ObamaCare: Victory for Elderly, Less for Near Elderly

In upholding the President Obama's health reform law, the Affordable Care Act,  the Supreme Court ensured the preservation and continued roll-out of improvements and protections for older adults.  These improvements include the extension of  Medicaid’s spousal impoverishment protections to those seeking long-term care in the community, financial incentives for states to keep long-term care recipients out of institutions, the gradual closing of Medicare  Part D’s infamous “doughnut hole,” expanded access to preventive services for Medicare beneficiaries, and the Elder Justice Act.

The Court did, however, scale back the Medicaid portion of the law, which could mean that fewer near-elderly will have access to health insurance than was originally envisioned.  The law expanded Medicaid eligibility starting in 2014 to people with income up to 133 percent of the poverty line.  But in its ruling, the Supreme Court gave states the freedom to opt out of this expansion without putting their current Medicaid funding at risk.  Some governors have already declared that they will not accept the federal money in order to expand coverage.  In states that decide not to participate, the poorest individuals below age 65 may be without access to affordable health insurance entirely because their incomes are too low to be eligible for federal subsidies provided under the law, which envisioned they would be covered by the Medicaid expansion.