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​B’nai B’rith International is concerned that repealing the Affordable Care Act (ACA) in favor of the Republican proposed American Health Care Act (AHCA) could cause the most vulnerable people—senior citizens—to lose coverage. Through Medicaid low-income seniors are relieved of the cost-sharing and out-of-pocket costs in their Medicare coverage. Low-income seniors are also eligible for some state services meant to make up for some care that Medicare does not cover, such as dental, vision and hearing, Medicaid helps to fill coverage gaps these seniors could not pay for on their own. 
Many seniors depend on Medicaid to cover the cost-sharing in Medicare—without this coverage they would not be able to afford co-payments and could be forced to skip needed care. Therefore, Medicaid plays a critical role in health and financial security for low-income seniors. B’nai B’rith welcomes the AHCA exempting Medicaid aid for low-income Medicare beneficiaries from the per capita cap proposal. However, changing any portion of the Medicaid funding to a per capita cap proposal an additional layer of pressure to state budgets, and put the health care and financial security of millions of older adults at risk. As the AHCA is being debated in Congress, we hope no additional Medicaid funding will be subject to a per capita cap.
Under the current ACA, health insurers were only allowed to charge older Americans three times more than younger policy holders for premiums. The proposed AHCA would allow health insurers to charge older Americans five times more than young people for premiums. The AARP reports that based on the tax credit changes and the increase in premium limits, low income adults in their 60s could see dramatic increases in premiums.
Lastly, the 2016 Medicare Trustee report states that the Medicare Part A Trust fund is solvent until 2028 (11 years longer than pre-ACA). The AHCA repeals a .9 percent payroll tax on higher-income workers. Repealing this tax could speed up the potential insolvency of the Medicare Part A Trust Fund by four years, from 2028 to 2024. 
At the same time, B’nai B’rith is encouraged that the proposed AHCA keeps in place the Medicare Part D coverage gap (known commonly as the “donut hole”) protections established under the ACA. We strongly urge the Trump administration and Congress to revise the AHCA proposal, as so many seniors and other vulnerable Americans are low income and cannot afford an increase in health care costs.