By Joe Baker

Congressional leaders and President Trump have made it clear: Upending our nation’s health care system is at the top of their agenda. First up, lawmakers intend to follow through on Trump’s campaign pledge to repeal the Affordable Care Act (ACA). This action alone would profoundly affect older New Yorkers’ health care costs and access to care.

Repeal of the ACA could have dire consequences for the more than 126,000 Erie County residents ages 55 to 64. Undoing the ACA and delaying a meaningful replacement could cause baby boomers to lose health coverage altogether. In fact, even so-called ACA “repairs” are likely to leave people in this group worse off than they are today. One such proposal would allow insurers to charge older enrollees even higher premiums than their younger counterparts – up to five times higher or more. Under the ACA, insurers can charge only three times more.

Access to Medicare benefits is also under threat for Erie County’s nearly 150,000 citizens over age 65. The ACA not only strengthened Medicare’s fiscal outlook, it also lowered seniors’ prescription drug costs and established coverage for low- to no-cost preventive care.

In New York State alone, almost 360,000 people with Medicare saved nearly $430 million on essential medications in 2015, with the average discount amounting to $1,195 per person. The same year, about 2.4 million New Yorkers with Medicare benefited from at least one preventive service.

The ACA is not the only health law targeted by some congressional leaders. Despite Trump’s promise to save Medicare and Medicaid from cuts, some lawmakers have vowed to slash Medicaid funding and privatize Medicare. Proposals to block grant or otherwise cap Medicaid funding could be particularly harmful for the oldest and frailest New Yorkers who rely on the program for access to long-term care, either at home or in a nursing home.

Guaranteed access to this long-term assistance is threatened by proposals that diminish the federal government’s obligation to help states pay for this Medicaid coverage and care.

Under proposals to convert Medicare to a premium support (or voucher) program, older New Yorkers would not fare any better. Through the most recent plans, people with Medicare would receive a voucher to cover their premium costs, choosing between Original Medicare or a private health plan. No matter what coverage they choose, turning Medicare into a voucher program is likely to shift higher health care costs to many, if not most, seniors, as the voucher’s value is unlikely to keep pace with rising health care costs.

Between the ACA, Medicaid and Medicare, a three-pronged assault on our nation’s health care system is well underway. For older New Yorkers, the stakes could not be higher. What New York’s baby boomers and seniors stand to lose is access to affordable care when they need it most.

Joe Baker is president of the Medicare Rights Center, a national nonprofit that works to ensure access to affordable health care for older adults and people with disabilities.

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