Insurance Take-Up Among the Near-Elderly in the Age of the Affordable Care Act

Near-elderly individuals, those 60 to 64 years old, have high health care needs and, if uninsured, often delay costly care until they enroll in Medicare (Card et al. (2008); McWilliams et al. (2009)). The passage of the Affordable Care Act (ACA) in 2014 provided new coverage options to uninsured near-elderly individuals. Although understanding the extent to which the ACA affected the near-elderly is key to future health policy decisions, little focus has been given to the near-elderly. I provide the first assessment of the ACA’s effect on nearelderly insurance coverage using three nationally representative surveys. I replicate and update the findings from Card et al. (2008), then extend the analysis by using a differencein-regression discontinuity design to quantify the effect of the ACA on insurance rates just prior to individuals transitioning into Medicare. I find that the gap in insurance coverage rates between 64and 65-year olds declines by almost half, from 8 to 4.5 percentage points, after the ACA went into effect in 2014. Consistent with these changes being attributable to the ACA, I also find that most coverage gains come from Medicaid in states that expanded Medicaid eligibility, while coverage gains in non-Medicaid-expansion states come from the kinds of insurance plans available on the exchanges. These results raise questions about the extent to which increasing coverage for the near-elderly may ease demand upon their entry into Medicare and the consequences of an ACA repeal on their access to health care.