Beginning January 1, 2014, the Affordable Care Act (ACA) requires everyone to have health insurance or pay a financial penalty. To help individuals and their families find plans that fit their needs and budgets, states will run Health Insurance Marketplaces. The new Health Insurance Marketplace (“the Marketplace”) open enrollment period begins Oct. 1, 2013 and ends March 31, 2014.

The Diverse Elders Coalition (DEC) understands that enrolling older people and their families in health coverage plans is a key part of improving the health of our nation. The DEC represents some of our most vulnerable older adults: older people of color and lesbian, gay, bisexual and transgender (LGBT) older people, many of whom begin dealing with the challenges of aging as early as their 50s. The Marketplace will impact uninsured or underinsured older people who are in the 50-64 age range differently than those who are 65 or older, many of whom are already covered by Medicare. Moreover, many elders age 65+ are confused on how the Marketplace and broader ACA implementation will affect them. Thus, there exists a need to educate them about new ACA benefits, such as expansion of Medicare benefits, lower-cost prescription drugs and free preventive services. And for uninsured older people 50-64 years old, they will need to actively interact with their Marketplace to find a health insurance plan that fits their needs.

This week, the U.S. Department of Health and Human Services (HHS) is highlighting how the Marketplace affects communities of color and, as part of these efforts, asked that the DEC describe how the marketplace will impact older people of color, a percentage of whom are LGBT. Here are five reasons:

1. The Health Insurance Marketplace offers affordable insurance to older people of color who face high poverty rates and are more likely to be uninsured than their peers—conditions that worsen with age. People of color are more likely to be poor and without health insurance coverage—they make up more than half of America’s uninsured. This demographic includes African Americans, Hispanics, African Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives. In addition, the number of uninsured older adults age 50-64 continues to rise—from 3.7 million in 2000 to 8.9 million in 2010. These high rates of uninsured people are due in part to a history of low earnings, discrimination in health care practices and high or unaffordable premiums for health insurance for many people of color. The Marketplace will address these challenges by offering affordable coverage and financial assistance to those with lower incomes.
2. The Health Insurance Marketplace will help to ensure that older people of color no longer feel the need to postpone critical health care services. According to the Center for American Progress, being uninsured often means postponing necessary care—and chronically ill, uninsured patients are four to six times more likely than sick patients with insurance to have problems accessing care. That’s why people of color in the U.S. are diagnosed at more advanced disease stages, and once diagnosed, they receive poorer care. The Marketplace will allow older people of color to manage their health more proactively, and it will also cut high out-of-pocket costs associated with emergency room visits when a crisis hits.
3. The Health Insurance Marketplace can address the health disparities widely affecting older people of color, many of whom are LGBT. Research shows that people of color, across the age span, face significant disparities in physical and mental health. Additionally, many people of color delay care because of potential medical costs and out of fear of discrimination or cultural incompetence from medical providers. These issues are especially true for LGBT people of color who face challenges on multiple aspects of their identities. A recent research report highlighted the many ways in which policy makers and professionals can better support LGBT older people of color across areas related to health equity and health care access. It can start with making insurance more affordable and health care more prevalent.
4. The Health Insurance Marketplace ensures that no application for health insurance is rejected due to preexisting medical conditions, such as HIV, which disproportionately affects communities of color and older people. For example, research project that within the next few years, one in two people with HIV in this country will be age 50 or older. The HIV/AIDS epidemic that has also adversely impacted LGBT people, many of whom are people of color. Prior to the ACA most states allowed health insurers to charge higher premiums because of these conditions. Insurers who sell coverage in the Marketplace will be required to accept all applicants, including those with preexisting medical conditions.
5. The Health Insurance Marketplace supports the entire family unit, including families of choice, while honoring the role that elders play in our communities. The DEC knows well that older adults play an important role in our communities and in our families, broadly defined to include blood relatives, spouses and partners, caregivers and friends. The 2000 U.S. Census shows that 4.5 million children are living in grandparent-headed homes, many of whom are between 55 and 64. Thus, when the Marketplace supports the health and health care options of an older person of color, it also supports the lives of the many people in his/her family unit and broader ecosystem.