The Republican leadership has rolled out its plan for repealing and replacing the Affordable Care Act. If enacted, the American Health Care Act (AHCA) or “Trumpcare,” drives up costs for older adults and would mean 24 million more uninsured Americans by 2026.
Here are some of the key features of Trumpcare, the AHCA, and how they affect older adults, Medicare, Medicaid and people with complex conditions:
- Trumpcare increases health care costs for older adults. Older Americans between 55 and 65, not yet eligible for Medicare, would see a 27 percent increase to $19,500 in annual premiums, as health plans would be allowed to charge them as much as five times more than people in their 20’s.
- Trumpcare ends ACA income-adjusted subsidies that help people with lower incomes afford needed care and increase as premiums increase; the subsidies would be replaced with a small flat tax credit for everyone earning up to $75,000, based on age, not adjusted for income– that do not increase as premiums increase. According to the CBO, whereas under the ACA a 64-year old adult earning $26,500 would have an adjusted annual premium of $1,700, under Trumpcare the adjusted annual premium would be $14,600. Older adults with low incomes also would face higher copays and deductibles.
- Trumpcare does nothing to lower drug costs. It increases profits further for Pharma, eliminating $24.8 billion in taxes the ACA imposed on Pharma.
- Trumpcare drives up costs even more for people with pre-existing conditions. Tens of millions of Americans with preexisting conditions will only be able to get coverage–if they have been without coverage for more than two months (63 days)–if they can afford a 30 percent premium surcharge; moreover, their coverage will be through a “high-risk pool.” These pools are notorious for having extremely high premiums and deductibles.
- Trumpcare ends funding for Medicaid expansion, dropping federal support for new enrollees in 2020 and cutting $880 billion from Medicaid between 2017 and 2026. The CBO projects that 14 million people with Medicaid will lose coverage entirely by 2026 and millions more are at risk of seeing their benefits cut. It will be up to each state to determine who gets Medicaid and what benefits Medicaid covers. States will get a block-grant, limiting the funds they have to spend on health care coverage for people with low incomes. Today, Medicaid pays for half of all long-term care spending in the U.S.
- Trumpcare cuts $117 billion from Medicare’s Trust Fund over ten years, shortening the projected time before which it will no longer be able to pay out full benefits by three years to 2025, giving Republicans an argument to gut the program, according to the Center on Budget and Policy Priorities.
- Trumpcare cuts an additional $229 billion in revenue from Medicare between 2016 and 2025.
- According to the Congressional Budget Office, Trumpcare will mean a total of 52 million Americans will be uninsured in 2026. Trumpcare will leave 14 million more Americans uninsured in 2018. Those new uninsured Americans include people who opt not to have insurance because Trumpcare does not require them to along with people who cannot afford their health insurance premiums. By 2020, 21 million more Americans will be uninsured. And, in 2026, an additional three million Americans will be uninsured.
- Trumpcare gives a huge tax cut to the wealthy, who will save an average of $50,000 a year. The wealthiest one tenth of one percent of Americans will save $195,000 annually. Trumpcare eliminates the additional 0.9 percent Medicare payroll tax on Americans earning more than $200,000 ($250,000 for couples) annually. It also eliminates the 3.8 percent tax on unearned investment income on Americans with annual incomes above $200,000. According to the Center on Budget and Policy Priorities, people earning more than $1 million receive 64 percent of the tax benefit and people earning between $500,000 and $1 million receive 20 percent of the tax benefit in 2025.
- Trumpcare destabilizes the health insurance marketplace, as far fewer people in good health will have insurance driving up costs for people who are in poor health.
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As horrendous as Trumpcare is, GOP leadership are likely to revise it, and it could become worse. Congressman Rand Paul and a few other Republicans oppose Trumpcare, which has now cleared the House Ways and Means Committee, the Energy and Commerce Committee and the House Budget Committee, on the grounds that it is too generous. They simply want to repeal the Affordable Care Act. For Trumpcare to pass, Republicans can lose no more than 21 votes in the House and no more than 2 in the Senate.
Here’s more from Just Care:
- 8.3 million people benefit from both Medicare and Medicaid
- Enrolling in Medicare? Here’s a checklist
- Free local resources to help older adults
- Four things to know if your income is low and you have Medicare