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What Striking Down The Affordable Care Act Would Mean For Seniors

(AP Photo/Patrick Sison)

Howard Gleckman / Senior Contributor / Forbes

US District Judge Reed O’Connor’s Friday night decision to strike down the entire Affordable Care Act would damage the well-being of older adults, those 50-64 nearing Medicare, and frail elders and younger people with disabilities who are receiving long-term care benefits under Medicaid.

Many lawyers believe the ruling is poorly reasoned and likely would be reversed on appeal. However, it is not possible to predict how the US Supreme Court, where the case will almost certainly land, will finally rule. Here are just some of the effects if the judge’s decision is upheld and the ACA is declared invalid:

Medicare. While the ACA primarily affects people of working age, it includes important provisions for those already on Medicare. The most far-reaching change Medicare from primarily a fee-for-service health program to one that encourages more integrated care. This includes a major expansion of Accountable Care Organizations where providers are responsible for a patient’s total cost of care, a value-based payment model where Medicare pays based on outcomes and not just number of procedures, and the growth of Medicare Advantage managed care.

The ACA also reduced drug costs for Medicare beneficiaries who fall into the so-called doughnut hole, where they are responsible for a large share of their pharmaceutical costs. The law is scheduled to completely eliminate that coverage gap starting in 2020. It also creates new payment incentives for primary care and community based transition programs for patients who are discharged from hospitals. All this would disappear if the ACA is invalidated.

Overall, killing the ACA would increase Medicare costs by about $1 trillion from 2018-2027, according to the Committee for a Responsible Federal Budget (based on data from the Congressional Budget Office). Those costs likely would be covered either by reducing benefits or increasing premiums.

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