What Happens to Medicare if Obamacare Is Repealed?

Health Writer

Congress is now in the midst of a heated debate on the fate of the Affordable Care Act. If you’re on Medicare, you might think it doesn’t affect you. You would be wrong. The cost and extent of your Medicare benefits could change significantly if the ACA were completely repealed. Here’s how:

• No more free preventive care. The ACA is why you don’t have to pay anything out of pocket for a long list of preventive services (some of which are available only if you are a certain age, gender, or have certain risk factors). Examples: flu shots, mammograms, heart disease screenings, diabetes screening and counseling, and an annual “wellness” visit.

• The return of the Part D doughnut hole. This is the notorious coverage gap that, pre-ACA, left patients on the hook for the full price of drugs once they had crossed a spending threshold each year, to the tune of as much as several thousand dollars. Obamacare has been closing the doughnut hole little by little since 2015 and is scheduled to eliminate it completely by 2020. So far, it has saved Medicare beneficiaries more than $20 billion in drug costs, according to the nonpartisan Medicare Rights Center. Overall Part D premiums would decline, though, because they are linked to total Part D spending.

• Higher Part B premiums and deductibles. The ACA cut back payments to doctors, hospitals, and private Medicare Advantage plans. The Congressional Budget Office estimates that repealing Obamacare would increase Medicare spending by a total of $802 billion by 2025. That in turn would increase Part B premiums and deductibles because they are pegged to Medicare’s overall costs.

But people in some Medicare Advantage plans might see richer benefits or fewer out-of-pocket expenses since the plans would once again be allowed to collect more money from the government than it spends on people in traditional Medicare.

• Lower Part B and Part D premiums for high-income Medicare beneficiaries. Higher-income people pay a surcharge on their Part B premiums. Pre-ACA, the income threshold rose slightly every year, but the reform law froze the threshold at $85,000 for an individual and $170,000 for a couple.

Unfreezing it would reduce the number of people hit by the surcharge. Repeal would also completely eliminate a similar Part D surcharge that the ACA imposed on wealthier beneficiaries.

Editor’s Note: This is the first in a series of articles on the impact of the health-care proposals being introduced in Congress this year. You can weigh in by contacting your representative in the U.S. House (click on the mail logo next to his/her photo) or the Senate.

E-mail us with your Medicare or health insurance questions.