A ARP PUBLIC POLICY INSTITUTE THE AFFORDABLE CARE ACT (ACA) AND OLDER ADULTS MARCH 2020 Fact Sheet Characteristics of Americans Ages 50 to 64 in the Nongroup Health Insurance Market Jane Sung and Olivia Dean Asha Saavoss and Robert C. Saunders* AARP Public Policy Institute KNG Health Consulting This fact sheet looks at characteristics of American older adults ages 50 to 64 in the nongroup (or individual) health insurance market. Background adults. However, there is a larger share of White Although the majority of Americans ages 50 to 64 Non-Hispanics in the older nongroup market have health insurance coverage through an employer relative to the rest of the market. One-third of (group coverage) or a public program (such as older adults ages 50 to 64 in the nongroup health Medicaid), 5.6 million (or 9 percent) purchase health insurance market, about 1.8 million people, are insurance coverage on their own in the nongroup non-White (figure 1). This includes an estimated (or individual) health insurance market.1 The 0.8 million Hispanic (15 percent), 0.4 million Black Affordable Care Act (ACA) of 2010 enacted significant Non-Hispanic (8 percent), and 0.5 million Asian improvements to health insurance offered in the (9 percent). The remaining two-thirds (67 percent nongroup market, including the establishment of or 3.8 million) of older adults are White Non- health insurance marketplaces, financial assistance Hispanics, compared with 61 percent of all adults to help people afford premiums and cost sharing aged 18 to 64. However, there is significant (e.g., deductibles, coinsurance, and copayments), variation in the racial and ethnic makeup of the and consumer protections to improve access to comprehensive coverage. Consumers can purchase nongroup coverage either on the health insurance Key Take-aways marketplaces or outside of such marketplaces (often referred to as “off-Marketplace”). This fact x Older adults in the nongroup market sheet reports on characteristics of adults ages 50 represent a similar racial and ethnic to 64 in the nongroup market (both on and off makeup to the rest of the market. the Marketplace), including the demographics and health status of older enrollees. A companion fact x Most older adults in the nongroup market sheet reports on older adult enrollment and coverage are working and are in good health. trends in the nongroup market. x Only a small percentage of older adults with incomes just beyond eligibility Race and Ethnicity for financial assistance are enrolled in The racial and ethnic makeup in the nongroup nongroup coverage. market is similar for both younger and older *Aishwarya Agarwal also contributed to this paper. A ARP PUBLIC POLICY INSTITUTE THE AFFORDABLE CARE ACT (ACA) AND OLDER ADULTS MARCH 2020 nongroup market across states, with some states FIGURE 1 having far greater diversity than others (appendix). Race and Ethnicity of Nongroup Enrollees For example, the older nongroup market in Ages 50 to 64 Washington D.C. is over 50 percent Black and 14 percent Hispanic. In Hawaii, 34 percent of the 50 to 64 18 to 64 market is Hispanic and 20 percent is Asian. At the same time, thirteen states have older nongroup 67% populations that are over 90 percent white. White Non-Hispanic 61% Employment Status 8% Black Non-Hispanic Most older adults with nongroup coverage 9% (62 percent, or 3.5 million) are in the labor force 15% and are working. About 35 percent (1.9 million) Hispanic 19% are not in the labor force, meaning they do not have a job and are not looking for one (figure 2). Asian 9% The remaining 3 percent (or about 145,000) are 11% unemployed, meaning they do not have a job but American Indian or 1% are actively looking for work. The vast majority of Alaskan Native 1% those not in the labor force, more than 90 percent, report not working because they are either are Source: 2018, KNG Health Reform Model. retired, have a disability/disabilities, or manage the home (homemakers; figure 2). Income threshold. People at this income level could qualify for financial assistance (premium tax credits and/ Similar to other age groups, the vast majority of or cost-sharing reduction subsidies available under older nongroup enrollees, an estimated 90 percent, the ACA). More than half (56 percent, or 3.1 million) or 5 million older adults, have incomes below of nongroup enrollees ages 50 to 64 have incomes 400 percent of the federal poverty level (FPL) below 250 percent FPL (figure 3).2 Another third FIGURE 2 Given Reason for Not Working Employment Status of Nongroup among Nongroup Enrollees Enrollees Ages 50 to 64 Ages 50 to 64 Outside Labor Force 3% 9% 9% 19%19% Retired Retired 35% Unemployed Disabled Disabled 47% 47% Not in Labor Force Homemaker Homemaker 62% Employed Other Other 26% 26% Source: 2018, KNG Health Reform Model. 2 A ARP PUBLIC POLICY INSTITUTE THE AFFORDABLE CARE ACT (ACA) AND OLDER ADULTS MARCH 2020 FIGURE 3 FIGURE 4 Income Distribution for Nongroup Enrollees Nongroup Enrollees Ages 50–64 in Good to Ages 50 to 64 Excellent Health 56% 86% 81% 77% 33% 9% 2% <250% 251–400% 401–500% 501%+ FPL FPL FPL FPL Unsubsidized APTC CSR Enrollees Recipients Source: 2018, KNG Health Reform Model. Source: 2018, KNG Health Reform Model. Notes: APTC refers to Advance Premium Tax Credit, and (1.8 million) have incomes between 250 percent CSR refers to cost-sharing reduction. The APTC column includes CSR enrollees. and 400 percent FPL. A very small portion of older nongroup enrollees (0.1 million) have incomes just beyond 400 percent FPL. This is likely because very good, or excellent health. Older enrollees with premium assistance under the ACA (in the form incomes over 400 percent FPL that would make of premium tax credits) is not available for people them ineligible for premium tax credits or cost- above 400 percent FPL; this is known as the sharing reductions were the healthiest group, with “subsidy cliff”. 86 percent (0.5 million) reporting being in good or better health (figure 4). Those at income levels Health Status conferring eligibility for premium assistance (100 The majority—68 percent, or nearly 3.8 million— percent to 400 percent FPL) were the next healthiest of nongroup enrollees ages 50 to 64 are enrolled (81 percent, or 2.5 million), followed by those at through the Marketplace. Most older Marketplace income levels eligible for cost-sharing reductions enrollees (82 percent, or 4.6 million) are in good, (77 percent, or 1.4 million). 3 A ARP PUBLIC POLICY INSTITUTE THE AFFORDABLE CARE ACT (ACA) AND OLDER ADULTS MARCH 2020 Appendix Race/Ethnicity of Adults Ages 50 to 64 in Nongroup Market, 2018 Total White Black American Indian Nongroup State Non-Hispanic Non-Hispanic Hispanic Asian or Alaskan Native Enrollment United States 67% 8% 15% 9% 1% 5,587,336 Alabama 72% 22% 5% 2% 0% 78,686 Alaska 71% 1% 15% 10% 2% 6,647 Arizona 70% 2% 16% 10% 2% 88,689 Arkansas 86% 8% 4% 1% 0% 141,589 California 52% 4% 25% 16% 3% 884,878 Colorado 81% 2% 9% 6% 1% 85,368 Connecticut 68% 6% 15% 11% 0% 56,345 Delaware 66% 17% 11% 5% 0% 9,778 District of Columbia 27% 53% 14% 6% 0% 4,372 Florida 56% 9% 24% 12% 0% 705,437 Georgia 56% 28% 10% 5% 0% 144,029 Hawaii 40% 0% 34% 20% 4% 12,770 Idaho 88% 0% 8% 3% 1% 43,260 Illinois 76% 5% 6% 10% 2% 189,780 Indiana 92% 3% 2% 3% 0% 69,535 Iowa 94% 1% 3% 2% 1% 51,914 Kansas 88% 1% 3% 6% 1% 50,685 Kentucky 89% 6% 4% 2% 0% 45,015 Louisiana 65% 25% 7% 3% 0% 53,559 Maine 92% 0% 4% 4% 0% 34,001 Maryland 58% 22% 13% 6% 0% 77,119 Massachusetts 69% 3% 16% 11% 0% 116,830 Michigan 88% 4% 3% 4% 1% 163,015 Minnesota 91% 1% 3% 4% 1% 74,075 Mississippi 71% 26% 3% 1% 0% 48,079 Missouri 92% 4% 2% 2% 1% 117,181 Montana 92% 0% 4% 3% 0% 22,792 Nebraska 93% 2% 1% 3% 1% 42,634 Nevada 63% 5% 19% 11% 2% 42,167 New Hampshire 92% 0% 4% 4% 0% 37,382 New Jersey 52% 7% 23% 16% 0% 128,330 New Mexico 51% 1% 25% 20% 2% 27,201 New York 56% 7% 19% 16% 0% 138,772 North Carolina 68% 19% 9% 5% 0% 201,212 North Dakota 93% 0% 3% 2% 1% 19,512 Ohio 90% 4% 2% 3% 1% 135,055 Oklahoma 70% 5% 17% 8% 0% 57,052 Oregon 85% 1% 8% 5% 1% 81,144 4 A ARP PUBLIC POLICY INSTITUTE THE AFFORDABLE CARE ACT (ACA) AND OLDER ADULTS MARCH 2020 Total White Black American Indian Nongroup State Non-Hispanic Non-Hispanic Hispanic Asian or Alaskan Native Enrollment Pennsylvania 78% 7% 8% 6% 0% 211,531 Rhode Island 73% 1% 14% 11% 0% 17,712 South Carolina 70% 21% 6% 3% 0% 97,271 South Dakota 91% 0% 5% 2% 2% 26,103 Tennessee 81% 11% 5% 3% 0% 106,068 Texas 43% 10% 32% 16% 0% 393,298 Utah 85% 0% 10% 5% 1% 52,641 Vermont 91% 0% 6% 3% 0% 15,711 Virginia 61% 18% 14% 7% 0% 133,982 Washington 79% 3% 11% 6% 1% 104,274 West Virginia 93% 3% 3% 1% 0% 14,000 Wisconsin 91% 2% 2% 5% 0% 117,467 Wyoming 88% 0% 9% 3% 0% 11,389 Source: 2018, KNG Health Reform Model. The data in this paper relies on the KNG Health Reform Model population file. This file combines many data sources, including the American Community Survey, the National Health Interview Survey, and the Current Population Survey. KNG Health also calibrates the file to be consistent with administrative data from the Centers for Medicare & Medicaid Services. This file allows for many types of integrated estimates that would not be possible with any single data source. However, many of this report’s findings are modeled estimates that may vary from other published resources. 1 2018 data, KNG Health Reform Model. State-level data for the indicators used in this report are included in the Appendix of this paper. More nongroup market, small group market, and uninsured data is available at the state level on AARP DataExplorer (dataexplorer.aarp.org), an interactive data website developed by AARP Public Policy Institute. 2 $12,140 for a one-person household in 2018. Fact Sheet 652, March 2020 © AARP PUBLIC POLICY INSTITUTE 601 E Street, NW Washington DC 20049 Follow us on Twitter @AARPpolicy on facebook.com/AARPpolicy www.aarp.org/ppi For more reports from the Public Policy Institute, visit http://www.aarp.org/ppi/. https://doi.org/10.26419/ppi.00099.001 5