Gutting The ACA: The Opening Salvo In The Republican War On Seniors

While Donald Trump and his fellow Republicans campaigned on undoing the Affordable Care Act, no one ran on undermining Medicare or Medicaid. No one ran on undermining the health security of seniors. But the so-called repeal and replacement of the ACA would do just that.
Nancy Altman
March 7, 2017
Paul Ryan and Donald Trump want to make you pay more money for worse healthcare.
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If Republican elites in Congress were honest about their agenda, no senior would ever vote Republican. The current fight over repealing and replacing the Affordable Care Act (ACA) is not generally couched in terms of its impact on seniors, but it should be. It is a thinly veiled — and serious — opening attack on the economic and health security of those who have spent a lifetime contributing to our nation.

While Donald Trump and his fellow Republicans campaigned on undoing the Affordable Care Act, no one ran on undermining Medicare or Medicaid. No one ran on undermining the health security of seniors. But the so-called repeal and replacement of the ACA would do just that.

Let’s start with Medicare. Seniors aged 65 and over, as well as people with serious disabilities, rely on Medicare for their basic health insurance. That program will be seriously weakened if the Republican plan to gut the ACA is enacted. The bill drains Medicare to gives tax breaks to wealthy Americans and corporations. In fact, even before Republicans pass a so-called “tax reform bill,” this bill’s giveaway amounts to a whopping $525 billion tax break for the wealthiest among us.

For those who have been paying attention, this weakening of Medicare is not surprising. In fact, it is just the first step in the eventual dismantling of this vital program, which Speaker Paul Ryan has been advocating for years. Consistent with that goal, as soon as the election ended, Ryan announced his intention to voucherize Medicare. He falsely claimed that Republicans had to “address” [code for dismantle] Medicare, saying, “because of Obamacare, Medicare is going broke.”

That is an enormous lie. The ACA strengthened Medicare’s finances. It is the Republican bill that would weaken Medicare. The next step will be undoing Medicare, by replacing its guaranteed insurance with vouchers. In that way, Republicans will shift Medicare’s costs from the government balance sheet to the shoulders of seniors, who will be on their own.

Medicaid is another program vital to seniors and people with disabilities. The Center for Medicare and Medicaid Services has found that at least 70 percent of seniors will need long-term care at some point. Medicaid currently pays for the long-term care of more than 60 percent of nursing home residents.

The GOP’s bill, if enacted, will place caps on Medicaid spending, again shifting costs away from the federal balance sheet and to the balance sheets of states and individuals. If that is enacted, seniors needing long term care and their families may find themselves out of luck, since nursing home care is extremely expensive. It is estimated that the typical annual cost of a semi-private room in a nursing home is $80,300. Very few families can afford that huge cost on their own.

And the impact on seniors not yet 65, and so, not yet on Medicare, will be the harshest of all. They will have more difficulty obtaining insurance and will face higher health care costs if this legislation is enacted and implemented.

In addition to slowing the cost of health care generally, the Affordable Care Act (ACA) limited the amount that insurance companies could charge seniors for healthcare. Upon repeal, insurance companies will be free to implement the ageist policy that charges even healthy seniors five times more for no reason other than their age. Not only that, the bill reduces what services insurance is required to cover. The result: people will be paying far more money for much worse coverage. This will be devastating for people in their fifties and early sixties, who aren’t yet eligible for Medicare.

The truth is that all of these cuts are entirely unnecessary. In fact, Medicare should be expanded to cover all of us. Medicare and Medicaid are more efficient than private insurance. Other nations are able to provide health care as a right, at a fraction of the cost with better health outcomes. We should be building on the successes of Medicare and Medicaid and the cost savings measures of the ACA. But instead, Republicans in Congress want to take us backwards.

Their reasons? Ideology, power, and greed. By proving that government can play a positive role in people’s lives, and provide wage and health insurance better and more efficiently than the private sector, Medicare and Medicaid, together with Social Security, disprove the GOP’s radical anti-government philosophy. Who would benefit from a nation without Social Security, Medicare, Medicaid, or the ACA? Wealthy donors.

While the top one percent has most of the nation’s wealth, we still are a nation of one person, one vote. Seniors and their families have the numbers to defeat this attack. But it will demand that all of us make our voices heard.

Nancy Altman Founding Co-Director, Social Security Works

Nancy J. Altman has a forty year background in the areas of Social Security and private pensions. She is co-director of Social Security Works and co-chair of the Strengthen Social Security coalition and campaign. She is the author of The Battle for Social Security: From FDR’s Vision to Bush’s Gamble (John Wiley & Sons, 2005), and co-author of Social Security Works! Why Social Security Isn’t Going Broke and How Expanding It Will Help Us All (The New Press, 2015).

 

March 7, 2017