n4a Releases Analysis of ACA Repeal’s Effects on Older Adults and the Aging Network
Policy Brief Outlines Key Considerations and Questions for Lawmakers
January 19, 2017
Last week, lawmakers in Congress took the first steps toward repealing the Patient Protection and Affordable Care Act (ACA) when, four months into the current fiscal year, the House and Senate passed an FY 2017 budget resolution that included instructions to legislative committees to develop proposals to rescind key parts of the law. The resolution, which passed both chambers largely along partisan lines, makes no immediate changes to the law, but rather sets in motion the legislative process to repeal the ACA. Lawmakers have not announced details on the policies they intend to replace the ACA, but four key committees in Capitol Hill now have until January 27 to develop the legislative proposals to repeal and ultimately replace the law.
n4a has developed an issue brief that evaluates the implications that ACA repeal could have for older adults, caregivers and Aging Network entities—especially AAAs and Title VI Native American aging programs—that serve these populations. We have also identified key issues and questions that Aging Network stakeholders and aging advocates should be asking their elected officials as ACA replacement proposals are discussed and introduced. Additionally, the issue brief highlights several comprehensive resources with more detailed information about the impacts that repealing the ACA could have on health care consumers and taxpayers.
What Would ACA Repeal Mean for the Aging Network and Older Adults?
Previous proposals to repeal the ACA have focused on both dismantling the federal insurance exchange Marketplace and rolling back state Medicaid expansion—particularly for low-income adults. However, ACA repeal proposals have also targeted both curbing efforts for delivery system reform promulgated through the Center for Medicare & Medicaid Innovation (CMMI) within CMS and also eliminating funding for disease prevention and health promotion activities through the Prevention and Public Health Fund (PPHF). Republicans crafting repeal proposals have also taken aim at efforts to rebalance state LTSS systems toward providing home and community-based options (HCBS). n4a details in our policy brief how each of these initiatives may affect both Aging Network agencies involved in ACA-driven driven programs and reforms and older adults.
Additionally, while many older adults age 65 and over would not be directly affected by Marketplace or Medicaid changes in an ACA repeal and/or replacement effort, there are key coverage and financial protections that could be at risk in an ACA repeal. Specifically, n4a evaluates both what changes to Medicaid might mean for the pre-Medicare population ages 54 to 65 and how Medicare benefits and solvency might be affected by ACA repeal.
Considerations for Policymakers in Developing ACA Replacement Proposals
Details about both a timeline for ACA repeal/replacement, as well as specific policy proposals, are vague at this point. However, there are key considerations that stakeholders and advocates should be raising with lawmakers as they discuss both the implications for ACA repeal and the forthcoming replacement packages. n4a outlines a few key concerns and questions that we are asking lawmakers, and we encourage advocates to raise these questions as well.
Primarily, Aging Network advocates should be asking both how ACA repeal efforts will preserve and continue to promote integration between health care and social services systems, as well as what lawmakers will do to continue to advance rebalancing efforts promoted through ACA.
Next Steps in Health Care Reform and ACA Advocacy
At this point there are many details still up in the air about exactly how Congress will move forward in reconsidering the ACA and any replacement provisions. National advocates, including n4a, remain focused on ensuring that Members of Congress understand the risks of repealing entrenched health care policy without sufficiently detailed replacement proposals. We encourage local agencies and advocates to echo these concerns to your Senators and Representatives, as well.
It remains to be seen whether Congress—specifically the Senate—will have the votes necessary to pass a repeal package in the coming weeks. A legislative package to eliminate the ACA would not be subject to filibuster and would require only a simple majority vote in the Senate to move to then-President Trump’s desk for signature, although the anticipated timeline for ACA repeal and replacement remains notably ambitious. However, there are currently 10 Republican Senators who have expressed significant concerns with voting to repeal without a clear vision for replacement. More details on the Congressional budget and reconciliation processes that we expect to shepherd ACA repeal proposals are available in our recent n4a Legislative Update.
We do know it is more critical than ever that local aging advocates weigh in with lawmakers and stress the need to protect key ACA provisions affecting older adults, caregivers and the Aging Network. We also encourage aging advocates to attend the 2017 n4a Aging Policy Briefing and Capitol Hill Day, April 3-4, to learn the latest in a rapidly changing landscape for aging and health care policy and to meet directly with your Members of Congress!