The series, called “What’s at Stake,” explores various policy ideas and their potential impacts on major health care programs, such as Medicare, Medicaid, and the Affordable Care Act.  

Understanding how these reforms might affect coverage, care, and outcomes for older adults and people with disabilities is essential, as they may influence voting behavior, donations to causes, and interactions with elected officials. The fact sheets include:  

• Medicare Reforms in the Inflation Reduction Act. The Inflation Reduction Act (IRA) of 2022 made key changes in Medicare law and coverage to improve prescription drug affordability for older adults and people with disabilities. Since its passage, various IRA policies have been targeted for revision or repeal, especially the law’s Medicare Drug Price Negotiation Program.

• Medicare Private Contracting. Some proposals would create Medicare “private contracting” arrangements, allowing providers to charge their Medicare patients more than they currently pay or require them to negotiate a contract for the cost of their care.

• Medicare Means Testing. A core component of Medicare is its universality. Some policy ideas would undermine that promise by limiting certain benefits to people with lower incomes or requiring those with higher incomes to pay more for care.

• Raising the Medicare Eligibility Age. Raising the Medicare eligibility age would reduce access to care and disproportionately harm some who can least afford it, including people who work in physically demanding jobs and older adults of color. 

• Medicare Premium Support. The idea of turning Medicare into a premium support system, also called a defined contribution system or a voucher program, is evergreen. Most of the proposals would give beneficiaries a voucher to purchase health care that would not cover the full cost.

• Affordable Care Act Coverage Expansions and Consumer Protections. The Affordable Care Act strengthened Medicare and Medicaid and created important coverage avenues and consumer protections for people of all ages. Despite these successes, the health law continues to face threats and opposition that would undermine access to care.

• Medicaid Financing. Proposals to restructure Medicaid’s financing often recommend transforming the program from a guaranteed benefit to a fixed payment system, coupled with new limitations on costs or care. Such changes would put access to care at risk, especially for older adults and people with disabilities. 

• Medicaid Waivers. Many states have improved Medicaid services through 1115 waivers, but some have attempted to use these tools to limit eligibility or restrict coverage.

• Medicaid Work Requirements. Conditioning Medicaid eligibility on compliance with monthly employment and reporting requirements would create harmful barriers to care and administrative burdens. 

View the fact sheet series here.