On March 24, the House of Representatives cancelled its vote to repeal and replace the Affordable Care Act (ACA). House Speaker Paul Ryan (R-WI) stated that the ACA will remain the law of the land for the foreseeable future.
However, the fights over programs and issues that affect older Americans and their families have only just begun.
Straight Talk for Seniors® provides information for older adults, their families, caregivers, and the professionals who serve them on key policy concerns involving the Affordable Care Act (ACA), Medicaid, Medicare, and the Older Americans Act (OAA).
This webpage will be updated as new information becomes available. You will find the latest facts on what’s at stake, what proposals are being considered, and—most importantly—what actions you can take to help defend and strengthen these vital programs for all Americans. Sign up for our Advocacy Alerts to get news in your inbox. And join the social media conversation using the hashtag #StandWithSeniors.
The Affordable Care Act
The Administration and the Republican House withdrew their plan to repeal and replace the Affordable Care Act, however they continue to express interest in going forward with their plans. The most recent bill included cuts and changes that would impact older adults, including:
- Fundamentally changing how the Medicaid program for low-income seniors, children, and people with disabilities would be funded, moving it to a per capita cap model of funding for the states that could lead to major cuts in services.
- Repealing the Medicaid eligibility expansion that includes coverage for low-income people aged 55-64.
- Repealing premium protections that limit the amount an health insurance company can charge people aged 55-64.
- Basing the premium subsidies on age, rather than income, setting a standard amount for all to people aged 55-64.
- Repealing provisions of the ACA that extended the Medicare Part A Trust Fund by at least four years.
- Repealing the Prevention and Public Health Fund, which includes critical investments for Chronic Disease Self-Management Education and Falls Prevention for seniors.
- Repealing the Community First Choice Option, which provides Medicaid home and community-based services for low-income seniors and people with disabilities.
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.
Other Proposals on the Horizon
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. A 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).
The Trump Administration and House Republicans have signaled that tax reform is 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.
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 a funding extension this year, and prior bipartisan Senate proposals have made funding for benefits outreach and enrollment permanent
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