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Monitoring the Impact of Health Reform on Americans 50-64: Use of Insurance Marketplaces

AARP’s Public Policy Institute collaborated with the Urban Institute’s Health Reform Monitoring Survey to learn about the experience of Americans ages 50-64 in the initial phase of implementation of health coverage reforms. This series of papers presents findings from surveys during the first open enrollment period.
The survey showed that awareness of new health insurance Marketplaces was strong overall.  Most of those who already had insurance expected they would continue to get coverage from the same source in 2014.  The uninsured had mixed expectations about getting coverage.  Interest in using the Marketplaces was highest among the uninsured and those with nongroup coverage, and  among those with income levels which would qualify for subsidies or Medicaid.  But more than two in five of the uninsured did not expect to gain coverage.  

Use of the Marketplaces varied widely by insurance status and income. The main reason the uninsured used the Marketplace was to find out if they were eligible for subsidies or Medicaid.  While many with nongroup insurance were also interested in finding out if they were eligible for subsidies or Medicaid, the most common reason they gave for using the Marketplace was to compare their current health plan with Marketplace plans.  There were differences in how people accessed information about health insurance in the Marketplace by education, income, and ethnicity.

For all 50- to 64-year olds the share of uninsured fell 1.3 percentage points (11%) between December 2013 and March 2014.   The uninsurance rate also fell among those with incomes that qualify for the Medicaid expansion, the unemployed, and Hispanics.   The survey also shows the impact of state decisions on whether or not to expand Mediciad.  In states that expanded Medicaid, the share of uninsured rate dropped 8.9 percentage points (30%) among adults with low incomes.  In contrast, the share of uninsured low income 50- to 64-year-olds did not change in states that did not expand Medicaid.   The newly insured differed from those insured for all of the past 12 months; on average they were low income, and more reported past problems paying medical bills.  

The findings point to the need for ongoing education and outreach that targets groups not reached by early outreach efforts.

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