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

03/05/2012

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 Foundations Employer Health Benefits Survey, 59 percent of all workers covered by their employers 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 Americas 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 Acts 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 Acts 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 Acts 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 Acts Prohibition on Lifetime Limits on Health Benefits, By State & Age/Gender

State

ChildrenAdult MalesAdult FemalesTotal
Alabama396,000561,000609,0001,566,000
Alaska64,00087,00086,000237,000
Arizona570,000752,000769,0002,091,000
Arkansas219,000313,000333,000865,000
California3,255,0004,389,0004,448,00012,092,000
Colorado521,000685,000696,0001,902,000
Connecticut367,000494,000525,0001,386,000
Delaware86,000113,000121,000320,000
District of Columbia34,00083,00091,000208,000
Florida1,411,0002,006,0002,170,0005,587,000
Georgia916,0001,145,0001,256,0003,317,000
Hawaii115,000174,000173,000462,000
Idaho173,000195,000198,000566,000
Illinois1,192,0001,735,0001,743,0004,670,000
Indiana615,000822,000822,0002,259,000
Iowa311,000443,000433,0001,187,000
Kansas279,000368,000374,0001,021,000
Kentucky362,000524,000528,0001,414,000
Louisiana385,000488,000538,0001,411,000
Maine103,000156,000172,000431,000
Maryland585,000794,000872,0002,251,000
Massachusetts*633,000912,000975,0002,520,000
Michigan977,0001,255,0001,315,0003,547,000
Minnesota553,000736,000754,0002,043,000
Mississippi223,000294,000327,000844,000
Missouri581,000775,000792,0002,148,000
Montana81,000122,000116,000319,000
Nebraska192,000252,000257,000701,000
Nevada269,000339,000329,000937,000
New Hampshire140,000197,000208,000545,000
New Jersey877,0001,183,0001,214,0003,274,000
New Mexico148,000194,000213,000555,000
New York1,609,0002,294,0002,529,0006,432,000
North Carolina804,0001,101,0001,186,0003,091,000
North Dakota66,00094,00093,000253,000
Ohio1,100,0001,512,0001,542,0004,154,000
Oklahoma317,000430,000450,0001,197,000
Oregon342,000485,000529,0001,356,000
Pennsylvania1,136,0001,677,0001,769,0004,582,000
Rhode Island89,000138,000147,000374,000
South Carolina397,000495,000566,0001,458,000
South Dakota82,000104,000109,000295,000
Tennessee523,000744,000775,0002,042,000
Texas2,094,0002,671,0002,771,0007,536,000
Utah411,000385,000387,0001,183,000
Vermont46,00082,00087,000215,000
Virginia817,0001,036,0001,121,0002,974,000
Washington580,000910,000937,0002,427,000
West Virginia147,000215,000219,000581,000
Wisconsin580,000771,000791,0002,142,000
Wyoming54,00073,00069,000196,000
Total27,827,00037,803,00039,534,000105,164,000
* 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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