The Senate health care bill released Thursday closely mirrors what the House narrowly approved in May. Some analysts called it a tempered version of the House bill ― which President Donald Trump called “mean.” But it nevertheless puts vulnerable seniors smack in its crosshairs, according to advocates for elderly people.
“Actually, the Senate bill is even meaner” than the House bill, Howard Bedlin, vice president for public policy and advocacy for the National Council on Aging, said in a phone interview.
Bedlin cited the Medicaid cuts and per-capita caps that would harm elderly people who rely on the program to pay for their long-term care. The Senate didn’t stop the weakening of the Medicare Trust Fund that will result from the repeal of the payroll tax on wealthy Americans, nor did it change the so-called age tax that would dramatically increase out-of-pocket costs for older Americans in the form of higher premiums.
“Over time, the Senate bill imposes even deeper cuts and caps on Medicaid than the House proposal,” Bedlin said.
Here are a few reasons why the Senate measure is worse for seniors than what the House passed:
The Senate imposes deeper cuts to Medicaid, which pays for 65 percent of nursing home residents.
Medicare, the health care system for people 65 and older, does not pay for long-term nursing home stays. Most people enter a nursing home as a private-pay patient until they exhaust enough of their assets to qualify for Medicaid. For every $1 Medicaid spends on a poor child, it spends $5 for an elderly person in a nursing home.
Medicaid is the primary support for 65 percent of nursing home residents. It is literally the last resort for affording nursing homes, which easily can cost upward of $80,000 a year.
Under Obamacare, everyone who qualified for Medicaid ― of any age ― was guaranteed to get it. That would change under the GOP’s plan. The House bill would let states decide who gets their health care needs met by Medicaid, and shrinks the total pot by a draconian $880 billion by 2026.
The Senate bill follows that same course ― states would receive a lump sum per year, or a lump sum per enrollee, that would function as caps. But the Senate bill makes even deeper cuts to the program by tying federal spending to a slower growth index. The House measure tied it to medical inflation.
Under the House bill, the federal spending can increase only up to 4.7 percent each year (the Medical Consumer Price Index, plus 1 percent). Under the Senate bill, it can rise up to this same rate until 2025, when the capped growth rate drops forever to 2.4 percent (the Consumer Price Index), explained Bedlin.
The Senate bill also slows the introduction of these Medicaid cuts, pushing the deepest wounds to the elderly into the future. The changes won’t fully kick in for seven years, which of course is long after the next Senate election. But make no mistake, said advocates for the elderly: When these changes to Medicaid fully kick in, they will pack a wallop.
The bipartisan Congressional Budget Office projected 14 million fewer people would receive Medicaid over the next 10 years under the House bill, and the Senate bill may mean an even higher number losing this coverage. The CBO isn’t expected to score the Senate bill until next week, but the number of people who would no longer get Medicaid help is an important one to watch. People aged 85 and over are the ones most likely to need expensive long-term care, and Baby Boomers will be turning 80 at right about the same time the full impact of the Medicaid cuts and caps kick in.
“Because the proposed caps do not adjust for an aging population, the nation’s oldest and most vulnerable seniors will be hit the hardest,” predicted Bedlin.
If Medicaid were to stop paying for nursing homes, there is nothing ― and no one ― else that would. The likely outcome here is that the ranks of family caregivers would swell.
Medicare’s troubles will worsen, despite promises.
The Senate bill repeals the payroll tax on wealthy Americans ― a tax cut for the rich that is expected to hasten the insolvency of the Medicare Trust Fund by about two years ― moving it from 2028 to 2026.
While the Senate version closely matches what the House measure did in this regard, GOP senators fell short of their promises to protect Medicare benefits for future generations.
“The Senate bill also cuts funding for Medicare which weakens the program’s ability to pay benefits and leaves the door wide open to benefit cuts and Medicare vouchers,” said AARP executive vice president Nancy LeaMond.
The age tax remains, and subsidies will be weakened.
Medicare kicks in at age 65. Those who are in their 50s and early 60s are too young to be eligible for Medicare and too old to be considered young and healthy, which makes them less attractive to private insurers. Older people are more prone to illness and require more medical care than younger age groups.
Under the current Affordable Care Act, the most an insurance company can charge an older person for premiums is three times whatever younger people are being charged. Under the GOP House bill, that ceiling jumps from three times to five times, and significantly reduces tax credits that help lower- and modest-income adults pay for coverage. The House bill includes a tax credit that maxes out at $4,000 ― far less than it does under the current law.
The Senate bill closely mirrors the Obamacare subsidies, which are currently available to those who earn between 100 percent and 400 percent of the federal poverty level. Under the Senate bill, starting in 2020 this assistance would be capped for those earning up to 350 percent of poverty level, with adults aged 59 to 64 paying up to 16.2 percent of their income.
The CBO has predicted that older people with lower incomes will likely opt out of buying coverage for themselves because the legislation allows insurers to charge them higher rates than they do now ― and the financial assistance provided doesn’t sufficiently offset that.
Advocates for elderly people commended the Senate for not allowing states to opt out of key protections for patients with preexisting conditions. But they said the devil lives in the details.
Josie Kalipeni, policy director for Caring Across Generations, noted that the Senate measure ”allows states to deny coverage for essential services like ambulance rides or prescription drugs” at the same time it raises costs.
Senate leadership has said it wants to vote on the bill by July 4.