Ripple effects, indeed.
The loss of coverage for adults in their 50s and early 60s could have ripple effects for Medicare, a possibility that has received little attention. If the AHCA results in a loss of health insurance for a meaningful number of people in their late 50s and early 60s, as CBO projects, there is good reason to believe that people who lose insurance will delay care, if they can, until they turn 65 and go on Medicare, and then use more services once on Medicare. This could cause Medicare to increase, and when Medicare spending rises, premiums and cost-sharing do too.
A 2007 study published in the New England Journal of Medicine that looked at previously uninsured Medicare beneficiaries helps explain this dynamic. It showed a direct relationship between lack of insurance (pre-65) to higher service use and spending (post-65). Previously uninsured adults were more likely than those with insurance to report a decline in health, and a decline in health (pre-65) was associated with 23.4% more doctor visits and 37% more hospitalizations after age 65. Depending on the number of people who lose coverage and how long they remain uninsured, the impact for Medicare may initially be modest, but could compound with time.
In addition, the AHCA would repeal the Medicare payroll tax imposed on high earners, a change that would accelerate the insolvency of the Medicare Hospital Insurance Trust Fund and put the financing of future Medicare benefits at greater risk for current and future generations of older adults – another factor to consider as this debate moves forward.
(Kaiser Family Foundation)