Column: Republican health care reform is the real disaster for older Americans

© Reuters. Trump holds health meeting at White House in Washington

By Mark Miller

CHICAGO (Reuters) – The Republican leadership in Washington says Obamacare is an imploding disaster. But if your income is low and your age is high, the real disaster is the repeal and replacement health care bill offered by the President of the United States, Donald Trump, and the Speaker of the House of Representatives, Paul. Ryan.

Congress’s official report card on the proposed American Health Care Act (AHCA) was released this week and concludes that older and low-income Americans will be its biggest losers; Ironically, many of the households that supported the candidacy of the president for the White House.

AHCA will increase premiums for older low- to middle-income users of commercial insurance exchanges and reverse Medicaid coverage for very low-income households, according to the nonpartisan Congressional Budget Office (CBO).

Just as important, the AHCA proposes massive cuts in Medicaid funding that would reduce the funding available for nursing home care in the coming years, just as the demand for care will skyrocket.

Overall, the CBO found that 24 million Americans would lose health insurance coverage in 2026, if the plan the House of Representatives is considering to replace the Affordable Care Act of 2010. Loss of coverage were adopted. it would fall disproportionately on low-income older people, according to the report. The bill would remove the individual mandate that requires people to buy insurance, and would make insurance plans bought on the stock market more expensive.

First, it would loosen current restrictions on “age ratings,” the additional amounts that insurers can charge older customers. Under former President Barack Obama‘s Affordable Care Act, insurers can charge older members three times more than younger members. Under the AHCA, they could charge five times more.

Second, the AHCA repeals Obamacare subsidies that offset the premiums of many lower- and middle-class buyers based on income, and replaces them with fixed age-based tax credits. The change won’t affect younger and higher-income buyers much, and could even lower premiums in some cases, the CBO found.

But premiums for a 64-year-old earning $ 26,500 would increase by $ 12,900 in 2026, from $ 1,700 a year now to $ 14,600, CBO reports. “There is no way anyone can increase their premiums by that amount and still eat and have a roof over their head,” said Debra Whitman, executive vice president for policy at AARP, who is fighting the AHCA along with associations representing physicians. , hospitals and insurance companies.


The political justification for all of this is that the ACA is a “disaster,” as the President and Ryan have said. They point to states where premiums have soared by more than 100 percent and insurers have pulled out of the markets. While some state exchanges have experienced these problems, that criticism is overblown.

“There is no question that the current system could be improved by stabilizing risk groups, but it is not in a state of total collapse,” said Dan Mendelson, CEO of Avalere Health, a healthcare research and consulting firm that studies tradeoffs. . . “There are some markets that are difficult, but that is the exception and not the norm.”

Meanwhile, AHCA proposes a fundamental transformation of Medicaid that would cut the resources available to states to help address an aging population.

Currently, Medicaid is jointly funded by the states and the federal government, and funding is determined by the actual need for health care spending. Under the AHCA, federal funding for states would be capped per beneficiary, based on what they spent in 2016, with specific targets for each category of Medicaid enrollees (seniors, disabled, children, and low-income adults), plus an adjustment for inflation. The Center for Budget and Policy Priorities estimates that this provision would transfer $ 370 billion in costs to states over the next ten years.

“Lock spending at the 2016 level,” Whitman said. “That might be fine for the first year or so, but we know that the boomers are on the early edge of aging – in ten or 15 years, they will be older and need a lot of services. But federal payments to states for meeting that need would not expand. “

Medicaid is the nation’s largest long-term care funder: In 2014, combined federal and state spending was approximately $ 152 billion, dwarfing the $ 9 billion paid by private long-term insurance underwriters, according to research from AARP. Limiting the dollars available to cover long-term care needs would force states to cut spending or fill in the gaps without federal assistance.

“The bill is so shortsighted,” said Stacy Sanders, director of federal policy for the Medicare Rights Center, a nonprofit consumer advocacy and research group. “It shows a total ignorance that we have an aging society.”

AHCA also threatens Medicaid funding for a program that helps low-income seniors who receive Medicare pay for their health care. The Medicare Savings Program helps pay for Part B premiums and out-of-pocket costs. Although federal Medicaid dollars for the program are exempt from AHCA cuts, 12 states and the District of Columbia have chosen to expand the program’s benefits by easing the asset or income eligibility tests, and those expansions could be threatened by the AHCA, possibly affecting 2.4 million Medicare enrollees. according to an analysis by the Medicare Rights Center.

The AHCA falls far short of Trump’s promise to pass health care reform that provides “insurance for all.” ( From where I’m sitting, it looks like bad policy and silly policy, all wrapped up in an ultra-hasty bill.

(Views expressed here are those of the author, a Reuters columnist.)