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CBO: Senate Bill Leaves 22 Million Uninsured

Higher premiums, out-of-pocket costs and Medicaid reductions would sting older Americans

The Senate bill that guts the Affordable Care Act would increase the number of uninsured Americans by 22 million by 2026, according to the analysis of the nonpartisan Congressional Budget Office (CBO) released Monday. 

Fifteen million more people would be uninsured next year, and the total number of uninsured would swell to 49 million in a decade, the CBO found. Some of the worst effects of the bill, the Better Care Reconciliation Act of 2017 (BCRA), would fall upon older, low-income individuals.

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“The increase would be disproportionately larger among older people with lower income,” the 49-page CBO analysis said, “particularly people between 50 and 64 years old with income of less than 200 percent of the federal poverty level.”

Current law bars insurers from charging older adults more than three times as much for premiums as they charge younger people for the same coverage. The Senate bill would allow what AARP has called an Age Tax, allowing insurers to charge older adults five times as much, and states could receive waivers to charge them even more.

The Senate bill also would diminish premium tax credits available under current law. The tax credits would decrease — or disappear entirely — as a person ages, thereby raising their premiums. "Premiums for older people ineligible for subsidies would be much higher under this legislation,” notes the CBO analysis.

The Senate bill would cost older Americans much more for the same coverage they have now. According to the CBO, in 2026 a 64-year-old with an income of $56,800 would pay $20,500 for a silver-level plan. Under current law, that same plan would cost the senior $6,800.

“Older Americans care deeply about access to and affordability of health care,” said Nancy LeaMond, AARP executive vice president, in a letter the organization sent to senators today urging them to vote against the bill. “They need and deserve affordable premiums, lower out-of-pocket costs, and coverage they can count on as they age. The BCRA does not achieve these goals.” 

The CBO also found that even though average premiums would drop for younger adults after 2020, health insurance at that time would cover fewer services and have higher deductibles. “As a result, despite being eligible for tax credits, few low-income people would purchase any plan,’’ the report estimated.

The bill would cut $772 billion from Medicaid by 2026, and 15 million people on Medicaid would lose coverage. Medicaid pays for long-term care services and supports, including home- and community-based care, and covers two-thirds of the care for people living in nursing homes.

By repealing a payroll tax on wealthy workers, the Senate measure would cut $58.6 billion that is dedicated to Medicare. That funding cut would diminish Medicare’s ability to pay for services in the future and hasten its insolvency.

The report found that the Senate bill would reduce the deficit by $321 billion over 10 years.

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