HHS/ASPE. U. S. Department of Health and Human Services.Background

ASPE ISSUE BRIEF

Under The Affordable Care Act, 105 Million Americans No Longer Face Lifetime Limits on Health Benefits

March 2012

By:
Thomas D. Musco and Benjamin D. Sommers, ASPE

This Issue Brief is available on the Internet at:
http://aspe.hhs.gov/health/reports/2012/LifetimeLimits/ib.shtml

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The Affordable Care Act prohibits health plans from imposing a lifetime dollar limit on most benefits received by Americans in any health plan renewing on or after September 23, 2010.  While some plans already provided coverage with no limits on lifetime benefits, millions of Americans were previously in health plans that did not.  According to the Kaiser Family Foundation’s Employer Health Benefits Survey, 59 percent of all workers covered by their employer’s health plan in 2009 had some lifetime limit placed on their benefits.[1]  In addition, 89 percent of people with individually purchased coverage had a lifetime limit on their benefits.[2]

The Department of Health and Human Services (HHS) estimated the number of Americans receiving these new protections, combining results from the 2009 Kaiser employer survey and 2009 America’s Health Insurance Plans (AHIP) report with data from the 2009 to 2011 versions of the Current Population Survey (covering calendar years 2008-2010).[3]

Overall, we estimated that 70 million persons in large employer plans, 25 million persons in small employer plans, and 10 million persons with individually purchased health insurance had lifetime limits on their health benefits prior to the passage of the Affordable Care Act (Figure 1).[4]  These 105 million Americans now enjoy improved coverage without lifetime limits.

Among the 105 million Americans for whom lifetime limits have been eliminated as a result of the Affordable Care Act, 75.3 million are non-Latino White, 11.8 million are Latino, 10.4 million are African-American, 5.5 million are Asian, and approximately 500,000 are American Indian or Alaska Native (Figure 2).[5]  Approximately 28 million of those benefiting are children, with the remainder of the 105 million split almost equally between adult men and adult women (Figure 3).  Approximately 15.9 million individuals lived in rural areas, with the remainder in urban areas.[6] 

Table 1 presents totals by state.

Figure 1:
Distribution (in millions) by Market of 105 Million Americans (Ages 0-64)
Benefiting from the Affordable Care Act’s Prohibition on Lifetime Limits

Figure 1: Distribution by Market of 105 Million Americans (Ages 0-64) Benefiting from the ACA's Prohibition on Lifetime Limits on Health Benefits, in millions, large group = 70, individual = 10, and small group = 25.

Source:  ASPE analysis using data from the Employer Health Benefits:  2009 Annual Survey, Washington, DC:
Henry J Kaiser Family Foundation and Health Research & Educational Trust, September 2009;
Individual Health Insurance, 2009:  A Comprehensive Survey of Premiums, Availability, and Benefits, AHIP Center for Policy Research;
and 2009-2011 Current Population Survey Annual and Social Economic Supplements

Figure 2:
Distribution (in millions) by Race/Ethnicity[5] of 105 Million Americans (Ages 0-64)
Benefiting from the Affordable Care Act’s Prohibition on Lifetime Limits

 Figure 2: Distribution by Race/Ethnicity[5] of 105 Million Americans (Ages 0-64) Benefiting from the ACA's Prohibition on Lifetime Limits on Health Benefits, in millions, White non-Latino = 75.3, Latino = 11.8, Black = 10.4, Asian = 5.5, Native = 0.5, American Indian/Alaska Native = 0.5, and Other = 1.9.

Source:  ASPE analysis using data from the Employer Health Benefits:  2009 Annual Survey, Washington, DC:
Henry J Kaiser Family Foundation and Health Research & Educational Trust, September 2009;
Individual Health Insurance, 2009:  A Comprehensive Survey of Premiums, Availability, and Benefits, AHIP Center for Policy Research;
and 2009-2011 Current Population Survey Annual and Social Economic Supplements

Figure 3:
Distribution (in millions) by Age/Gender of 105 Million Americans (Ages 0-64)
Benefiting from the Affordable Care Act’s Prohibition on Lifetime Limits

Figure 3: Distribution by Age/Gender of 105 Million Americans (Ages 0-64)  Benefiting from the ACA's Prohibition on Lifetime Limits on Health Benefits, in millions, Adult Females=39.5, Adult Males=37.8, and Children=27.8.

Source:  ASPE analysis using data from the Employer Health Benefits:  2009 Annual Survey, Washington, DC:
Henry J Kaiser Family Foundation and Health Research & Educational Trust, September 2009;
Individual Health Insurance, 2009:  A Comprehensive Survey of Premiums, Availability, and Benefits, AHIP Center for Policy Research;
and 2009-2011 Current Population Survey Annual and Social Economic Supplements

Table 1:
Estimated Number of Americans (Ages 0-64) Benefiting from the
Affordable Care Act’s Prohibition on Lifetime Limits on Health Benefits,
By State & Age/Gender

State

Children Adult Males Adult Females Total
Alabama 396,000 561,000 609,000 1,566,000
Alaska 64,000 87,000 86,000 237,000
Arizona 570,000 752,000 769,000 2,091,000
Arkansas 219,000 313,000 333,000 865,000
California 3,255,000 4,389,000 4,448,000 12,092,000
Colorado 521,000 685,000 696,000 1,902,000
Connecticut 367,000 494,000 525,000 1,386,000
Delaware 86,000 113,000 121,000 320,000
District of Columbia 34,000 83,000 91,000 208,000
Florida 1,411,000 2,006,000 2,170,000 5,587,000
Georgia 916,000 1,145,000 1,256,000 3,317,000
Hawaii 115,000 174,000 173,000 462,000
Idaho 173,000 195,000 198,000 566,000
Illinois 1,192,000 1,735,000 1,743,000 4,670,000
Indiana 615,000 822,000 822,000 2,259,000
Iowa 311,000 443,000 433,000 1,187,000
Kansas 279,000 368,000 374,000 1,021,000
Kentucky 362,000 524,000 528,000 1,414,000
Louisiana 385,000 488,000 538,000 1,411,000
Maine 103,000 156,000 172,000 431,000
Maryland 585,000 794,000 872,000 2,251,000
Massachusetts* 633,000 912,000 975,000 2,520,000
Michigan 977,000 1,255,000 1,315,000 3,547,000
Minnesota 553,000 736,000 754,000 2,043,000
Mississippi 223,000 294,000 327,000 844,000
Missouri 581,000 775,000 792,000 2,148,000
Montana 81,000 122,000 116,000 319,000
Nebraska 192,000 252,000 257,000 701,000
Nevada 269,000 339,000 329,000 937,000
New Hampshire 140,000 197,000 208,000 545,000
New Jersey 877,000 1,183,000 1,214,000 3,274,000
New Mexico 148,000 194,000 213,000 555,000
New York 1,609,000 2,294,000 2,529,000 6,432,000
North Carolina 804,000 1,101,000 1,186,000 3,091,000
North Dakota 66,000 94,000 93,000 253,000
Ohio 1,100,000 1,512,000 1,542,000 4,154,000
Oklahoma 317,000 430,000 450,000 1,197,000
Oregon 342,000 485,000 529,000 1,356,000
Pennsylvania 1,136,000 1,677,000 1,769,000 4,582,000
Rhode Island 89,000 138,000 147,000 374,000
South Carolina 397,000 495,000 566,000 1,458,000
South Dakota 82,000 104,000 109,000 295,000
Tennessee 523,000 744,000 775,000 2,042,000
Texas 2,094,000 2,671,000 2,771,000 7,536,000
Utah 411,000 385,000 387,000 1,183,000
Vermont 46,000 82,000 87,000 215,000
Virginia 817,000 1,036,000 1,121,000 2,974,000
Washington 580,000 910,000 937,000 2,427,000
West Virginia 147,000 215,000 219,000 581,000
Wisconsin 580,000 771,000 791,000 2,142,000
Wyoming 54,000 73,000 69,000 196,000
Total 27,827,000 37,803,000 39,534,000 105,164,000
* Massachusetts previously permitted lifetime limits only on non-core benefits.
Source:  ASPE analysis using data from the Employer Health Benefits:  2009 Annual Survey, Washington, DC: Henry J Kaiser Family Foundation and Health Research & Educational Trust, September 2009; Individual Health Insurance, 2009:  A Comprehensive Survey of Premiums, Availability, and Benefits, AHIP Center for Policy Research; and 2009-2011 Current Population Survey Annual and Social Economic Supplements

Endnotes

[1]  Employer Health Benefits:  2009 Annual Survey, Washington, DC:  Henry J Kaiser Family Foundation and Health Research & Educational Trust, September 2009.

[2]  Individual Health Insurance, 2009:  A Comprehensive Survey of Premiums, Availability, and Benefits, AHIP Center for Policy Research.

[3]  We used estimates of the percentages of individuals covered by small group and large group plans subject to lifetime limits (from the Kaiser employer survey cited in note 1), and an estimate for the non-group market from the AHIP survey cited in note 2, and multiplied these percentages by the number of individuals in each type of plan, as estimated from the Current Population Survey (CPS) Annual Social and Economic Supplement, 2009-2011 datasets. We then made the same calculations based on the number of individuals covered in each type of plan at the state level.  Similarly, we used CPS data to estimate the distribution of small, large, and non-group coverage by race/ethnicity, and then used the Kaiser and AHIP results to estimate the number of people by race and ethnicity that benefited from the prohibition on lifetime limits.

[4]  Patient Protection and Affordable Care Act:  Preexisting Condition Exclusions, Lifetime and Annual Limit, Rescissions, and Patient Protections, Interim Final Rule, Federal Register Vol. 75, No. 123, June 28, 2010

[5]  Race/ethnicity based on self-report from the Current Population Survey.  White non-Latino, Black, Asian, and American Indian/Alaska Native groups exclude Latinos, who comprise their own category.  'Other' contains any individuals not included in the first five categories (including biracial and multiracial individuals).

[6]  The method for this calculation was analogous to that described for race/ethnicity in Note 4.  We used the Census definition in the CPS of living in a 'metropolitan area' as urban, and all others as rural.


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Last updated:  04/25/12