American Health Care Act

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Deena Flinchum

We are now going through the second round of health insurance reform in a decade — this time with the Republicans appearing to go it alone on the American Health Care Act (AHCA), just as the Democrats did on the Affordable Care Act (ACA), aka “Obamacare.”


I have held off writing about the proposed bill, because it was difficult to find out a great deal about what it encompassed. Details remain murky, but the following are a few observations in no particular sequence regarding how the AHCA would affect those 55 or older.

The AHCA would retain the phase out of the doughnut hole for Medicare Part D, set to be completed in 2020.

It would eliminate at least two revenue provisions that would help shore up the Medicare Trust Fund, hastening its insolvency. These taxes are the 3.8 percent tax on some investment income and the 0.9 percent income tax on high earners ($200,000 for an individual, $250,000 for a couple).

Medicaid would be modified in ways that could have a severe impact on seniors. First, the Medicaid funding plan would be changed so that a per-capita cap from the federal government would not enable states to keep up with the increased needs of an aging population.

Generally, seniors who are older tend to need more Medicaid services than those who are younger, and the new formula doesn’t take need into consideration. It also cuts programs that states now use to enable seniors to receive services in their homes and thus avoid stays in costly long-term care facilities.

The phase out of the Medicaid expansion in 2020 would not affect Virginia as it didn’t expand Medicaid, but other cuts would come into play.

The phase out of the Medicaid expansion in 2020 would not affect Virginia as it didn’t expand Medicaid, but other cuts would come into play.

The current complex system of subsidies based upon income would be replaced with tax credits geared more to age. The new system would be especially bad for older, poorer seniors below the age for Medicare.

The AHCA would allow premium rates based upon age to be five times higher for older persons, up from three currently. The Congressional Budget Office (CBO) estimates that premiums would increase before 2020, then decrease thereafter.

Unfortunately, the decrease would not be helpful for those who still couldn’t afford the costs.

The CBO suggests that 24 million persons would lose insurance coverage over the next decade, including those losing Medicaid, employer coverage and individual market insurance.

Part of this drop would be because people would no longer be required to purchase health insurance or suffer penalties. Two groups that would make up a substantial part of this drop would be healthy people who no longer felt the need to purchase insurance and those who could no longer afford to purchase insurance because of the loss of subsidies.

The AHCA will certainly be modified and modified again over the next few weeks as few on either side in Congress seem to like it as is, so it is difficult to define where it will end up.

It is becoming increasingly obvious that the Republicans will need to proceed with extreme caution, because they will own the AHCA just as Obama came to own the ACA.

Replacing “Obamacare” with “Ryancare” or “Trumpcare” will not be considered progress in 2018 and 2020 unless the latter corrects problems in the ACA and gives more people access to health care.

Insurance that isn’t useful does not produce true health care, just business for insurance companies.

Below is the contact information for the local representatives in the House and Senate:

House of Representatives, Morgan Griffith, 1-202-225-3861

Senate, Tim Kaine , 1-202-224-4024

Senate, Mark Warner, 1-202-224-2023 or toll-free: 1-877-676-2789


Deena Flinchum is a retired IT professional who has lived in the New River Valley since 2002. She serves on the board of the NRV Agency on Aging and as an RSVP volunteer. She also serves the Agency on Aging as an insurance counselor.