Published by The Commonwealth Institute.

As we wait to hear details about the Senate’s healthcare bill, we can assess the impact that the Affordable Care Act (ACA) has had on people in Virginia, and which groups or communities are likely to experience the greatest changes if a version of the House’s American Health Care Act (AHCA) moves forward. There’s a common denominator among those who are likely to be harmed: they will be the ones who benefited most from the ACA over the past eight years. Older adults, both those in the 55-65 and in the 65+ brackets, will be hit hard by proposed replacements to the ACA.

Over 100,000 older adults in Virginia signed up for health insurance through the ACA Marketplace, and many would no longer be able to afford health insurance if the AHCA is passed. Even those who could still afford coverage, including many who have employer-sponsored insurance, would see their costs go up and their coverage limited. They’d be at risk of losing everything they’ve worked for near the end of their working careers if they are hit with high medical bills.

The GOP plan allows insurance companies to charge older adults far higher premiums than under the ACA, and also reduces the tax credits many older adults get to help pay those premiums. A 60-year old making $22,000 per year, for example, would see their premium go up by more than $8,000 a year.
The plan would also allow Virginia lawmakers to give insurers permission to charge far higher premiums for those with pre-existing conditions, putting coverage out of reach for many who need it most. Older adults are much more likely than young adults to be diagnosed with conditions that would lead to unaffordable premiums.
Additionally, with the reinstatement of annual and lifetime maximum payments for benefits, as well as returning to the practice of excluding specific types of health care services such as mental health coverage and prescription drug coverage, older adults could lose key protections they gained through the ACA.
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Seniors over age 65, who have likely ended their working careers and so have reduced income at the very time their need for health care services is increasing, would be at risk of receiving lower quality services and of seeing their benefits cut. Once retirement age is reached, almost all seniors receive coverage for a majority of their medical care through Medicare or Medicaid or both – and they both would receive significant cuts under the House-passed AHCA.

Currently over 1.3 million seniors and disabled persons in Virginia have their health care coverage provided by Medicare, and the AHCA’s proposed cuts could affect virtually all of them. Under the AHCA, the Medicare trust fund’s support would be cut, depleting it sooner than expected; seniors and people with disabilities could expect benefit cuts in the future as this occurs. Additionally, Medicare premium and cost-sharing could eventually rise due to an increase in uninsured older adults waiting until they have Medicare to seek treatment, eventually driving up costs for the whole Medicare system.
And then there’s Medicaid, which over 250,000 aged, blind, and disabled people in Virginia rely on for home health care, nursing care, and other critical services. Proposed federal cuts to Medicaid from the GOP bill will put pressure on states to adopt cost saving measures that will directly impact those who need long term care. That’s because a per-capita or block-grant scheme for Medicaid reimbursements to states would result in large cuts over time, forcing Virginia and other states to choose between cutting enrollment, cutting services, or cutting reimbursement rates – any of which mean that care will cost more and provide less. As a result, home health services and nursing home care coverages would very likely be reduced, causing harm to those with significant limitations due to age, illness, or disability. Reductions to home health services, which allow seniors and the disabled to receive care that allows them to remain in their homes and retain some of their independence, would be particularly damaging, since it would force more seniors into costly nursing home care.

Key provisions of the Affordable Care Act benefit older adults, increasing access to care, quality of care, and cost. It isn’t perfect, particularly in states like Virginia where Medicaid has not been expanded. But the proposed “cures” of the American Health Care Act are worse than the supposed ills of the ACA.

–Laura Goren, Research Director, and Lisa Salita, Communications Associate