Replacing Obamacare (the Affordable Care Act, ACA) for older Americans involves addressing several complex challenges related to affordability, coverage, and access to care. Older adults, especially those between 50 and 64 who are not yet eligible for Medicare, face rising premiums, limited plan options, and potential loss of subsidies that have helped make insurance more affordable under the ACA. Any reform aimed at this group must carefully balance cost control with maintaining or improving access to necessary health services.
One possible reform approach is to **expand and make permanent the enhanced premium tax credits** that were introduced during the COVID-19 pandemic. These tax credits significantly lowered monthly insurance premiums for millions of older adults on ACA marketplaces, many of whom pay much higher premiums than younger people for similar coverage. Without these credits, premiums are expected to rise sharply, making insurance unaffordable for many. Permanently extending and possibly increasing these subsidies could help older adults maintain coverage and reduce financial strain.
Another reform could involve **broadening eligibility and improving the structure of catastrophic health plans**. These plans have lower monthly premiums but very high deductibles, requiring enrollees to pay thousands of dollars out of pocket before coverage kicks in. While catastrophic plans have had limited appeal due to these high deductibles, reforms could make them more accessible and attractive by adjusting deductible levels or providing additional subsidies for out-of-pocket costs. This would offer a lower-cost option for older adults who do not qualify for premium subsidies but still need some form of coverage to protect against major medical expenses.
A third avenue is to **strengthen Medicaid and Medicare Savings Programs** that assist low-income older adults with premiums and out-of-pocket costs. Recent legislative changes have included cuts to Medicaid funding and restrictions on improvements to Medicare Savings Programs, which could reduce access to care for millions of older adults relying on these programs. Reversing these cuts and expanding support could help ensure that vulnerable older adults maintain access to essential health and long-term care services.
Additionally, reforms could focus on **allowing Medicare to negotiate drug prices more aggressively**. The Inflation Reduction Act gave Medicare this power for certain high-cost medications starting in 2026, which could lower prescription drug costs for older adults. Expanding this authority and applying it to a broader range of drugs could reduce one of the largest out-of-pocket expenses for seniors.
Another reform idea is to **create a public insurance option or Medicare buy-in for people aged 50 to 64**. This would allow older adults who ar
