Today, the Senate voted on a motion to debate the Republican healthcare bill, even though no one knows exactly which version of the bill they're going to debate (or if they're going to instead vote on a so-called "skinny repeal" of Obamacare with no replacement). But whether they end up debating the original House version of Trumpcare or one of the Senate versions, there's one thing we can be pretty sure of: it will be bad news for anyone who has parents.
Under the first version of the Senate plan (we know, it's hard to keep up when every new plan seems like a ' dude, you know what we should do?' idea conceived during a night of drinking), 4 million more older Americans ages 50 to 64 would lose their health insurance compared to Obamacare—and three million of those older adults would be people with low incomes.
While that number may tick up or down slightly, Senate Majority Leader Mitch McConnell's most recent version keeps the most heartless features intact: it allows insurers to charge older Americans five times more than younger adults and it guts Medicaid, which covers more than 60 percent of nursing home residents.
Under Trumpcare, you may find yourself supporting your parents as they get older. Even if they're healthy right now and have some money in the bank, Trumpcare has ways to make them sick—and make you pay for it.
The Republican plan will make older Americans sick
The Republican plan penalizes people for getting old and sick, which is not only the opposite of what a healthcare system should do, but also pretty much guarantees that they will get even sicker.
That's because McConnell, who is 75 himself, decided to keep the age rating change in the revised version of the BCRA. Meaning older Americans could be charged five times more than a younger adult versus the current limit of three times as much. (Please don't worry about McConnell or Senator John McCain, 80, who was recently diagnosed with brain cancer, as members of Congress and their staffs are exempt from the changes thanks to the budget process they're using to force this bill through the Senate!)
But for lesser mortals, charging older adults five times more means a 64-year-old could spend an additional twenty percent of their income on healthcare. If they make $56,800 a year but buy their own health insurance, their annual premiums would be anywhere from $9,650 to $11,500 more, according to the most recent CBO analysis. Then there's the deductible on top of that.
That will create a scenario where either you (or someone who is not the government or an insurance company) would pay the extra 10 grand or so every year for your parents, or else they may need to go without insurance until Medicare kicks in at age 65.
"Before the ACA, it was not uncommon to hear people talk about this period in their lives where they were in their early 60s, uninsured, couldn't afford to purchase health insurance, and they would wait until they got to Medicare," says Tricia Neuman, senior vice president of the Kaiser Family Foundation and director of the foundation's Program on Medicare Policy.
But by forcing older Americans to wait for Medicare, the Republican plan may create healthcare disasters that weren't there to begin with. In one pre-Obamacare study, researchers found that people who were uninsured in their 50s and 60s and were now on Medicare were "significantly more likely than insured adults to report health declines." They needed nearly 25 percent more doctors visits and nearly 40 percent more hospitalizations, often for cardiovascular disease, diabetes, and joint replacement.
These services would drive Medicare costs up even more, putting healthcare even further out of reach of many older Americans. "When Medicare spending rises, then Medicare premiums and cost sharing also rise," Neuman explains. Older adults might ask their children to help them pay for their medical expenses, go without care, or run out of money.
Who will pay for nursing home care?
As people go from being "older Americans" to "elderly Americans," nursing home care often enters the conversation. On June 15, the AARP and more than 100 other organizations, including the National Council on Aging, sent a letter to McConnell to "vehemently oppose" their changes to Medicaid, the government insurance program that Obamacare tried to expand to the lowest income Americans. After all, 11 million seniors and people with disabilities on Medicare also need Medicaid to pick up some costs, including costs for two out of every three people in nursing homes.
"The dramatic slashing of the Medicaid program is a horrible development and would be particularly horrible for the nursing facility population," says Eric Carlson, directing attorney at Justice in Aging. "Even if people have some money, your savings don't last very long."
Neuman adds: "It's hard to imagine how someone living on $15,000 could cover the cost of nursing home care which averages more than $80,000 [a year]."
The cuts to nursing homes via Medicaid will punish people in Red states the most, which is a strange thank-you from Republicans for voting them into office. In 2015, eight Red states—Alaska, West Virginia, Mississippi, Louisiana, Georgia, Alabama, Kentucky, and Arkansas—depended on Medicaid to pay for more than two-thirds of people in nursing homes, according to the Kaiser Family Foundation.
The Senate Bill is expected to cut Medicaid by $772 billion over 10 years—a move that would affect 15 million human beings, or, in Republican terms, cost the rough equivalent of 2,200 F-22 fighter jets.
What could that mean for you? Besides those pesky hard-to-measure losses like having your parent alive and healthy and able to enjoy their final years on earth, the rest of your life could get much harder, too. According to a 2011 MetLife study, men who cut back on work to help their parents lost around $127,000 and their Social Security dropped by $38,000; for women, it was even worse: they lost $324,000 if they had to stop working to take care of their parents.
Jason Silverstein is a lecturer and writer-in-residence in the department of global health and social medicine at Harvard Medical School and an Instructor at the Harvard TH Chan School of Public Health.
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