While the nation waits for the Supreme Court’s decision on the Affordable Care Act, we think it’s important that the real-world implications of this decision for millions of American seniors not get lost in the shuffle. Here is an analysis of the impact on seniors’ Medicare and Medicaid benefits if the ACA is completely overturned: If the individual mandate is declared unconstitutional and is not severed from the rest of the law the whole ACA would be struck down. All of the provisions which positively impact senior’s health would be stripped away. The Part D Donut Hole will return.  Prescription drug costs will rise because discounts provided by ACA will be revoked. Beginning in 2011, brand-name drug manufacturers provided a 50% discount on brand-name and biologic drugs for Part D enrollees in the donut hole.  By 2013, Medicare would have begun to provide an additional discount on brand-name and biologic drugs for enrollees in the donut hole. By 2020, Part D enrollees would have been responsible for only 25% of donut hole drug costs.  All of these savings will be gone if the ACA is repealed New Preventive Services provided with the ACA will disappear.
  • Prior to the ACA, Medicare beneficiaries were required to pay a deductible and 20% co-pay for many preventive health services.
  • The ACA eliminated cost-sharing for many preventive services and introduced an annual wellness visit for beneficiaries.
  • The ACA also eliminated cost-sharing for screening services, like mammograms, Pap smears, bone mass measurements, depression screening, diabetes screening, HIV screening and obesity screenings.
Savings for Chemotherapy and Dialysis patients in Medicare Advantage plans lost
  • In the past, Medicare Advantage plans have had flexibility to impose cost-sharing structures that differ from traditional Medicare.  Prior to the ACA, plans increased co-insurance for some services, like chemotherapy and dialysis.  Beneficiaries who were enrolled in MA plans that needed those services were left worse off than if they had the same conditions and were in traditional Medicare.  Many beneficiaries enrolled in these plans did not understand the differences in cost sharing.
  • The ACA attempts to remedy this by preventing Medicare Advantage plans from imposing higher cost-sharing for chemotherapy and dialysis than is permitted under Medicare Parts A and B.
  • The Centers for Medicare and Medicaid Services (CMS) issued final regulations on these improvements in 2011, and many became effective January 1 of this year.
Improvements in care for individuals with chronic conditions gone
  • The ACA has several provisions targeted to improving the quality of care for patients with chronic illness and reducing the costs to Medicare and Medicaid for serving those beneficiaries.
Improvements to help seniors transition from the hospital back home repealed
  • The ACA established the Community-Based Care Transition Program which targets individuals who are in traditional fee-for-service Medicare and are hospitalized and at risk for readmission.  The program provides grants to hospitals to work with community-based organizations to provide transitional care interventions.
  • 30 community-based organizations across the country have already partnered with local hospital systems and are committed to reducing readmissions by 20% and hospital acquired conditions by 40%.
Improvements in seniors’ access to primary care physicians lost
  • Through the Independence at Home demonstration, that ACA will pay physicians and nurse practitioners to provide home-based primary care to targeted chronically ill individuals for a three-year period.
  • CMS recently launched this primary care initiative with 16 practices across the country.
Medicare’s Trust Fund will face insolvency 8 years (or even more) sooner than expected
  • The Affordable Care Act includes many measures to control costs as well as models for reform that will increase the solvency of the Medicare.  If the ACA is repealed those cost saving measures will be lost and Medicare’s solvency threatened.
The National Committee has partnered with the highly respected National Senior Citizens Law Center to provide detailed analysis of the various Affordable Care Act rulings that could come from the Supreme Court. Our full analysis will be available immediately following the Court’s ruling, expected soon.