An end to Obamacare could hurt those who never even thought about it

Jan. 30--If you're on Medicare and think you don't have to worry about the growing threat to the Affordable Care Act, you might want to check your confidence at the door. And if you're not quite at the magical age of 65, when Americans become eligible for the federal health insurance program, you might want to start fretting, too.

Some ACA provisions that have helped the 65-and-over set might go bye-bye if it's repealed, as Republicans have threatened for years. Among the most important benefits for seniors on the chopping block:

--Obamacare, as the ACA is commonly known, expanded Medicare's prescription drug benefit in an effort to slowly close the doughnut hole, the term used to describe a gap in coverage. The gap is created when Medicare stops paying part of the cost of drugs, so beneficiaries have to pay full price. Once out-of-pocket costs reached "catastrophic" level, however, Medicare kicks in, paying a portion of drug costs again.

In 2017, Medicare beneficiaries who fall into the doughnut hole will receive discounts and savings of 60 percent on the cost of brand-name drugs and 49 percent on the cost of generics. Those savings will increase to 75 percent for both brand-name and generics by 2020, under the current law. In 2020 the coverage gap disappears completely. This year, the coverage gap kicks in when a beneficiary's total drug costs, both his and his insurer's, reach $3,700. The gap closes and coverage kicks in again when the beneficiary's total costs reach $4,950.

--Seniors' free screenings for diabetes, heart disease and cancer, in addition to free flu and pneumonia vaccinations included under the ACA could also fall by the wayside. House Rep. Tom Price ,R-Ga., Trump's choice to head the Department of Health and Human Services, introduced healthcare legislation in 2015 and 2016 that included axing these.

--One of the proposal to replace Obamacare is to convert Medicaid from a guaranteed benefit to block grants, where states would get a set sum from Washington and decide how to spend it. While Medicaid provides healthcare to the poor, it has a not-so-well-known allowance: It also pays for long-term care for older people, mostly nursing home residents.

Senior advocates fear that the frailest seniors citizens might lose this assistance when they most need it, especially if states have to choose between programs in an economic downturn.

--The cost of insurance premiums for people in their 50s and 60s is likely to go up, more so than in past years. Before Obamacare, insurance companies charged the older set several times more than a younger person for the same policy. The ACA limited insurance companies to charging older people only three times more.

There is some good news, however. Some Republican proposals made public shy away from messing with Medicare. One by Republican Sen. Rand Paul, for example, does away with the ACA's individual mandate and allows insurers to sell less comprehensive (and less expensive plans) -- but it doesn't touch Medicare.

Another proposal, introduced by four Republican senators last week, gives states three options in a repeal-and-replace environment. States can either syay on with Obamacare, move to what senators are calling a "market-based" insurance expansion, or simply opt for no coverage expansion "without any federal assistance."

Called the "Patient Freedom Act of 2017," the senators' proposal doesn't touch the Medicare reforms and senior benefits under Obamacare.

In addition, the advocacy group AARP announced Monday it was launching a comprehensive campaign to protect Medicare in the face of some Congressional proposals. "The average senior, with an annual income of under $25,000 and already spending one out of every six dollars on health care, counts on Social Security for the majority of their income and on Medicare for access to affordable health coverage," wrote AARP CEO Jo Ann Jenkins in a recent letter to Congress. "We will continue to oppose changes to current law that cut benefits, increase costs, or reduce the ability of these critical programs to deliver on their benefit promises. We urge you to continue to do so as well."

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