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, the Affordable Care Act (ACA), and other related topics. 

2023

Medicaid in Midlife: A Profile of Enrollees Ages 50 to 64

This Fact Sheet analyzes the most recent reliable Medicaid enrollment subpopulation data and establishes a profile of midlife Medicaid enrollees. Read

2022

Medicaid Expansion Population and Cost Estimates for Eleven States

The fact sheets in this series offer data for each of the 11 states that have not yet expanded Medicaid, including the number of people who would be eligible under expansion, their demographic characteristics, what kind of insurance they currently have, the likelihood they would enroll in Medicaid, and the potential cost savings for each state’s budget. Read

Trends in Utilization Management of Prescription Drugs in Top Marketplace Plans 

This Spotlight discusses and examines utilization management (UM) trends in top 10 marketplace prescription drug plans between 2016 and 2020. Read
 

2021

State and Federal Affordability Fact Sheets

52 state and federal fact sheets analyze enrollment and affordability issues among older nongroup enrollees in the context of expanded premium tax credits in the American Rescue Plan Act. Read

Estimating Impacts of Pandemic-Related Job Loss on Health Insurance Coverage among Adults Ages 50 to 64 During the First Year of COVID-19

New analysis examines the impact of the COVID-19 pandemic on health insurance coverage for older adults ages 50 to 64. Read

Health Care Affordability and the Nongroup Health Insurance Market

This series of reports looks at older adults ages 50 to 64 in the nongroup (individual) health insurance market, for whom high health care costs and affordability of health coverage are growing concerns. Read
 

2020

The ACA is Helping Fight Coronavirus – But It's Not Enough 

The ACA’s milestone 10^th anniversary underscores the importance of this historic legislation during a pandemic. Despite the importance of the ACA, more is needed to expand access to coverage to all Americans.  Read

Hear Their Voices: The Experiences of Midlife Adults Who Gained Medicaid Coverage in Four Expansion States

To learn more about people’s experiences before and after gaining access to health insurance through state Medicaid coverage, the AARP Public Policy Institute commissioned a series of focus groups of midlife adults (ages 45-64) who were previously uninsured, had no dependent children and had gained coverage through Medicaid in four expansion states (Kentucky, New Mexico, Ohio, or Pennsylvania).  Read

Putting People First by Strengthening Medicare for the Future: Promising Payment and Delivery System Innovations in Medicare

This report highlights and describes in detail seven innovative programs that represent a variety of approaches and span a wide range of Medicare services. Read

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

This report provides detailed information on how much people with traditional Medicare pay out-of-pocket for health care. Read

Medicare Financial Outlook: What Do Trust Fund Solvency Projections Mean?

In their 2020 annual report, the Medicare Trustees estimate that in 2026 Medicare’s Hospital Insurance (or Part A) trust fund will become “insolvent”—a term that can be misleading when taken out of context. This report explains what exactly Medicare Trust Fund solvency means, puts the current projections for the trust fund’s financial outlook into perspective, and shows why Medicare is not “going broke” and does not need drastic change. Read

The Affordable Care Act and Older Adults

A decade ago the Affordable Care Act (ACA) was signed into law. Two new AARP Public Policy Institute fact sheets look at how the ACA has significantly improved coverage for older adults ages 50 to 64 who purchase coverage on their own in the nongroup (individual) health insurance market. Read
 

2019

Section 1332 State Innovation Waivers: Understanding Federal Law and Guidance

Section 1332 State Innovation Waivers, named after the section of the Affordable Care Act (ACA) that created them, are intended to allow states to implement innovative or alternative strategies to achieve health coverage. This report highlights five key steps that states should take to understand and evaluate the impact of these waivers on older adults. Read

Telehealth and Medicare: What Is Covered

This fact sheet describes the telehealth-provided services available to Medicare beneficiaries, including both current and new services resulting from recent policy changes. Read

Supplemental Benefits in Medicare Advantage

Starting in 2019, Medicare Advantage can cover a much wider array of supplemental benefits than was previously allowed, due to a significant change to federal rules. Medicare’s private insurers now also have greater flexibility to design and tailor those benefits to enrollees’ health conditions. These changes could have positive implications for people enrolled in Medicare Advantage if plans choose to offer meaningful new benefits (e.g. support for family caregivers, in-home supportive services, benefits to address social determinants of health). However, they could also raise potential new challenges for Medicare beneficiaries. Read

The New Medicaid Waivers: Coverage Losses for Beneficiaries, Higher Costs for States

Section 1115 waivers are intended to give states the flexibility to experiment with new ways to administer their Medicaid programs, including innovative coverage strategies. However, emerging waivers that impose work requirements and other harmful obligations on beneficiaries as conditions of Medicaid participation lead to significant numbers of people losing coverage, even as states incur greater costs. Read

Blog: What Consumers Need to Know About Medicaid 

As a decades-old program effectively fulfilling a key need every day, Medicaid is not always fully understood. Moreover, the program continues to evolve.  Here are some things you should know about this popular and proven program. Read

Supplemental Benefits Under Medicare Advantage Part 1: An In-Depth Look at What They Are Today 

The first of a two part paper series taking a closer look at Medicare Advantage (MA) supplemental benefit offerings. By discussing how MA supplemental benefits have worked in recent years, prior to 2019, this paper sets the stage to discuss the impact of impending changes that will take effect beginning in 2019.  Read
 

2018 

Taking a Closer Look: Myths about the Medicaid Program and the People It Helps

Medicaid is a lifeline for millions of children, adults with low incomes, individuals with disabilities and older adults who depend on Medicaid for health care services and assistance with long-term services and supports (LTSS) such as eating, bathing, and dressing. Read

Breaking Through the Noise: The Facts about the Medicaid Program

Medicaid is a lifeline for millions of children, adults with low incomes, individuals with disabilities and older adults who depend on Medicaid for health care services and assistance with long-term services and supports (LTSS) such as eating, bathing, and dressing.

This Fact Sheet highlights several key facts that are important to know about Medicaid and the millions of people who depend on this program to address their daily needs. Read
 

2017 

Medicare Spends More on Socially Isolated Older Adults

Studies have shown that socially isolated older adults are at greater risk for poor health and death than their well-connected counterparts. Now a new study—the first to examine whether social isolation also affects health care spending among older adults—finds that a lack of social contacts among older adults is associated with an estimated $6.7 billion in additional Medicare spending annually. The study’s findings raise issues for Medicare and public health officials. Read

Consumer Protections in New Medicare Payment and Delivery Models: A Checklist

This research report identifies and describes a checklist of concrete consumer protections that should be integrated into the design of all Medicare value-based models. Read

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

Many Medicare beneficiaries face significant out-of-pocket expenses to meet their health care needs. In 2013, people with traditional Medicare spent an average of $5,680 on insurance premiums and medical services. One in 10 people on Medicare spent at least $10,852. Health care expenses can create a significant financial burden for many Medicare beneficiaries, with half the people in fee-for-service Medicare spending at least 17 percent of their income on health care. Read

Understanding Medicare's Home Health Benefit

This Spotlight describes Medicare rules for coverage of home health care services. Read

Higher Income Individuals Pay More for Medicare

The Medicare program requires higher-income individuals to contribute more toward the cost of the program than other people. Read

Who Relies on Medicare? A Profile of the Medicare Population

This fact sheet provides 10 key facts about the Medicare population. Read

Premium Support is the Wrong Direction for Medicare: Highlights from a New Research Report

This Insight on the Issues summarizes the key findings from a new Urban Institute research report examining a proposed Medicare reform that would significantly change the program for people with Medicare. The Urban report offers important insights into how transforming Medicare to a “premium support” system would work in practice—and how it would adversely affect people with Medicare. The report—Restructuring Medicare: The False Promise of Premium Support by Robert A. Berenson, Laura Skopec, and Stephen Zuckerman— was funded by the AARP Public Policy Institute. Read

Graham-Cassidy Would Lead to Unaffordable Costs for Older Adults Who Get Sick or Have a Pre-Existing Condition

The Graham-Cassidy bill, as released on September 13, 2017 and circulated on September 24, 2017, would lead to unaffordable increases in health care costs for older adults ages 50-64 who get sick or have a pre-existing condition. Read

Graham-Cassidy Legislation Threatens Affordable Coverage for Older Americans

The Graham-Cassidy (GC) bill threatens to make health care unaffordable and inaccessible for millions of older Americans. Read

Health Insurance Cost-Sharing Reductions Are Critical to Ensuring Affordable Health Care for Older Adults

For over 2 million older adults ages 50-64, subsidies known as cost-sharing reductions are critical financial protection that reduces out-of-pocket health care costs. Read

Spotlight on the Impact of the Graham/Cassidy/Heller/Johnson Bill on Non-Expansion Medicaid Spending in Ten States

New AARP Public Policy Institute fact sheets show the depth of Medicaid cuts proposed by the Graham/Cassidy/Heller/Johnson Bill in Alaska, Arizona, Colorado, Iowa, Maine, Montana, North Dakota, Ohio, Tennessee and West Virginia. Read

Major Threat: How the Better Care Reconciliation Act Jeopardizes Medicaid Home- and Community-Based Services

The Better Care Reconciliation Act (BCRA) puts Medicaid home- and community-based services (HCBS) on the chopping block. The proposed demonstration program for Medicaid HCBS, included in the revised version of the Senate Bill on July 13,  does not change the big picture. According to newanalysis from the AARP Public Policy Institute, states may cut Medicaid HCBS by as much as $46 billion in 2026 to stay within their allotted per capita caps-- a 22 percent cut. Read the new Insight on the Issues to learn more and find out the potential impact on your state. Read

Spotlight on the Impact of the Senate Better Care Reconciliation Act on Total Medicaid Spending

These new fact sheets show the depth of Medicaid cuts proposed by the BCRA in Alaska, Colorado, Nevada, North Dakota, Ohio and West Virginia. Read

Impact of the Senate Better Care Reconciliation Act on States

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

Basing Per Enrollee Caps on Historical Medicaid Spending Just Does Not Work

The Better Care Reconciliation Act (BCRA), released by the U.S. Senate, would dramatically change the way the federal government funds Medicaid, likely causing millions of people who currently receive coverage for health care and long-term services and supports (LTSS)—like help with bathing, dressing, eating, wound care and medication management—to lose Medicaid coverage. Read

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

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 Pools Do Not Serve Consumers Well

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