JustCare

Tag: ACA

  • ACA repeal means higher costs for people with Medicare

    ACA repeal means higher costs for people with Medicare

    There has been a lot of focus on the implications for working people of the Republican leadership’s plan to repeal the ACA. Precious little has been written about the consequences for older adults and people with disabilities. According to the Kaiser Family Foundation, ACA repeal means higher costs for people with Medicare–higher premiums, deductibles and copays.

    While the ACA primarily is designed to provide affordable coverage to people not yet eligible for Medicare and without employer coverage, it also strengthens Medicare in a variety of ways, bringing down out-of-pocket costs for enrollees and extending the life of the Trust Fund:

    • It expands coverage under the Medicare Part D drug benefit. In 2017, the ACA ensures that the millions of people with high drug costs–with total drug costs of more than $3,700–are not responsible for the full $1,250 of their drug costs before the Medicare Part D catastrophic cap kicks in at $4,950 in drug costs. Instead, people are only required to pay 40 percent of the cost of their brand-name drugs and 51 percent of the cost of their generic drugs. And, if this ACA protection remains, the amount they pay in the coverage gap or “donut hole” will continue to shrink to 25 percent of their drug costs by 2020.
    • It requires that many Medicare preventive care services be covered in full, without a deductible.
    • It extends the life of the Medicare Trust Fund by 12 years to 2029.

    The Congressional Budget Office estimated in a June 2015 report that if the ACA were repealed, it would add $802 billion to Medicare’s costs over the ten-year period ending in 2025. The ACA reined in payment rates under both traditional Medicare and Medicare Advantage plans. Specifically, it reduced some provider payments in traditional Medicare. And, it reduced overpayments to Medicare Advantage plans so that they are no longer 14 percent higher than average per person costs under traditional Medicare, as they had been.

    Because enrollees are responsible for 25 percent of the Medicare Part B premium, if Medicare’s costs rise, so does the Part B premium.

    The ACA also imposes an extra payroll tax and tax on investment income for people with high incomes to help offset the cost of additional benefits. And, it imposes annual fees on health insurers. If those taxes were repealed, the program would lose $631 billion.

    If you want Congress to keep its hands off Medicare, sign this petition.

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  • Up to 4 million will be uninsured if Medicare eligibility age raised to 67

    Up to 4 million will be uninsured if Medicare eligibility age raised to 67

    In a recent report published by the National Committee to Preserve Social Security and Medicare Foundation based on research by the Actuarial Research Corporation, we demonstrate that Speaker Paul Ryan’s proposal to raise the age of Medicare eligibility from 65 to 67 would harm the health of 65- and 66-year old adults as well as the financial health of the institutions that care for them.

    If Congress raises the Medicare eligibility age to 67, between two and four million people 65 and 66 years old would be left uninsured, depending on whether or not the ACA is repealed. Currently, Medicare covers almost everyone 65 and over, with only 1.1 percent of people over 65 uninsured. But if the eligibility age for Medicare increases by two years, even if the ACA is not repealed, the percentage of uninsured would increase seventeen-fold to 18.7 percent or 1.9 million people 65 and 66. If the ACA is repealed, the percentage of uninsured would increase to 37 percent or 3.8 million people, more than one in three people 65 and 66.

    These uninsured older Americans will be hard-pressed to get needed care, particularly if the ACA is repealed. To the extent they have chronic conditions, insurers may no longer agree to cover them and, even if coverage is available, it is unlikely to be affordable for most people; if it’s affordable, it is likely to cover only limited benefits, with annual and lifetime caps. They will, therefore, end up using emergency services at far greater cost to our health care system and the institutions that provide them care.

    Doctors and hospitals in particular will find themselves covering the cost of care for most of these newly uninsured Americans (without reimbursement), putting these health care providers at financial risk. To the extent they raise their rates to absorb these costs, insurance premiums will rise further, escalating health care costs for insured Americans.

    Medicare is far better than commercial insurance at guaranteeing coverage, containing costs, and giving people with costly conditions access to the care they need. We should be expanding Medicare to everyone in the U.S., not driving up health care costs and the number of uninsured by raising the eligibility age.

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  • 150 million people at risk of losing good affordable coverage

    150 million people at risk of losing good affordable coverage

    JoAnn Volk of the Georgetown University Center on Health Insurance Reform writes for Health Affairs about the consequences for people with employer coverage of the Republicans’ plan to repeal the Affordable Care Act.  We know that if the ACA is repealed, 22.5 million people are at risk of losing their health insurance because they will no longer be eligible for Medicaid or will lose subsidies to help afford coverage in the individual market or have preexisting conditions. In addition 150 million people who get their health insurance through their jobs are at risk of losing good affordable coverage and being underinsured.

    Here’s what tens of millions of Americans will be facing if the ACA is repealed and replaced with a health insurance plan lacking strong consumer protections:

    • Health plans with only limited benefits, leaving people underinsured: The ACA ensures that large employer plans cover essential benefits and not simply a minimal set of benefits that would leave people needing costly care without adequate coverage. If the ACA is repealed, we will return to a state where health insurers sell tens of millions of Americans less coverage than they may need.
    • Health plans requiring people to pay up for preventive care: The ACA ensures that the cost of preventive services does not interfere with people getting these services; it has required that vaccines, annual check-ups and other key screenings to detect health issues before they develop are covered in full. If the ACA is repealed insurers can once again make people meet hefty deductibles and/or pay a large portion of the cost of preventive care.
    • Long delays in coverage for people with pre-existing conditions: The ACA prevents employers from making people wait to get coverage for their pre-existing conditions. Until the ACA was implemented, employers were able to make people with pre-existing conditions wait as long as a year. Only people who had the option of buying COBRA from a prior job and were able to afford the high cost of that insurance were able to avoid the wait if they had a pre-existing condition.
    • No dependent health care coverage for young adults up to age 26: The ACA ensures coverage to young adults through their parents’ job coverage until they are 26. As a result, many more young adults have health coverage today then ever before. (This is one provision of the ACA that the Republican leadership says it will keep in a replacement plan.)
    • Unlimited annual out-of-pocket costs for reasonable and necessary care: The ACA ensures a limit on how much money health insurers can require people to pay for their care in a given year. This provision in turn helps people with costly conditions afford the cost of their care without going bankrupt. Without it, people who need a lot of care may be forced to go without it or pushed into poverty paying for it.
    • Yearly and lifetime dollar limits on health plan coverage of reasonable and necessary care. The ACA prevents employers from limiting the amount of coverage they provide based on the cost of people’s care in a year or in their lifetimes. Caps on benefits are prohibited, ensuring that people with costly and complex conditions will always have coverage. If the ACA is repealed, people with costly conditions could lose their health care coverage mid-year or, worse still, for the rest of their lives.
    • No right to challenge denials of coverage or payment: The ACA ensures that workers who are in employer health plans that are self-funded (60 percent of workers) can question decisions by their health plans to deny them coverage or not pay for their care through an inexpensive independent review process.

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  • Who’ll lose health care after ACA repeal?

    Who’ll lose health care after ACA repeal?

    Later this month, Republicans in Congress plan to repeal large portions of the Affordable Care Act (ACA), aka Obamacare. The consequences for the health and financial security of tens of millions of Americans will be severe. Who’ll lose health care after the ACA is repealed? In a post-Obamacare world, access to care will be in jeopardy for tens of millions of working Americans whose employers don’t offer them coverage as well as for non-working Americans between jobs, unemployed or with pre-existing conditions.

    While the ACA did little if anything to restrain the growing cost of health care, it required that health insurers both provide coverage to anyone wishing to buy it and cover essential benefits. It also put a cap on insurer profits and administrative costs. Once Republicans repeal the ACA, there’s every reason to expect that insurers will once again 1) refuse to cover people with pre-existing conditions or charge them unaffordable premiums, 2) sell plans offering inadequate health coverage, and 3) take greater profits, raising premiums, copays and/or deductibles.

    In a post-Obamacare world, comprehensive health insurance will be unaffordable or unavailable to a large portion of non-elderly Americans. The Kaiser Family Foundation projects that 27 percent of people under 65 have pre-existing conditions that would lead health insurers to deny them coverage. In 11 states, three in ten nonelderly Americans will not be able to buy health insurance. Those states are West Virginia (36%), Mississippi (34%), Kentucky (33%), Alabama (33%), Arkansas (32%), Tennessee (32%), Oklahoma (31%), Louisiana (30%), Missouri (30%), Indiana (30%) and Kansas (30%).

    Pre-Obamacare, 52 million Americans could not buy health insurance because of their pre-existing conditions. And, millions more Americans were underinsured, with inadequate coverage to meet their health care needs if they developed costly or complex conditions.

    A new report from the Urban Institute projects that 58.7 million Americans will be uninsured by 2019, more than double the number of uninsured today, 28.9 million. In 2019 alone, the federal government will spend $109 billion less on health care.

    • About 9.3 million people will lose the government subsidies the ACA offers and will no longer be able to afford coverage.
    • Nearly 13 million people will lose Medicaid or coverage through CHIP, the Children’s Health Insurance Program.
    • Many employers will stop covering their workers once they are no longer required to do so.

    And, while Republicans are saying that they may keep the ACA subsidies in place until they pass a replacement plan, it’s more than likely that a large number of health insurers will stop offering coverage in 2018.  Insurers will fear attracting too many people with costly conditions once Republicans repeal the ACA’s mandate that most everyone have health insurance.

    The full consequences of the ACA repeal for people with Medicare are less clear but not good. The ACA extended the life of the Medicare Trust Fund 12 years. It also reduced Medicare Part D prescription drug costs. Moreover, once the ACA is repealed, Medicare premiums are likely to rise as more people under 65 go without coverage and forego needed care before becoming Medicare eligible.

    The smartest and most cost-effective solution to this brewing health care crisis would be to expand Medicare to everyone in America, a solution most Americans support. In the meantime, please sign this petition to tell Congress: Hands off Medicare.

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