What the Senate health bill may mean for older adults

Liz Seegert


Photo: Todd Ehlers via Flickr

The Senate last week finally released its long-awaited version of legislation to repeal and replace the Affordable Care Act. The Better Care Reconciliation Act (BCRA) not only mirrors many of the House’s cuts but in some cases deepens the impact on older adults.

Even before the Congressional Budget Office released its updated score of the bill late Monday – now estimating that at least 22 million American would lose health coverage by 2026 if the BCRA passes – reaction from elder advocacy groups was fierce and swift.

The Alliance for Aging Research and more than 30 organizations sent a sign-on letter to Senate leadership, urging them to “oppose efforts to change Medicaid financing by limiting federal funding to states through per capita caps.” It notes the negative impact the bill could have on those with chronic conditions such as Alzheimer’s disease.

The legislation would hit millions of Americans with higher costs and result in less coverage, according to AARP. As it did for the House bill, the organization vowed to hold senators accountable by informing its 38 million members how they vote on their health care bill.

“This proposal puts access to needed health care at risk for every older adult, person with a disability, and American family,” Joe Baker, president of the Medicare Rights Center, said in a statement. He pointed out that the bill also puts Medicare at greater risk since it repeals a tax on the highest earners and will create a manufactured funding crisis that could be used as justification for future Medicare cuts.

Howard Bedlin, National Council on Aging vice president for public policy and advocacy, called the Senate bill “even more mean spirited” than the House’s version. “The bill will pull the rug out from under millions of families who are struggling to keep their spouses, parents, and grandparents out of nursing homes.” He predicted that the nation’s oldest and most vulnerable, those over age 85, will be hit the hardest.

The BCRA would result in a dire health care crisis, according to the Service Employees International Union, which represents home care and nursing home workers. Not only would it put vulnerable residents at greater risk of reduced care, but it would also impact the livelihood of care workers who depend on Medicaid’s nursing home payments to fund their jobs.

Like the House version, the Senate bill would allow insurers to charge older adults five times more than the youngest. “Old” in this case means over age 40, as Julie Appleby notes in this Kaiser Health News story. The ACA limits the difference to no more than three times greater.

Nursing home residents may suffer since many rely on Medicaid to pay for long-term care. (Medicare only pays for up to 100 days of skilled nursing). Under both the House and Senate versions of repeal, Medicaid payments to states would be cut and turned into block grants. This would leave many state lawmakers with tough choices about which program and service get funding. Alternatively, they may have to change eligibility criteria, leaving dual-eligible older adults at risk of losing their coverage.

Older adults are more likely to have at least one pre-existing condition. According to the CDC, 78 percent of people over age 55 have one chronic condition; nearly half (47 percent) have two. While the Senate bill would still require insurers to accept everyone, regardless of health status, but it would also allow states to apply for waivers, to reduce the currently required essential health benefits. So an older adult with conditions such as heart disease, cancer, arthritis, or Type II diabetes — all common in people over age 50 — may not obtain needed screenings or treatment or be forced to purchase a plan with such high out-of-pocket costs that treatment essentially becomes unaffordable.

Sen. Susan Collins (R-Maine) is considered a key swing vote on this legislation, and as this Portland Press Herald story notes she is on record that she could not support a bill that leaves tens of millions of people without insurance. Maine has the second highest elderly population in the United States, and the bill not only would “substantially” drive up premiums for older Mainers, but also put a severe squeeze on rural hospitals, the article notes. Sen. Lisa Murkowski (R-Alaska) is another key vote; this story looks at how the bill will affect her constituents.

For more on the BCRA and its potential effects:

Journalists, let us know how you are reporting on this legislation in your state or community.

Earlier coverage

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Liz Seegert

Liz Seegert

Liz Seegert is AHCJ’s health beat leader for aging. She’s an award-winning, independent health journalist based in New York’s Hudson Valley, who writes about caregiving, dementia, access to care, nursing homes and policy. As AHCJ’s health beat leader for aging,