Implications of ACA Repeal for Seniors

Obamacare ready to be signed.

Q. It is clear that the Republican congesss wants to pass a measure to repeal the Affordable Care Act (ACA) outright. In my view, the ACA has been good for seniors because it eliminates pre-existing condition exclusions, keeps children on parents’ policies to age 26, eliminates gender discrimination in pricing, and provides significantly more preventive and screening tests without cost. What will happen if it is repealed?

A. When it comes to healthcare reform, President-Elect Donald Trump and Congressional Republicans have expressed their desire to make the repeal of the ACA their number one priority this month – even as they struggle to find agreement on how to go about doing that.

According to the New York Times, “(b)efore the new members could even be sworn in, Senate Republicans revealed the parliamentary language that congressional Republicans will use to dismantle Mr. Obama’s signature domestic achievement, the Affordable Care Act, without fear of a filibuster by Democrats in the coming months.” Debate began on the Senate floor yesterday, bypassing the Senate Budget Committee to speed passage.

The question remains: What will happen to more than 20 million Americans now insured under the Affordable Care Act, or to the 27% of Americans with pre-existing medical conditions who, under the health care act, cannot be denied coverage by insurance companies?
This is how the repeal will affect seniors and others:

53.8 million people on Medicare. The ACA contains provisions designed to strengthen Medicare. According to Elder Law Answers, “(r)epealing the ACA may eliminate those provisions, potentially destabilizing Medicare. The ACA also established programs to reduce Medicare waste, fraud, and abuse. Thanks to these measures, according to the Center on Budget and Policy Priorities, the Medicare hospital insurance fund is projected to remain solvent eleven years longer than before the ACA was enacted. These factors combined with the fact that millions of near-seniors aged 50-64 could lose coverage, leaving them in poorer health when they become eligible for Medicare, could raise future Medicare costs for existing beneficiaries.”

12 million people on Medicaid. That’s the number who are newly insured thanks to the ACA’s expansion of Medicaid. Repeal the ACA, and they lose their coverage.

37 million seniors who take advantage of preventative care. The ACA requires insurers to provide free preventative care coverage to Medicare beneficiaries. Without that requirement, seniors may end up having to pay for many preventative care services.

9 million people on the exchanges. These people get substantial subsidies to buy coverage, and they wouldn’t be able to afford it otherwise. The Republican answer for them is to make available bare-bones catastrophic plans, which don’t cover any routine medical needs but will help if they become very ill or are the victim of an accident.

1.4 million young people. These people, between the ages of 19 and 25, are allowed to stay on their parents’ insurance thanks to the ACA. The Republicans insist that this is one of the parts of the ACA they want to keep.

52 million people with pre-existing conditions. The Kaiser Family Foundation estimates this many Americans have conditions that threaten their ability to get coverage, and whom insurers are now required to cover. If you’ve bought insurance since the ACA went into effect, you were probably relieved to find that you didn’t have to document every time you’ve been to the doctor in the last decade the way you used to, with the threat that if there was something the insurance company didn’t like the look of, they’d deny you. Republicans say they want to protect all those people, but they can only do it by requiring insurers to cover you if you maintain “continuous coverage.” If you don’t because you lost your job or started your own business, then you will be placed into a “high-risk pool,” which is almost guaranteed to be underfunded and outrageously expensive.

8 million seniors saved over $11.5 billion (since 2010) on prescription drugs due to the closing of the donut hole. When a prescription drug benefit was added to Medicare in 2006, it included a “donut hole,” where your drug benefits disappeared after a few thousand dollars, then started up again after you spent a huge chunk of your own money. It sometimes meant catastrophically high drug costs for seniors on fixed incomes, which is why the ACA phased it out. Repeal the law, and the donut hole comes back.

Hospitals. Before the ACA, hospitals had to spend billions of dollars treating people who had no insurance and showed up to emergency rooms; some of those costs would be borne by the states. Because so many people now have insurance under the ACA, the hospital industry has been willing to accept some cuts to their reimbursements, which helped make the whole thing more affordable. If the ACA is repealed, the American Hospital Association warns that the nation’s hospitals will lose hundreds of billions of dollars.

As you can see, actions resulting from a repeal of the ACA will certainly have a major 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 who is 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

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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.


  1. William Jones says

    Mr. Farr, I have subscribed to your newsletter for a couple of months now and I’m surprised at your stance on repealing ACA. First, many of your comments take no account of the Republicans and Mr. Trump indicating that many of the “good points” of ACA would be included in replacement legislation.

    But let’s consider how affordable the care really is. My brother in law is a plumber in New Mexico earning a little less the $50K/yr. He is in his upper fifties and so is his wife. They have never had health insurance and were hoping for the first time they would have coverage based on ACA. He applied and his gross premiums would have been around $600 per month for each of them but with subsidies, only about $300 apiece. This policy would have a deductible of $6k per year, so his total premium for he and his wife would have been over $7200 per year and the policy would not have paid a dime until they have $6K out of pocket. The premiums alone would have taken 15% of his income and with the deductible, he potentially spend as much as 40% of his income before any coverage would pay. Affordably health care? As scrooge would say – Bah Humbug.

    The only people that can afford this coverage are those that are subsidized at extreme levels. I think both houses of Congress can find a better solution than Mr. Obama’s plan.

    Bill J

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