AHCA would hit older, low-income Americans hard, Kaiser says

The American Health Care Act (AHCA) as passed by the House in early May would result in a 5.1 million increase in the number of uninsured 50- to 64-year-olds in 2026, Kaiser Family Foundation said in an issue brief published this week.

Basing its argument on a Congressional Budget Office (CBO) analysis of the AHCA released on May 24, Kaiser said the bill would “make a number of changes to current law” that would result in older Americans not yet eligible for Medicare to lose health coverage.

“These changes would disproportionately affect older adults with incomes below 200% of poverty,” Kaiser researchers wrote. “Adults age 50-64 with incomes below 200% of the poverty level would see the biggest loss of coverage under the AHCA – a 150% increase in the number of uninsured in 2026 relative to current law, compared to 90% for all adults. CBO projects the share of low-income older adults who are uninsured would rise from 12% under current law to 29% under the AHCA by 2026.”

Kaiser said language in the current version of the AHCA would:

Allow insurers to charge older adults five times more than younger adults starting in 2018. The Affordable Care Act (AHA) limits how much insurers can charge older Americans to three times the premium level for younger Americans.

Allow states to seek waivers to let insurers opt out of the ACA’s community rating and benefit requirements, enabling insurers to charge a higher premium to applicants with pre-existing conditions whose coverage lapsed for 63 days or more.

“Because many health problems and pre-existing conditions tend to increase with age, the opt-out could particularly affect older adults,” Kaiser wrote. “For example, 47% of adults age 60-64 have a pre-existing condition that would have led to a denial of coverage pre-ACA, compared to 27% of non-elderly adults overall.”

Lower tax credits, resulting in reduced premium subsidies for low-inclome Americans.

Limit federal funds for states that have expanded coverage under Medicaid. The CBO estimates this change, along with a proposed cap in federal Medicaid funding, would cause 14 million Americans to lose Medicaid coverage by 2026.

Kaiser concluded that “the loss of coverage for adults in their 50s and early 60s could have ripple effects for Medicare, a possibility that has received little attention.”

“If the AHCA results in a loss of health insurance for a meaningful number of people in their late 50s and early 60s, as CBO projects, there is good reason to believe that people who lose insurance will delay care, if they can, until they turn 65 and go on Medicare, and then use more services once on Medicare,” the researchers wrote. “This could cause Medicare to increase, and when Medicare spending rises, premiums and cost-sharing do too.”

You can read the entire Kaiser issue brief here.

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