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Straight Talk for Seniors®: The American Health Care Act

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Last week, the House of Representatives passed the American Health Care Act (AHCA) by a slim margin of 217-213. The bill to repeal and replace the Affordable Care Act (ACA) would affect millions of older Americans—but it also has a long way to go before becoming law.

What’s in the bill?

The AHCA retains most of the same provisions found in an earlier version that failed to make it to a vote. But it also includes new elements that could further impact people with pre-existing conditions and those aged 50-64 who are not yet eligible for Medicare. Here are some highlights:


Medicaid is a lifeline for 7 million vulnerable older adults who depend on it, primarily for long-term services and supports that are not covered by Medicare. The AHCA would:

  • Cut Medicaid by $839 billion by 2026.
  • Fundamentally change how Medicaid is funded by capping the federal contribution based on a preset formula that would grow at a fixed rate, below the actual cost of care.
  • Repeal the Community First Choice program, which gives states incentives to provide seniors and people with disabilities access to home and community-based services.
  • End the ACA Medicaid expansion in 2020.


The bill weakens the Medicare Trust Fund by repealing the ACA tax provision that imposes a 0.9% payroll tax on incomes above $200,000 for single individuals and $250,000 for couples. This means that the Trust Fund would be insolvent at least 3 years sooner—in about 2025 instead of 2028.

Age Tax

Under the ACA, insurers cannot charge pre-Medicare older adults with nongroup coverage premiums that are more than three times what they charge younger adults. Under the House bill, insurers would be able to charge these seniors five times or more for premiums.

Prevention and Public Health

The bill eliminates the Prevention and Public Health Fund created under the ACA. For older adults, the Fund includes funding for Chronic Disease Self-Management Education (CDSME) and Falls Prevention. But it also has improved access to disease prevention, vaccines, and health screenings for all Americans. The repeal bill eliminates the Fund entirely in October 2018.

Pre-Existing Conditions

The House bill allows for states to apply for a waiver that would let them define the essential benefits covered in their state, and a waiver that would allow health insurance companies to charge some people with certain pre-existing conditions higher premiums.

What’s ahead?

The Senate will now take up the ACA repeal and replace effort. The expectation is that the Congressional Budget Office will release an estimate on the House bill’s cost and impact this week or next, and that the Senate Parliamentarian will then review that bill to see whether certain sections can pass the so-called Byrd Rule, which requires provisions have a clear budget impact if only a simple majority is needed for passage.

While some House provisions will remain intact, changes to the bill will be made—potentially major changes. With a 52-48 margin, Republicans can afford to lose only two votes to pass the bill. Many expect that they will try to pass a bill by the end of June or the end of July. If they do, the House could pass the Senate bill, or, more likely, a House-Senate conference committee would be formed to work out differences, and then a single bill would have to be passed in each chamber.

NCOA will continue to be active in opposing provisions that would harm older Americans and urge that a bipartisan bill that improves coverage and quality, while reducing out-of-pocket costs, be pursued. As the debate continues, we will need your help educating Senators about what the House proposal would mean for older adults.

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Howard Bedlin

About Howard Bedlin

Howard Bedlin is NCOA's Vice President of Public Policy and Advocacy. He is responsible for all of NCOA’s federal and state legislative advocacy efforts on issues and programs of concern to older adults, which include the Older Americans Act, Medicare, Medicaid, long-term care, income security, and community services programs.