What the ACA Verdict Means for Seniors

Q. I recently read that a federal court ruled to strike down the Affordable Care Act? Sounds kind of scary if you ask me. How is this going to affect seniors and people with disabilities?

A.You are correct. US District Court Judge Reed O’Connor rendered his decision to invalidate the entire Affordable Care Act. According to O’Connor, the ACA “could no longer stand now that there’s no penalty for Americans who don’t buy insurance.”

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If (and that’s a BIG IF) O’Connor’s ruling is ultimately upheld by the Federal Circuit Court and then by the U.S. Supreme Court, it will drastically impact the well-being of older adults, those 50-64 nearing Medicare, frail seniors,and younger people with disabilities.

The ruling came on December 14, on the eve of the deadline for Americans to sign upfor coverage in the federal insurance exchange created by the ACA. At this point, however, nothing will change in health-care services or insurance while the courts consider the issue.

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 The Affordable Care Act was passed in 2010 and became the signature domestic policyachievement of the Obama administration. The Supreme Court upheld the law in 2012 and again in 2015, and it was modified by Congress in 2017.

According to Senate Minority Leader Chuck Schumer, if upheld in both higher courts,” it will be a disaster for tens of millions of American families, especially for people with pre-existing conditions.”

Here are just some of the effects if the judge’s decision is upheld and the ACA is declared completely invalid:


The ACA has important provisions for those already on Medicare, as follows:

  • Under the ACA, Medicare went from being primarily a fee-for-service health program to one that encourages more integrated care.
  • The ACA helped facilitate a major expansion of Accountable Care Organizations where providers are responsible for a patient’s total cost of care, where Medicare pays based on outcomes rather than just number of procedures
  • The ACA resulted in growth of Medicare Advantage managed care.
  • The ACA also reduced drug costs for Medicare beneficiaries who fall into the “doughnut hole,” where they are responsible for a large share of their pharmaceutical costs. The law is scheduled to completely eliminate that coverage gap starting in 2020.
  • The ACA also created new payment incentives for primary care and community-based transition programs for patients who are discharged from hospitals. This would disappear if the ACA is invalidated.

Eliminating the ACA would increase Medicare costs by about $1 trillion from 2018-2027, according to the Committee for a Responsible Federal Budget (based on datafrom the Congressional Budget Office). Those costs likely would be coveredeither by reducing benefits or increasing premiums. In addition, if the ACA isinvalidated, the ruling would eliminate what O’Connor characterized as “minorprovisions” of the ACA, including:

  • expansion of Medicare preventive services requirements;
  • expansion of Medicare drug coverage in the “donut hole”;
  • numerous changes in payment for Medicare providers, possibly pitching the Medicare program into chaos;
  • The ruling would also invalidate taxesthat finance the Medicare program.


The ACA greatly expanded home and community-based care under Medicaid, making iteasier for states to provide Medicaid services at home. The ACA’s state waiver authority would be struck down with the rest of the law, making it more difficult for frail older adults and younger people with disabilities toreceive care at home.

The 2010 law also created a federal grant program that funded wide-ranging experiments in new care models for those 9 million Americans who are dually eligible for Medicare and Medicaid. These include many integrated care alternatives for those with chronic conditions.

If the repeal is upheld, it would:

  • invalidate the Medicaid expansions, throwing millions of Americans off Medicaid;
  • invalidate Medicaid coverage for children aging out of foster care;
  • deter expansion of Medicaid community care options for long-term support services; and
  • not support simplification of Medicaid eligibility.

Costs for those age 50-64

The ACA includes three important provisions aimed at holding down premiums forthose aged 50-64 who buy insurance on the private market. They include premiumlimits for those 50-64, minimum benefit requirements, and the ban on insurance companies rejecting potential purchasers due to pre-existing conditions.

Prior to the ACA, in a practice known as age-rating, 60-year-olds could pay premiums that were 11x higher than younger buyers. The ACA capped that ratio at 3:1. If the ACA is tossed out, full age rating would certainly return and premiums forolder buyers would rise sharply.

At the same time, allowing carriers to underwrite for pre-existing conditions would make insurance widely unavailable for people aged 50-64. AARP estimates that 25 million people, or 40%, have a conditionthat could disqualify them from non-group insurance. Eliminating the ACA’sminimum benefit requirements likely would result in many people losing coverage for needed treatments.

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If O’Connor’s ruling is upheld, it would likely leave tens of millions of older adults and younger people with disabilities with much worse coverage than they have today or none at all.

We’ll keep you up-to-date on the status of the ACA as more information becomes available.

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As you can see, actions resulting from a repeal of the ACA will certainly have amajor effect on seniors and others. We will continue to keep you updated on this issue, as more information becomes available.

Have you planned for your future and for your loved ones? Regardless of possible changes in the law, the need to plan in advance remains. If you have not done Incapacity Planning, Estate Planning, or Long-Term Care Planning (or had your documents reviewed in the past several years), or if you have a loved one whois nearing the need for long-term care or already receiving long-term care, please don’t hesitate to call us as soon as possible for an initial consultation:

Fairfax Elder Law: 703-691-1888

Fredericksburg Elder Law: 540-479-1435

Rockville Elder Law: 301-519-8041

DC Elder Law: 202-587-2797

Update: Among the first things Democrats did after officially taking control of the House was to express support for efforts to appeal the Texas district court decision declaring the Affordable Care Act unconstitutional. Read more here.

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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