Now that both the House and the Senate have produced repeal and replace bills on the ACA, the analysis on the proposed TrumpCare is this:

AGE TAX

Tens of thousands of individuals will lose coverage while older adults will face significantly higher premiums for less benefits. Interactive map by county calculates and compares the ACA to estimated BCRA premiums and credits (Kaiser Family Foundation).

MEDICAID CUTS

Medicaid — the program that funds in-home and community based services, nursing home care, and health insurance — will be cut by over 700 billion dollars and with other budget cuts it is expected to top a trillion dollars. Medicaid will be substantially restructured to the detriment of older adults, those with disabilities, and special needs children.

TAX CUT TO THE WEALTHIEST

Savings and cuts of between 700 billion to a trillion dollars — mainly by cutting services under Medicaid, the nation’s safety net program — will largely go to the wealthiest individuals in the form of a tax cut.

PROTECTIONS FOR PRE-EXISTING CONDITIONS ARE NOT ASSURED
For individuals of any age, protections for pre-existing conditions are not assured under the GOP plan. Where you live will matter as the states are free to design the health care benefits and conditions offered by insurance companies. And these plans can be determined by the Governor and the State Insurance Commission, bypassing the state legislatures and public disclosure.

How do the GOP bills in the House and the Senate affect family caregivers of adults with disabilities or multiple health conditions such as dementia, stroke, Parkinson’s, COPD, CHF, and other conditions?

IS YOUR LOVED-ONE SPENDING DOWN?

Depending on the state, caregivers caring for a relative who is spending down their assets, (or on a Medicaid program), may face wait lists or fewer hours of service across providers when they finally become eligible for Medicaid. No state is able to fill in the revenue lost from the proposed cuts in Medicaid funding. States have few options: pay providers less; change eligibility criteria; or provide less service to individuals. Who is expected to take up the slack? Families.

WHAT’LL HAPPEN IF YOU QUIT OR SCALE BACK YOUR EMPLOYMENT?

Employed caregivers may find that the volume of hours of services for their relative will be cut, leaving gaps in care during a workday. And, if you are over 50 — and working in a job or multiple jobs without health care benefits, or if you have quit your job — you may find your healthcare premiums skyrocketing. Under the ACA, the premium charged to older adults is allowed to be a maximum of three times that of a younger person. Under the GOP bills, the premium can be five times that of a younger person and the subsidies will likely be smaller. (See AGE TAX section above.)

WHAT ABOUT YOUR FUTURE LONG-TERM CARE?

Family caregivers who are thinking about their own future needs should know: 70% of individuals over 65 will need some type of long-term care and support over their lives. Most will get help from family and friends, but almost all families need help with more complex and consuming care needs. Paying privately is expensive: a home care aide is estimated at $3,861/month; $3,628/month for assisted living, and $7,698/month for nursing home care. By the time baby boomers will need care Medicaid funding will be cut, capped, and no longer tied to changing needs within the states. The proposed cap in the GOP plan is not expected to keep pace with the aging demographics of the country. The Medicaid safety net will be changed forever for those needing services in the future and many will not be able to save the now-estimated $240,000 needed by a couple to cover their long-term care service needs.

States and communities cannot back fill the revenue needed to keep pace with demand. The costs are too high and many communities where Medicaid is the most used are not economically positioned to increase local revenue. Who is expected to take up the slack? Families.