What Happens to Medicare If the Affordable Care Act Is Overturned?

Experts say if the ACA is repealed or rescinded "it would be devastating for Medicare." Here's what might happen -- and how it could be costly for you.

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Supreme Court Justice Ruth Bader Ginsburg’s death heightened the stakes in a case scheduled to appear before the court Nov. 10 that could reverse improvements to Medicare and raise out-of-pocket costs for beneficiaries. The case, California v. Texas, which was filed by 20 Republican-leaning states, challenges whether the Affordable Care Act can exist without the individual mandate to buy health insurance. A Republican-controlled Congress removed the financial penalty for those without insurance in 2017.

“If the ACA was repealed or rescinded in full, it would be devastating for Medicare,” says David Lipschutz, associate director of the Center for Medicare Advocacy, which along with AARP and Justice in Aging filed an amicus brief supporting California and 16 other Democratic-leaning states defending the health care law. Many of the law’s provisions that strengthen the program’s fiscal solvency also strengthen consumer protections for beneficiaries, he says.

“The ACA’s changes are so ingrained in the program that people don’t remember what Medicare was like before the law,” adds Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center. Without the ACA, she says, the doughnut hole for prescription drug coverage, which closed in 2020, reopens, and “the expansion of preventive care services goes away.” The effects encompass both traditional Medicare and Medicare Advantage plans, eliminating ACA improvements that helped drive costs down for the program and beneficiaries. Here’s what happens to Medicare if the court invalidates the law.

Managing Editor, Kiplinger's Retirement Report

Siskos is an old hat with the Kiplinger brand. More than a decade ago, she spent eight years writing about personal finance for Kiplinger's Personal Finance magazine, including a monthly column—Starting Out—that served young adults. That was in her salad days. Now she's turned her attention to an audience she hopes to join in a decade or so: retirees. Siskos is the managing editor for Kiplinger's Retirement Report. In between, she broadened her personal-finance repertoire with real estate and investing stories at Old-House Journal, Investing Daily and U.S. News. She comes to Kiplinger by way of the Newseum, where she worked as an exhibit editor.