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, some stakeholders and lawmakers have targeted IRA policies for revision or repeal, especially the law’s Medicare Drug Price Negotiation Program. Depending on the provisions targeted, this would increase beneficiary costs and increase Medicare spending.

Some policies would give Medicare providers the right to charge beneficiaries more for care than is currently allowed through balance billing or private contracting arrangements. Under these Medicare private contracting, providers could charge their Medicare patients more than they currently pay or require them to negotiate a contract for the cost of their care.

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. Means testing any portion of Medicare would add administrative complexity and access barriers.

A commonly discussed reform would raise the Medicare eligibility age from 65 to 67 or even 70. This 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. 

Proposals to turn Medicare into a premium support system, also called a defined contribution system or a voucher program, are evergreen. Such programs would give people with Medicare a voucher or coupon worth a certain amount toward the purchase of health coverage. If the voucher did not cover the full cost, the person would presumably have to pay the rest or go without coverage.  

The Affordable Care Act (ACA) 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 opposition from some policy corners in Congress, the states, and the courts. If repealed, people would lose protections, including free preventive services in Medicare.