Workers who lost their jobs in the recession often lost not only their incomes but also their health insurance. Older jobless people who were not yet eligible for Medicare were at the mercy of the individual insurance market, where the likelihood of pre-existing conditions meant that they paid much higher premiums — and higher deductibles — if they could find coverage at all.
But the passage of the Affordable Care Act in 2010 changed that, and the number of pre-Medicare older Americans without health insurance has dropped during the decade.
This year, 9.4 percent of adults ages 50 to 64 were uninsured, a decline from 14 percent in 2010, according to the Commonwealth Fund. The decline would have been much greater if 14 states had not rejected the law’s Medicaid expansion, according to Commonwealth — in states that expanded, the rate for this age group has fallen to 6.4 percent.
“People in that age group have much better protection now,” says Sara Collins, vice president for health care coverage and access at Commonwealth. “If they have to leave a job, or elect to leave to do something different as they approach age 60, they can buy a policy in the individual market — that used to be quite risky and often out of reach due to pre-existing conditions.”
In Medicare, the decade has been marked by sharp increases in enrollment and federal spending — and privatization.
This year, 61 million Americans are enrolled in Medicare, 33 percent more than in 2010. Program spending will be $749 billion, up 47 percent compared with 2010. And an aging population means there are just 2.9 workers contributing to the system for every Medicare enrollee this year, down from 3.4 in 2010, according to a Kaiser Family Foundation analysis of Medicare data.
The standard premium for Part B (which covers outpatient services) in 2020 will be $144.60 — 31 percent higher than it was in 2010. And Medicare’s trustees project annual increases of nearly 6 percent over the coming decade.
“The numbers speak to an underlying question and challenge that we have yet to embrace: How will we pay for a growing and aging population?” says Tricia Neuman, director of Kaiser’s program on Medicare policy.
Another striking trend has been the growth of privately offered Medicare Advantage plans, the all-in-one managed-care alternative to original fee-for-service Medicare. This year, 34 percent of enrollees are in Medicare Advantage plans, up from 24 percent in 2010, according to Kaiser.
The growth comes despite studies that raise doubts about Advantage plans. For example, a report last year by federal investigators found a pattern of inappropriate denial of patient claims; other studies have questioned their quality of care. And this week, a report released by the U.S. Department of Health and Human Services Office of Inspector General raised concerns that Advantage plans were overbilling the program by improperly adding conditions to patient records.
“The growing role of private plans — Medicare H.M.O.s and PPOs — stands out as perhaps the most significant change to Medicare over the past decade,” Ms. Neuman said. “This growth has occurred without an explicit policy debate or major change in policy.”