Senate Republicans’ try at replacing the Affordable Care Act—the Better Care Reconciliation Act, which many medical groups say is neither better nor provides care—could come with side effects: the need for older Americans to work longer and to save less for retirement.

That’s according to a MarketWatch report, which also details how hard the hammer would fall on older Americans.

The BCRA would not only increase the number of people who are uninsured by 22 million in 2026, it would also—according to the Congressional Budget Office—result in 35 percent less spending on Medicaid by 2036 than under the ACA, a Huffington Post report says.

But wait, there’s more.

The result of all these cuts, says MarketWatch, could mean that “older Americans may have to reduce the amount they save for retirement, or use retirement funds to pay for current health-care needs, or keep working to age 65 if only to keep their employer-sponsored health insurance plan.”

What a rosy picture. And if that’s not enough, the CBO points out that the increase would be disproportionately larger among older people with lower income—particularly people between 50 and 64 years old with income of less than 200 percent of the federal poverty level.

Under the House bill, known as the American Health Care Act, it was bad enough, with the CBO estimating that more than five million older adults aged 50–64 would lose health insurance.

But under the BCRA’s “age tax” on older adults—something that the AHCA also imposed—even more older people, such as those who aren’t yet eligible for Medicare but who need insurance, are also at risk of losing coverage, thanks to the Senate bill’s wider age bands and less generous subsidies.

A Medicare Rights Center brief is quoted saying in the report that “The ACA limits the premiums people 60 to 64 pay to three times what younger people pay, but the AHCA lets insurers charge older adults five times (or more if state law allows) what a younger person pays for the same health plan.”

And their options, if that happens?

Not many, according to experts: going back to work, hitting their retirement accounts to pay the bills, stop saving for retirement altogether or just go without health care.

Tricia Neuman, a senior vice president with the Henry J. Kaiser Family Foundation, is quoted in the report saying, “People living in high-cost areas and have incomes 350 percent and 400 percent of federal poverty level (FPL) will see substantially higher premiums as a result of these changes.”

An interactive map published by the KFF that The compares county-level estimates of premiums consumers would pay under the ACA in 2020 with what they’d pay under the Senate’s BCRA shows just how bad it can be.

The report cites the example of a 60-year-old in Grant County, West Virginia, with income of $40,000 (roughly the median household income in that county and 320 percent of FPL), who would see after-tax credit premiums rise 124 percent, from $4,080 for an ACA silver plan (10 percent of income), to $9,120 (23 percent of income) for a BCRA silver premium plan.

For a bronze plan, the premium increase would be even steeper.

And author Jae Oh, who has written a book about Medicare, warns in the report that Medicare beneficiaries who haven’t yet signed up for Medicare Part B enrollment and who are covered by an employer-sponsored group plan, will “definitely” want to reconsider.

Oh is quoted saying, “It has always been the case that the premium may or may not be superior to Medicare along with either a Medigap/Part-D or Medicare Advantage plan. The BRCA adds a further set of factors to consider. The BRCA could potentially change the definition of essential health benefits, and if that is the case, then the quality and services provided by the employer-sponsored plan may not be appropriate for the employee.”

Oh adds that in theory, an employer with employees in multiple locations will be able to choose a state, in which an employee resides, as the template for the entire group plan—then change the benefits of the whole plan, which can include lifetime benefit limitations or limitations against certain conditions.

He warns that such an action will also affect spouses, especially since lots of employers charge higher rates for the spouses of active employees.

And then there’s the BCRA’s potential effect on Medicare, which primarily comes from two changes that weren’t in the House bill.

In the report, Neuman says, “The Senate bill repeals the payroll tax surcharge on people with high earnings which helped strengthen the Medicare trust fund. Repealing this surcharge accelerates the insolvency of the Medicare Trust Fund which means policymakers will need to take action sooner to be sure Medicare can continue to meet its obligations beginning less than a decade from now.”

A 2016 Medicare Boards of Trustees report says that the Hospital Insurance trust fund, which pays for Medicare Part A (inpatient) services, is expected to go negative in 2028. From that point, without changes, the program would only be able to pay 87 percent of benefits.

Neuman points out that the Medicaid changes in the BCRA will also affect Medicare, if not directly. She is quoted saying, “The Senate bill caps the growth in Medicaid spending, and over time, this cap is expected to rise more slowly than the actual cost of care. This is an issue because 11 million people on Medicare rely on Medicaid to help cover their health and long-term care costs.”

She adds, “Only a fraction of the Medicare population have sufficient savings to cover their own long-term care costs, which is why Medicaid plays such an important role, and why changes to Medicaid could impact a surprisingly large number of older adults over time.”

In addition, federal funding caps on nursing homes and home care options—which will be changing over from the CPI-U medical (Consumer Price Index) to the regular CPI-U—will not be adequate to pay for nursing home costs, increases in staff wages and an expanded need by an aging population—many of whom will be hitting the age of 80, just the point at which many will need more extensive and long-term care and support.

Instant Insights /

GOP health proposal could mean working longer, saving less for retirement

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