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Straight Talk for Seniors®: The ACA Is Safe for Now, But What’s Ahead?

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On March 24, the House of Representatives cancelled its vote to repeal and replace the Affordable Care Act (ACA). Speaker Paul Ryan (R-WI) stated that the ACA will remain the law of the land for the foreseeable future.

While opponents of the repeal bill are breathing a sigh of relief, this is only round one of several fights that are expected this year over programs for America’s seniors.

Your advocacy worked!

Thanks to advocacy by you and thousands of others around the country, these programs will stay intact for the foreseeable future:

  • The Medicaid program for low-income seniors, children, and people with disabilities will not be subject to a cap on spending.
  • The Medicaid eligibility expansion that includes coverage for low-income people aged 55-64 will not be repealed.
  • Insurance premium subsidies and protections, which help make health insurance coverage affordable for people aged 55-64, will not be repealed.
  • The Medicare Part A Trust Fund will not face a shortfall until 2028 – not sooner.
  • The Prevention and Public Health Fund, which includes critical investments for Chronic Disease Self-Management Education and Falls Prevention for seniors, will not be repealed.
  • The Community First Choice Option, which provides Medicaid home and community-based services for low-income seniors and people with disabilities, will not be repealed.

If your Representative expressed opposition to the repeal bill, please take the time to say thanks. Look up your Representative’s contact information and send a thank you via email, phone, or social media.

The challenges ahead

While ACA repeal is behind us for now, there are several important issues on the horizon:

Tax Reform

The Trump Administration and House Republicans have signaled that tax reform will be their next goal. If they enact large-scale tax cuts, a big question will be how to pay for them. It’s possible that lawmakers will again look for savings from programs seniors rely on, such as Medicaid. Medicaid was slated for a $880 billion cut under the ACA repeal bill, and efforts to turn it into block grant have been proposed for many years. Expect to see Medicaid targeted again at some point in the future.

Federal Budget

The Trump Administration’s budget blueprint would eliminate key senior programs such as the Senior Community Service Employment Program, Low-Income Home Energy Assistance Program, Community Services Block Grant, and Corporation for National and Community Service. Other programs such as the Older Americans Act were not mentioned in the blueprint, but non-defense discretionary programs will be targeted for funding cuts. Congress is expected to finish up the FY17 budget by the end of April, and the Administration’s detailed FY18 budget should be released in mid-May. That detailed budget is expected to include more proposals for cuts, including in mandatory programs that could impact the Medicare State Health Insurance Assistance Program (SHIP), Social Services Block Grant, and Supplemental Nutrition Assistance Program (SNAP).

Continued Funding for Low-Income Benefits Outreach & Enrollment

Since 2008, the Medicare Improvements for Patients and Providers Act (MIPPA) has provided federal funding for SHIPs, Area Agencies on Aging, and Aging and Disability Resource Centers to help low-income Medicare beneficiaries apply for programs that make Medicare affordable. MIPPA is up for at least an extension this year, and prior bipartisan Senate proposals have made funding for benefits outreach and enrollment permanent.

ACA and Medicaid Regulations

Lastly, the fight over the ACA is not over—it’s just shifting. Although the repeal bill failed in Congress, there are regulatory and legal hurdles ahead. The Trump Administration could choose to defund parts of the law, such as cost-sharing reduction payments that pay the deductibles and cost-sharing for some low-income enrollees. It also could choose not to promote or enforce other provisions, such as the individual mandate. Additionally, the Centers for Medicare and Medicaid Services (CMS) has already signaled an interest in allowing increased flexibility in state Medicaid programs. For example, CMS may allow states to impose work requirements or increased premiums and co-payments on their Medicaid beneficiaries.

As these debates unfold, we encourage you to turn to us for Straight Talk on what’s happening and how it affects you.

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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.