Last week, President Biden and former President Obama spoke about the state of health care in the United States a dozen years after the Affordable Care Act’s (ACA) passage. It’s easy to forget just how many people lacked coverage before the ACA was enacted: 18.2% of the country, or about 48.2 million non-elderly Americans, had no coverage in 2010 – one in six of whom were 50-64 years old.
Today the number is closer to 30 million, or 11.1%. Among 50–64-year-olds, the uninsured rate has fallen by nearly 35 percent, which is a meaningful improvement, yet also a call for policymakers to do more.
AARP has continued to advocate in statehouses and on Capitol Hill, and through legislative, regulatory and legal channels to ensure everyone has access to affordable health care – and importantly, to eliminate the health and financial insecurity that comes with being uninsured or underinsured. It’s been a multi-pronged campaign, and we will not rest in our fierce fight to expand access to affordable health care.
More than 12 years later, it’s worth remembering that the Great Recession and the unemployment that came with it had swelled the ranks of the uninsured by the time of the ACA debates. Many people couldn’t afford health care, while others couldn’t access care because insurers were legally permitted to discriminate against people based on pre-existing conditions. For many 50–64-year-olds, pre-existing conditions are a fact of life—40% of this age group (25 million people) have a pre-existing condition.
Today, thanks to the ACA, no insurance plan can reject or charge people more for coverage based on pre-existing health conditions. We are especially proud of our fight against a rollback of protections for pre-existing conditions and against the repeal of important protections against an age tax on older Americans. AARP has also opposed backdoor efforts to remove these consumer protections, such as by opposing the expansion of short-term plans.
AARP helped lead the charge to defend the ACA against repeal efforts in Congress in 2017, and also to defend it against legal challenges. AARP and AARP Foundation urged the Supreme Court to uphold the ACA in 2020 because of its importance in providing access to affordable coverage to older Americans. During the expanded open enrollment period in 2021, we conducted an outreach and education campaign aimed at 50–64-year-olds in multicultural and underserved communities in more than 10 states. We will be expanding this campaign to 20 states during this year’s open enrollment.
We have also been active in helping to achieve the ACA’s promise of greater coverage. Our state offices are actively engaged in fighting for improved coverage through Medicaid expansion. Twelve states still haven’t expanded this crucial program, which would help as many as 6 million low-income Americans, and we are as committed as ever to pushing for expansion. This has been a work in progress, as some states adopted expansion as soon as possible under the ACA, while other states took time. With AARP’s help, six states have embraced expanded Medicaid coverage in recent years:
- Idaho, Nebraska, Utah and Virginia adopted expansion in 2018, and
- Missouri and Oklahoma adopted expansion in 2020.
And our work continues on this front, with South Dakotans set to vote on a ballot measure to expand Medicaid later this year that has wide bipartisan support from voters 50 and older.
Protecting Medicaid eligibility has been a vital front in our regulatory efforts, too. For example, core to our positions, the AARP Policy Book notes that “States should not use the waiver process to gain permission to disenroll people from Medicaid, deny services to eligible beneficiaries, impose lifetime limits on Medicaid eligibility, eliminate retroactive eligibility, limit or cap spending for important benefits or necessary care, or otherwise inappropriately restrict access to Medicaid.”
We have also lobbied hard for Medicare reforms and improvements, such as closing the Part D coverage gap achieved in the ACA, as well as ongoing efforts to add new benefits to the traditional Medicare program, including dental, hearing and vision benefits.
AARP is firmly on record supporting expanded access to affordable health care so that our country, at long last, can assure quality, affordable health care to every American. The fight isn’t over yet. But those we serve are better off because of the progress of the last twelve years, and AARP won’t stop until every battle is won. Whether in Congress, in the states, in the courts or through the regulatory process, we are in this fight for the long haul.