Repeal of the ACA—Without a Replacement—Threatens California Seniors

There are currently 7.6 million older adults living in California who rely on Medicare, Medi-Cal, and the Affordable Care Act (ACA) to see a doctor, receive care in their home, and pay for prescription drugs. The repeal of the ACA threatens these critical programs, jeopardizing the care seniors receive every day.

California has led the way in expanding health insurance coverage under the ACA, reducing the uninsured rate by over 50 percent. If the ACA is repealed, 4.9 million Californians will lose coverage, including over one million older adults ages 55-64. Repealing the ACA would also end programs that help keep seniors and people with disabilities living in their homes. For example, nearly 500,000 older adults and persons with disabilities could see reductions in their In-Home Supportive Services (IHSS) benefits if the ACA is repealed. Older adults in California will also face higher prescription drug costs when they fall into the Medicare “donut hole.” Further, an ACA repeal without replacement puts both Medicare and Medi-Cal at greater risk for cuts in the coming year. This post describes just some of the dangers seniors in California will face if the ACA is repealed.

Eliminating coverage for adults 55-64

California increased coverage to adults ages 55-64 by offering marketplace plans through Covered California and through the expansion of Medi-Cal. Before the ACA, these older adults struggled to find and afford coverage. Now more than a million of those older adults are covered. Approximately 400,000 adults age 55-64 purchased health insurance through Covered California – 93% of whom receive subsides to purchase their coverage. Another 600,000 have obtained coverage through the Medi-Cal expansion. If the ACA is repealed, more than one million older adults in California will lose coverage and will not be able to afford needed medical care or prescription drugs.

Threatening IHSS and other home and community based services

In addition to expanding coverage for more than one million older adults, the ACA provides critical support for programs that help keep seniors and people with disabilities in their homes and in the community. The Community First Choice Option (CFCO) program increases federal funding for home and community-based services. California applied for CFCO in 2011 and now receives 6% more in federal funding for more than 50% of IHSS recipients—nearly 250,000. Consequently if the ACA is repealed, all 500,000 IHSS recipients, whether in the CFCO program or other IHSS programs, are likely to see their hours reduced in order to make up for the loss in federal funding. These cuts would threaten IHSS recipients’ ability to remain safely in their homes.

ACA repeal and changes in leadership at the Centers for Medicare and Medicaid Services could also impact California’s 1115 waiver, “Medi-Cal 2020,” which currently authorizes the provision of Community Based Adult Services (CBAS). CBAS is an important program that helps to ensure older adults can remain living in the community through the provision of skilled nursing care, social services, therapy, nutrition services, and more at adult day health care centers. Without these robust programs, more seniors will be forced to seek care in institutional settings like nursing facilities.

Increasing costs for seniors and people with disabilities

The impact of the ACA repeal would also likely lead to cuts in other health benefits and increased out-of-pocket costs for older adults. In total, California will lose $160.2 billion in federal funding under repeal. To make up this enormous loss of federal funding, California will have to make drastic choices. It could eliminate optional Medi-Cal benefits like dental coverage or begin charging premiums for Medi-Cal services. Older adults could be faced with paying for services out-of-pocket, forgoing treatment, or seeking services in emergency rooms.

The ACA also made Medicare more affordable for older adults in a number of ways. It eliminated the Medicare Part D “donut hole,” which decreased high out-of-pocket prescription drug costs for seniors and adults with disabilities. According to MedPAC, if the ACA is repealed one in four Medicare Part D enrollees will fall back into the coverage gap. This means that older adults in California will again have to make the difficult choice between paying for necessities like rent or food and paying for their prescription drugs. The ACA also expanded the number of preventative services that individuals receive for free including yearly wellness exams, screenings for cardiovascular disease and diabetes, mammograms, and flu shots. If repealed, Medicare recipients will see out-of-pocket costs rise for these preventative services.

Diminishing innovation and protections for seniors

The ACA allowed California to adopt innovative programs that benefit seniors by improving care coordination. California adopted the Cal MediConnect program, which coordinates enrollees’ Medicare and Medi-Cal benefits with the goals of improving quality of care, keeping people living in the community, and reducing health care spending. Early data shows that Cal MediConnect plans are helping enrollees remain living in the community and transition out of nursing facilities. Currently, the Cal MediConnect program serves approximately 113,000 dual eligibles. If repealed, dual eligibles would transition back into a fragmented system to navigate care on their own. Repeal would also threaten the Health Homes Program, which California is currently implementing to better coordinate care for people with chronic health care conditions, and the Whole Person Care Pilots aimed at improving health outcomes for the sickest Californians through coordination of health, behavioral health, and social services.

Repealing the ACA puts California seniors’ health at risk

California was a leader in ACA implementation to the enormous benefit of older adults. The repeal of the ACA, therefore, would be especially detrimental in California where millions of individuals have gained coverage and access to better and more affordable health care. The loss of both the federal funding and the expansion of innovative health programs provided by the ACA would be catastrophic to older adults in California who deserve a system which supports their health and well-being.

About Amber Christ

Amber works on Justice in Aging’s Health Care team from our Los Angeles, CA. office. She's focused on ensuring dual eligibles are able to access the health care they need under California's Coordinated Care Initiative.