at all. The researchers also asked about how those who had heard of the unwinding had gotten their information.

Eric T. Roberts, Ph.D., senior author of the second study and an associate professor at the University of Pennsylvania, added, “Ongoing assistance from state Medicaid agencies, health plans, and community organizations is needed to help dual-eligible adults maintain Medicaid coverage or connect them with financial assistance programs like Medicare Savings Programs or the Part D Low-Income Subsidy.”

References:

1. Health Care Utilization and Costs for Older Adults Aging Into Medicare After the Affordable Care Act, JAMA Health Forum, doi:10.1001/jamahealthforum.2024.5025

2. Medicaid Unwinding Experiences in Dual-Eligible Older Adults, JAMA Health Forum, doi:10.1001/jamahealthforum.2024.4692

(Newswise/CD)