Affordable care act turns 10 as u. S. Battles coronavirus

ACA’S KEY REFORMS — AND GROWING GAPS The ACA’s reforms to the individual health insurance market were critical to the expansion in health insurance coverage for older adults. Prior to the

ACA, many older adults without access to coverage through their employer were denied affordable coverage due to their age, health or a preexisting condition. For the first time, the ACA

guaranteed Americans access to health insurance coverage, limited how much premiums can vary by age, provided protections for people with preexisting conditions, and extended financial

assistance to help people with low and modest incomes pay for premiums and out-of-pocket costs . These consumer protections now ensure that millions of older adults won’t have to worry about

whether they have comprehensive insurance coverage — especially during a public health emergency like the coronavirus outbreak. Under the ACA, health insurance plans must also cover 10 

essential health benefits, including preventive and diagnostic services (which should cover COVID-19 tests), emergency services and hospitalizations, and prescription drug coverage. These

benefits are especially important for older adults, who are more likely to have chronic health conditions, placing them at higher risk for serious illness from COVID-19 that may require

hospitalization, medication or both. The ACA got more people covered, but more needs to be done. The ACA’s individual market reforms plus its expansion of the Medicaid program led to a 43

percent reduction in the uninsured rate among adults ages 50 to 64 between 2013 and 2016, the first few years of the law’s implementation. Older adult enrollment in the individual health

insurance market grew 65 percent over the same time period. But premiums rose in 2017, as the ACA’s federal transitional reinsurance program ended. In 2018, premiums rose with market

instability, due to factors such as federal debate to repeal the law and the individual mandate (which was changed in the last tax reform bill), the halting of federal cost sharing reduction

payments, and significantly reduced federal enrollment outreach and advertising. The result: Older individual enrollment dropped from 10 to 9 percent, and the uninsured rate increased from

8 to 8.6 percent. That means that a smaller number of older Americans have the security of comprehensive insurance coverage than before. State-by-state variations in individual enrollment

and in the uninsured rate among adults ages 50 to 64 could also have big implications on the spread and impact of COVID-19. For example, the uninsured rate was 17 percent in Texas but just 3

percent in D.C., Rhode Island and _Massachusetts, as of 2018._ High uninsured rates in some states, stemming from economics and state decisions such as whether to expand Medicaid under the

ACA, can make state efforts to contain the spread of COVID-19 especially difficult. The uninsured may avoid seeking testing or treatment due to cost.