March 3, 2017 – For Immediate Release
By Bill Kallio
Virginia Interfaith Center for Public Policy Healthcare Consultant
Whether you receive your health insurance from your employer, the private marketplace or a government program, the Affordable Care Act (ACA) affects us all. Repealing the ACA outright would have an immediate effect on all Medicare beneficiaries. Dismantling the ACA would likely mean higher premiums, deductibles and cost-sharing for the 57 million senior citizens and disabled Americans enrolled in the program. It would also eliminate several new benefits and bring back the infamous “donut hole” in Medicare’s prescription drug coverage.
While much of the past year’s discussion about the ACA has centered around its effects on Medicaid, the law also made many changes to Medicare, the federal health insurance program for people 65 and older and disabled persons of any age. In exchange for the promise that more Americans would have coverage, it slowed the growth of Medicare payment rates to hospitals and other providers. It also reduced payments to Medicare Advantage plans, bringing them in line with the per capita costs of traditional Medicare. It improved benefits for enrollees by adding several preventive care services at no cost to beneficiaries. Repealing the ACA would increase Medicare spending by $802 billion over 10 years, according to estimates by the non-partisan Congressional Budget Office.
As a result, Medicare beneficiaries would pay more because premiums and deductibles are tied to the growth of federal outlays. Seniors would face higher deductibles and co-payments for their Part A, which covers hospital stays, and higher premiums and deductibles for Part B, which pays for doctor visits and other services. The White House has estimated that the typical Medicare beneficiary is paying about $700 less in premium and cost sharing this year because of slower growth in costs.
Under the ACA, Medicare enrollees receive free preventative benefits, such as screenings for breast and colorectal cancer, heart disease and diabetes, with no copayments and before reaching annual deductibles. Preventive care is key to reducing long-term costs of Medicare, since the most effective way to treat individuals is by detecting health problems early when they can be treated in a more cost-efficient way. These provisions would disappear under a full repeal.
One of the most important benefits of the ACA is closing the gap in Medicare’s drug coverage in stages, completely eliminating it by 2020. Before the ACA, Medicare Part D plans left seniors vulnerable to falling into a coverage gap that caused many to find their prescription drugs unaffordable part way through a calendar year. This was called the “donut hole”. Senior citizens have to pay more for drugs while they are in the donut hole. In 2016, the gap began when enrollees and their insurers have spent $3,310 for medication and ends after they hit $4,850 in costs. Since the ACA was approved in 2010, more than 11 million people have saved an average of more than $2,100 a person on prescription drugs, according to the White House. The “donut hole” would return if ACA were repealed.
For those approaching Medicare (50-64 years old), the ACA also limited the amount an insurance company could charge for premiums based on age. Prior to the ACA, many older citizens were unable to affordable health insurance because of this age bias and could only hope they didn’t get sick until they reach the age of 65. By making health insurance more affordable for the pre-Medicare population, this ACA provision held the promise of creating a healthier Medicare population.
Finally, the ACA significantly improved the financial solvency of the Medicare Part A Trust Fund. The Part A Trust fund is funded by payroll taxes and pays for hospital and nursing home care. Due to demographic changes and healthcare inflation, the Trust Fund was at risk of becoming insolvent in 2017. As a result of changes implemented by the ACA, the solvency of the trust fund was extended by more than 10 years.
Medicare beneficiaries need to pay close attention to legislative efforts to repeal the Affordable Care Act. Without a meaningful replacement that addresses their needs, they are at risk of losing several important benefits and will experience increasing out-of-pocket costs over the next several years.
Here’s a list of no-cost Medicare preventive care benefits under the ACA:
- Abdominal aortic aneurysm screening
- Alcohol misuse screening and counseling
- Bone mass measurements
- Breast cancer screening (mammograms)
- Cardiovascular disease (behavioral therapy)
- Cardiovascular disease screening
- Cervical and vaginal cancer screening
- Colorectal cancer screening
- Depression screening
- Diabetes screening and self-management training
- Glaucoma tests
- Hepatitis C screening test
- HIV screening
- Lung cancer screening
- Medical nutrition therapy
- Obesity screening and counseling
- Prostate cancer screening
- Sexually transmitted infections screening and counseling
- Shots (flu, pneumococcal, and Hepatitis B)
- Tobacco use cessation counseling
- “Welcome to Medicare” preventive visit
- Yearly “wellness” visit
