Helen Bell, a 59-year-old former hospital worker, suffers from several chronic conditions that often land her in the hospital and require frequent doctor visits and expensive medications.

But health issues aren’t her biggest worries these days. It’s whether she can afford the insurance she needs if the GOP plan to replace the Affordable Care Act becomes law.

The House is expected to vote Thursday on the Republican bill, known as the  American Health Care Act. It’s unclear whether the Republicans can muster enough votes, despite a flurry of last-minute changes meant to appease conservative and moderate Republicans. If it does pass, it will move to the Senate for approval or changes.

For Bell and many older Americans, the stakes are especially high, for three main reasons:

  • People 50 to 64 years old who buy health insurance will face much higher costs under the Republican plan, according to the nonpartisan Congressional Budget Office’s recent analysis. That’s because the GOP legislation would dramatically shift how assistance to pay for health insurance is distributed.
  • The CBO’s analysis predicts rising costs will result in fewer older people being insured. Among people over 50 who don’t yet qualify for Medicare, the uninsured rate would jump to 30 percent by 2026 from about 13 percent today, the CBO says.
  • People in this age group are also more likely to have serious health problems, compounding the overall negative impact on them.

“We’re getting flooded with calls on our help line from people worried about losing their coverage because they can’t afford it,” says Stacy Sanders, director of federal policy at the nonprofit Medicare Rights Center, which helps older people find affordable healthcare options and transition into Medicare. “For some older people, we don’t see how they’ll be able to pay these kind of prices.”

In some states, older low-income people would face premiums that exceed their annual income, according to an analysis by Cynthia Cox of the Kaiser Family Foundation, a health policy research group.

Helen and Mike Bell worry they'll have to deplete their retirement savings to pay for Helen's health insurance.

Consumers Worried About Potential Higher Costs

In a recent nationally representative CR Consumer Voices Survey, 55 percent said they’re not sure they or their loved ones could afford insurance to get quality healthcare.

Senators—some signaling their own concerns about the law—are expected to offer amendments if and when the bill goes to them. For example, they might try to increase the funding for the tax credits that older people receive.

But no tinkering around the bill’s edges is likely to make much of a difference for Bell, who lives near Asheville, N.C.

She says she suffers from Crohn’s disease, arthritis, and fibromyalgia and is unable to work because of the pain and fatigue from her conditions.

When Bell’s husband, an Episcopal minister, now 72, retired from the church two years ago, he went on Medicare. Bell had the option of staying on his employer insurance, but it would have cost nearly $700 a month. So she enrolled in a more affordable ACA health plan.

Bell says her premiums are about $10,000 a year, but because her annual household income is $25,000, she qualifies for tax credits that lower her payment to $1,800 a year, or $150 a month. She also gets additional financial assistance that covers most of her out-of-pocket costs for copays and deductibles.

Under the American Health Care Act, much of that help would go away and premiums would skyrocket. Where she lives in North Carolina, annual premiums would climb to $14,000 by 2020, but she would get a tax credit of only $4,000, leaving her to pay $10,000 a year, according to a tax credit comparison calculator by the Kaiser Family Foundation.  

In other words, about three-quarters of Bell’s family income would go toward paying for her healthcare. By the time she qualifies for Medicare in six years, she’d have burned through half of her retirement savings, she estimates.

“I am frankly terrified at the thought of not having health insurance I can afford,” she says. “This is literally about my life.”


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How the AHCA Changes the Equation for Seniors

As a group, older people who aren’t wealthy have the most cause for concern.

Under the ACA, tax credits to help pay for insurance were structured so that low- and middle-income people got the most help. But the GOP proposal shifts the way assistance is meted out. It provides a flat credit according to age, ranging from $2,000 for people under 30 to $4,000 for those over 60.

But while older people get larger tax credits, the new bill also would allow insurers to charge them more—up to five times as much as what younger people pay for individual policies. It completely eliminates the cost-sharing subsidies Bell and 3 million other older Americans currently receive, and would no longer tie the amount of financial assistance you get to the cost of health insurance where you live.

On the other hand, the GOP plan could benefit some higher-income seniors, says Christine Eibner, a senior economist at Rand Corp., a nonpartisan research organization. Under the ACA, people who earn more than $48,000 a year aren’t eligible for tax credits. But under the GOP plan, individuals who earn up to $75,000 would get one.

But that helps just a small slice of the people affected by the proposed changes, says Eibner. “For people who need to buy individual health insurance, virtually all older adults will pay more because insurers can charge more,” she says.

The CBO estimates that by 2026, insurance premiums for a 64-year-old will be 20 to 25 percent higher vs. 20 to 25 percent lower for a 21-year-old and 8 to 10 percent lower for a 40-year-old.

“If you’re older and financially strapped, insurance may be out of reach,” says Eibner.

Ill health forced Dolores Garm to retire but she was able to afford health insurance through the ACA.

Seniors With Employer Insurance May Feel Changes

If the AHCA becomes law, even older people who get insurance through their job, as more than half of Americans do, may feel the impact, says Sanders from the Medicare Rights Center.

The ACA mandates that employers with 50 or more employees must offer insurance to them or face a penalty. While larger employers are likely to keep providing the benefit as a way to stay competitive, smaller ones may discontinue it.

The ACA also gives more freedom of choice to employees who feel chained to their jobs.

“The ACA is a safety net. If you need to leave the workforce because you’re too sick to work, you need to care for a family member, or just because you want to retire early and pursue other things, you had peace of mind knowing you could get insurance on the individual market,” says Sanders.

That was Dolores Garm’s situation. A database manager and graphic designer who lives near Milwaukee, Garm was diagnosed with rheumatoid arthritis in 2014, and decided to retire last year because the pain was growing worse. “Mornings are devastating. I’m stiff till 10 a.m. and only have a few good hours during the day,” says Garm, 64. Working part-time wasn’t an option.

After researching insurance plans through the ACA, Garm said she was confident she could retire and afford health insurance even though her main source of income is just the $13,000 a year she gets from Social Security. She pays $160 a month for health insurance. If she didn’t qualify for the ACA subsidy, Garm says her monthly premium payment would be over $800.

Garm turns 65 in February and hopes that whatever changes Congress makes to the health insurance market won’t kick in this year. “I”m counting the days till I can sign up for Medicare,” she says.