March 17, 2017 Advocacy Alert

Tell Congress to Reject Medicaid Cuts, Higher Costs for Seniors in 
Health Care Reform Bill


As detailed in n4a's March 10 Legislative Update, the House is advancing the first of several measures to ultimately repeal the Affordable Care Act (ACA). n4a is opposing the American Health Care Act (AHCA), as it does not adequately address the ACA issues we raised in our January ACA Policy Brief and goes beyond ACA-related provisions to fundamentally undermine federal support for Medicaid, weakening this key health and long-term care safety net. The Congressional Budget Office estimated that if enacted, the bill would cut $880 billion from Medicaid over 10 years and result in health insurance coverage loss for up to 24 million people. The bill, which may come to the House floor for a vote as soon as next week, also makes major changes to Medicaid by shifting the current federal-state funding formula to a per-capita cap structure.
We encourage all n4a members and allies to reach out to your Members of Congress immediately to share your concerns with this legislation.
Congress must hear from local AAAs, providers and other stakeholders about the value of the life-saving home and community-based services in Medicaid. They need to hear from aging advocates about how this bill would negatively impact seniors by increasing the cost of health insurance for older adults not yet on Medicare. Members of Congress need to understand the value of the Prevention and Public Health Fund (PPHF) to older adults who are receiving falls prevention or chronic disease self-management classes that the AHCA would eliminate.
Here’s What We Are Asking You To Do:

  • Put Your Concerns in Writing Today. 
    If you can, put your concerns on agency letterhead and fax a letter to your House and Senate delegations. If you can’t do that on behalf of the agency, enlist your advisory board or commission to consider doing so. Then supplement with a personal letter of your own. (You can speak to your expertise and role in serving older adults without bringing your title or agency into the letter.)
    Tip: Borrow text from n4a’s Letters to House and Senate leaders or the talking points below, but address your letters to YOUR Representative(s) and Senators and be sure to cite state and local data.
  • Call Congress!
    We know, you just wrote to them, but we need to put a lot of pressure on quickly, so follow-up on your letter with a call to their DC or district offices (wherever you can get through!). Phone lines are busy these days, but keep trying—calls get Members’ attention better than an email. The Capitol Switchboard is 202.224.3121 to reach DC offices, but you can find district office phone numbers on Members’ websites!
  • Engage Your Community NOW.
    There’s been little to no time to vet this legislation—no hearings and just a few days between introduction and markup. The two House committees even advanced their sections of the bill without knowing what the total cost would be! To slow this down for more thoughtful consideration—and to stop Medicaid restructuring—we need A LOT of voices raised in opposition, or even just polite concern. So please activate your provider, partner, ally, stakeholders and even consumer lists!

Here’s What We Are Providing:

  • Key Messages
    We’ve given you our take on AHCA, but for your letter/email/call, customize the talking points below to fit your agency’s style, your comfort with the advocacy messages and, most importantly, with local data and stories!
  • Grassroots Alert Template
    To expedite your stakeholder outreach efforts, we’ve developed a sample for you to use. It’s based on n4a’s analysis of the bill and reflects the key messages we developed for our members. However, we have crafted it to appeal to a broader audience, including your clients, caregivers and other interested community members. (This is our first time doing this, so let us know what you think!) You can leave the n4a branding on the alert or replace with your agency’s logo—whatever will work best for you and your local stakeholders.

Key Messages on AHCA:  
Medicaid is Critical to the Health and Well-Being of Many Older Adults
AHCA’s per capita cap would lead to significant cuts in Medicaid long-term care for both home and community-based services (HCBS) and institutional care. By capping the federal government’s funding for Medicaid, costs will be shifted to the states over time. The Congressional Budget Office estimates this would reduce federal Medicaid spending by $880 billion over 10 years. The cut would put pressure on states to reduce benefits, limit eligibility, increase consumer cost-sharing or lower reimbursement rates. This in turn could lead to sicker, more vulnerable older adults. Capping Medicaid also jeopardizes recent gains toward rebalancing Medicaid long-term care from institutional care to HCBS—which would only increase Medicaid costs! We must preserve Medicaid’s safety net entitlement nature and federal-state funding partnership in order to keep older adults healthy and living safely in their homes and communities.
Older Adults Should Not Be Penalized for their Age
AHCA rolls back ACA’s 3:1 age rating provision, which limited how much more an insurance company could charge an older consumer vs. a younger one. AHCA would allow at minimum, a 5:1 rating, and would even let states exceed that rating. Despite the attempt in AHCA to provide older consumers with larger tax credits to offset higher premiums, we believe the bill will still mean higher costs for individuals age 55-64, most especially lower-income Americans. Pre-ACA, higher age-rating limits meant that many older adults, who couldn’t afford much higher premiums, were uninsured. Uninsured people in this age group are more likely to delay seeking health care, and are ultimately sicker when they reach Medicare eligibility—only increasing costs in the long run.
Do No Harm to Medicare
Although AHCA dramatically changes Medicaid, it does not make major changes to Medicare. However, by eliminating a specific ACA tax and thus a source of revenue for Medicare, the bill would hasten insolvency of Medicare by four years (to 2024 instead of 2028, which was extended a full 11 years by the ACA).
Prevention Works for Older Adults
The AHCA would reduce funding for the Prevention and Public Health Fund (PPHF) by $100 million (10 percent) in 2018 and completely eliminate the fund in 2019. Currently, PPHF supports Administration for Community Living grants for falls prevention activities, chronic disease self-management programs and Alzheimer’s disease prevention and education efforts. These cost-effective programs that improve health are implemented by states, AAAs and Aging Network providers. Without PPHF funding, these vital, money-saving programs may be on the chopping block.
Let us know how your agency is getting involved, and thank you for your advocacy on these important issues! 

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If you have questions or concerns about this Advocacy Alert or n4a’s policy positions, please contact Autumn Campbell at and Amy Gotwals at

USAging Fact: Learn about your peers’ work—and how it can fit into your agency’s goals! The AIA Awards recognizes successful and innovative programs that USAging members have developed to serve older adults. Get inspiration from our 2023 winners!