美国国家公共电台 NPR Obamacare Repeal Could Threaten Provisions That Help Older Adults（在线收听）

SCOTT SIMON, HOST: 

Congressional Republicans are trying to figure out when to repeal and how to replace the Affordable Care Act. Whatever happens, there's a lot at stake for older Americans. NPR's Ina Jaffe covers aging. She joins us for our regular conversation we call 1 in 5, which refers to the 1 in 5 Americans who, by the year 2030, will be 65 years of age or older. Ina, thanks so much for being back with us.

INA JAFFE, BYLINE: It's good to be back with you, Scott.

SIMON: Now, don't Americans over 65 have Medicare?

JAFFE: Well, they do. But what people don't always realize about the Affordable Care Act is it's not just a discrete program in and of itself. It changed other government programs, too, and that includes Medicare.

SIMON: What was the biggest change for Medicare?

JAFFE: Well, the one that's gotten the most attention is the change to prescription drug coverage. You may have heard about something called the doughnut hole. That's where Medicare would get you a discount on prescriptions but only up to a point. After that, you had to pay full price for drugs until you shelled out around 1,300 bucks. Then Medicaid would help you out again.

Now, some people never really reached that point because when they had to pay full price, they just started skipping some of their prescription meds. So the Affordable Care Act has been phasing out this gap. It saved people on Medicare more than $23 billion. But this program could go away with the repeal of the law.

SIMON: That could go away, and we should say, once again, that we don't know yet what any replacement will look like. What have you heard among the ideas being proposed that might affect older Americans?

JAFFE: Well, a few members of Congress, Republicans, have circulated their own proposals for replacing the Affordable Care Act. And one thing that comes up in some of them, including in House Speaker Paul Ryan's plan, is a major change to Medicaid. Now, that's known as the program that provides health care for the poor. But it's also the program that pays for long-term care for a lot of older people. In fact, Medicaid pays the bills for most nursing home residents.

SIMON: That could be jeopardized?

JAFFE: Well, certainly the people putting forth these plans don't think it would be. What they want to do is change Medicaid from a guaranteed benefit to a block grant to states. So a state would get a fixed amount of money from the federal government and decide for itself how to spend it. The idea is that states know their needs better than the feds, and this would give them flexibility.

What critics of this idea worry about is, what happens in an economic downturn when demand on Medicaid goes up? They say states could be left with a sort of Sophie's choice. Do you cut back on services for poor children or for the frail elderly?

SIMON: I know we've talked about Medicare and Medicaid. Are there proposed changes that would affect older Americans who might buy their own health care coverage?

JAFFE: Yeah. In fact, there's a little-known feature of the law that helps people in their 50s and early 60s, people who aren't yet eligible for Medicare. Insurance companies used to be able to charge them many times more than they charge a younger person for the same policy. The Affordable Care Act put a limit on that.

Now insurance companies can only charge them three times as much. But the various replacement proposals that are out there either set the limits higher at five or six times more or they don't have any limit. And researchers say that could result in around 400,000 older adults being unable to afford to buy health insurance anymore.

SIMON: NPR's Ina Jaffe, thanks so much.

JAFFE: You're welcome.

(SOUNDBITE OF JULIAN LAGE AND CHRIS ELDRIDGE'S "BUTTER AND EGGS")

SIMON: This is NPR News.