Issues: Medicare, Medicaid and ACA

AARP PPI issue - Medicare & Medicaid


The AARP Public Policy Institute focuses on issues of critical importance as we age. Below we highlight research, analysis, background and commentary on Medicare, Medicaid, and the ACA.


Recent Analysis

Under the Health Reform Bill, People with Preexisting Health Conditions Would Face Unaffordable Premiums in State High-Risk Pools

The American Health Care Act (AHCA) would allow states to create high-risk pools where people with preexisting health conditions could go to purchase health insurance. This Fact Sheet shows state-by-state estimates of just how high annual premiums could be in these high-risk pools— ranging from at least $19,330 in Iowa to over $38,600 in Alaska. Nationally, annual premiums in high-risk pools could average at least $25,000. Read


Spotlight on the Impact of the American Health Care Act on Total Medicaid Spending in Eight States

New fact sheets from the AARP Public Policy Institute illustrates the depth of the cuts in select states and shows the implications of the AHCA for Medicaid funding and enrollment. These new fact sheets show the depth of Medicaid cuts proposed by the AHCA in Alaska, Arizona, Colorado, Iowa, Nevada, Ohio, Tennessee, and West Virginia. Read


Health Care Bill Harms People with Job-Based Coverage

People who have health insurance coverage through large employers may assume the health care debate won’t affect them. In fact, the American Health Care Act could negatively affect them in several ways. Read


Capped Financing for Medicaid Does Not Account for the Growing Aging Population

New projections from the AARP Public Policy Institute suggest that the AHCA’s per capita cap financing proposal will not keep pace with changing demographics, specifically the growing and aging of the 65+ population. Over time, states will not have adequate funding to serve this vulnerable population under the proposed bill. Read


Impact of the American Health Care Act on States (Updated 6/13/2017)

The American Health Care Act would make health care unaffordable and inaccessible for millions of Americans. The impacts of the bill on each state are included in this series. Read


Impact of Block Grants and Per Capita Caps on Medicaid Enrollees: State Fact Sheets

Changing Medicaid to block grant or per capita cap model could end Medicaid’s guaranteed access to care and shift costs over time to both states and to Medicaid enrollees. What would be the impact on Medicaid in your state? Read


Adequate Premium Tax Credits are Vital to Maintain Access to Affordable Health Coverage for Older Adults (Updated 3/22/2017)

Over 3 million low- to moderate- income older adults ages 50–64 currently rely on tax credits under the Affordable Care Act (ACA) to purchase health insurance coverage. Proposals to replace the current-law tax credits with new “flat” tax credits adjusted for age would substantially reduce their value by as much as $5,900 for an individual and would put health insurance and care out of reach for many. Read


Experience Has Taught Us That High-Risk

Recent health reform proposals would allow insurance companies in the individual market to—once again—consider people’s health when deciding whether to sell them coverage. Individuals denied coverage because of a pre-existing condition would likely rely on high-risk pools to access health insurance. In their latest report, PPI’s Lynda Flowers and Claire Noel-Miller describe high-risk pools and highlight their limitations: they were very expensive, they tended to charge high premiums and deductibles, they typically offered limited coverage, and they were not adequately funded—resulting in very low enrollment. Read


Low-Income Medicare Beneficiaries Rely on Medicaid for Critical Help

Medicaid is a lifeline for close to 11 million Medicare beneficiaries. These individuals—called dual eligibles or duals—are the poorest and sickest Medicare beneficiaries.  In this Fact Sheet, PPI’s Jean Accius, Lynda Flowers, and Brendan Flinn discuss how Medicaid benefits duals, describe how Medicare beneficiaries become dually eligible for Medicaid, describe some of the characteristics of duals, and analyze how recent health care reform proposals could harm vulnerable Medicare beneficiaries. Read


The Basics: Medicaid and Long-Term Services and Supports

This Fact Sheet discusses Basic Facts about Medicaid and Long-Term Services and Supports. Read 


In Health Reform, Stakes are High for Older Americans with Preexisting Health Conditions

The Affordable Care Act protects individuals with pre-existing health conditions by prohibiting insurance companies from considering people’s health when they apply for coverage. Without these protections, four out of 10 adults ages 50 to 64 – or about 25 million people in this age group – could be denied health coverage because of a pre-existing condition if they sought to buy an individual plan. Read


Savings Expected from Slowdown in Medicare Spending 

Medicare’s fiscal outlook in the mid and long term is stronger and projected spending is dramatically lower than previously expected. Read


Block Grants and Per Capita caps Pose Risks for Medicaid Beneficiaries and for States

Recent proposals would change the way the federal government pays for the Medicaid program.  This  change could hurt millions of poor seniors and people of all ages with disabilities who rely on Medicaid for needed health care and necessary long-term services and support—like help with eating, bathing, and dressing. Read


Impact of Changing the Age Rating Limit for Health Insurance Premiums

AARP Public Policy Institute released a research report from Milliman that modeled and analyzed the impact of changing the age rating limit for health insurance premiums.  This Spotlight summarizes the findings of the report. Read


Impact of Premium Support on Medicare Beneficiaries: State Fact Sheets

Changing Medicare to a premium support model raises several concerns, including increased costs for beneficiaries. What would be the impact on beneficiaries in your state? Read


Who's Gained Affordable Care Act Coverage with Financial Help?

This Fact Sheet takes a closer look at the 1.4 million adults ages 50-64 who gained health insurance coverage with the assistance of Affordable Care Act (ACA) tax credits. Read


Medicare’s Financial Protections for Consumers: Limits on Balance Billing and Private Contracting by Physicians

The Medicare program protects consumers by limiting how much physicians and other health professionals can charge Medicare patients. This fact sheet describes Medicare’s “balance billing” rules for physician services and related rules for physicians who choose not to accept Medicare payment and instead have “private contracts” with all their patients who have Medicare. Read


Protecting Affordable Health Insurance for Older Adults: The Affordable Care Act’s Limit on Age Rating

As policymakers consider potential changes to the Affordable Care Act (ACA), this fact sheet examines a critical consumer protection for older adults ages 50-64:  the ACA’s 3:1 limit on age rating. Read


Premium Support and the Impact on Medicare Beneficiaries

Under a premium support system, the federal government would replace Medicare beneficiaries’ guaranteed benefit package with a fixed dollar amount or “defined contribution” that beneficiaries would apply toward their health care coverage.  This fact sheet describes the likely impact on Medicare beneficiaries of moving to a premium support system, also known as a defined contribution or voucher system. Read


Rx Price Watch Report: Trends in Retail Prices of Brand Name Prescription Drugs Widely Used by Older Americans: 2006 to 2015

The latest Rx Price Watch report by Leigh Purvis and Dr. Stephen Schondelmeyer finds that retail prices for widely used brand name prescription drugs increased substantially faster than general inflation between 2006 and 2015, and that the difference between the rate of brand name drug price increases and the rate of general inflation has been widening. Read


Monitoring the Impact of Health Reform

New data from the Urban Institute and the AARP Public Policy Institute show that insurance coverage for 50- to 64-year-olds has improved significantly under the Affordable Care Act (ACA). Read


Trends in Retail Prices of Specialty Drugs

New Rx Price Watch Report finds that the average annual cost for a specialty drug exceeded the median U.S. family income in 2013. Read


Medicare Beneficiaries' Out-of-Pocket Spending for Health Care

Half of all Medicare beneficiaries in the fee-for-service program spent at least $3,595 of their own money on health care in 2011. Read


Medicare Part B Premiums and Deductible in 2016: The Effect of No Cost-of-Living Increase in Social Security Benefits

This fact sheet describes what will happen to next year’s Medicare Part B premiums—and how that will affect Medicare enrollees and states—as a result of no Social Security cost-of-living adjustment  for 2016. Read


Work and Health Insurance for 50- to 64-Year-Olds

Part-time workers and the self-employed are much less likely than full-time workers to have insurance through their employment.  Read


Effect of Health Reform for 50- to 64-Year-Olds

What do the reforms in the Affordable Care Act (ACA) mean for 50- to 64-year-olds? Read


Who Relies on Medicare?

Ten key facts about the Medicare population. Read


The Medicare Program: a Brief Overview

Basic facts about what Medicare covers, how the program is financed and how much it spends. Read


Options for Reforming Medicare
National experts discuss a range of perspective on leading proposals to reform Medicare. Read


Higher-Income Individuals Pay More for Medicare

Higher-income individuals contribute more toward the cost of the program than the general population. Read


Medicare Beneficiaries’ Out-of-Pocket Spending for Health Care

This report assesses the out-of-pocket spending burden on beneficiaries enrolled in traditional Medicare. Read


How Does Medicare Compare?

Benefits and cost sharing: How does Medicare compare with typical large employer health plans? Read


Medicare Part D Open Enrollment for 2014: Popular Plans Continue to Evolve

Premiums for many popular Part D plans are noticeably higher in 2014. Read



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