Over 50? You'll want to back health care law

The new health care reform law will be under attack in 2011 in the courts and in Congress. If you're over age 50 but too young for Medicare, you'd do well follow the battles closely.

No age group stands to lose more than Americans age 50 to 64 if the conservative efforts to strangle the Affordable Care Act (ACA) in its crib succeed. The number of older Americans without health insurance has continued to soar in the recession - and a new study documents just how much the ACA will help the pre-Medicare crowd.

The number of Americans without health insurance age 50 to 64 grew by 1.1 million in 2009, according to the report by The Commonwealth Fund, a foundation focused on health care affordability and access issues.

The report found that 8.6 million Americans in that age group were uninsured last year - 15 percent of the total. Meanwhile, another 9.7 million in this age group had coverage with such high deductibles that they were considered "effectively underinsured," according to the study.

While data isn't available yet for 2010, "the trends suggest it got worse this year," according to Sara Collins, Commonwealth's vice president for affordable health insurance.

The main culprit is unemployment, and the subsequent loss of employer-sponsored coverage. About 2.2 million Americans over age 55 were jobless in November. And nearly two-thirds of older Americans have at least one chronic health condition, which means unemployment also poses serious problems with health care.

That financial stress is reflected in recent data on the rising rate of bankruptcy filings due to medical issues. Filings by people over age 55 are rising much faster than those for younger age groups, according to a recent study by John Pottow, an expert on bankruptcy law and a professor at the University of Michigan Law School.

The Commonwealth Fund study found that the ACA will bring dramatic relief by 2014, when implementation of the new law is complete. Of those 8.6 million uninsured adults, 6.8 million will gain subsidized coverage - 3.3 million through an expanded Medicaid program and 3.5 million through the new private insurance exchanges that will be created in each state.

The ACA expands Medicaid eligibility to cover all adults with incomes below 133 percent of the federal poverty level, starting in 2014. "The Medicaid expansion is significant," Collins said. "It's nearly all federally financed, so it will mean a huge injection of cash into state budgets. And for people who meet the income definitions, the care is 100 percent subsidized."

As a transitional measure, new high-risk insurance pools were created this year for people who had been without insurance for at least six months and had pre-existing conditions that made it hard for them to gain coverage. Twenty-seven states formed their own pre-existing condition pools, and the federal government offered a program in states that didn't form their own plans.

The uptake for these plans has been slow - only about 8,000 people are covered. Commonwealth thinks the big problem here is affordability, since these transitional plans can carry premiums of $1,000 per month or more.

The federal plan will be enhanced in 2011. You can check on coverage available in your state at this page on the federal government's health care reform website: bit.ly/9pXgbM.

Meanwhile, starting in 2014, insurance companies won't be able to turn away people with pre-existing conditions or to charge sick people higher premiums. And the new public insurance exchanges will come online.

The court challenges to ACA focus on the constitutionality of the law - specifically, the mandate that most Americans buy insurance. Meanwhile, Republicans are promising to use their new control of the House of Representatives to block implementation of ACA in any way they can.

It's impossible to know at this juncture how any of this might affect the long-term prospects for ACA's success. But it's clear that Americans over 50 ought to be rooting for ACA to survive the challenges.

Mark Miller's Retire Smart column is carried on Tribune Media Services.