About 56,000 Hawaii residents will lose health care coverage by 2022 under the Senate’s health care bill, according to a new analysis of the legislation by the AARP Public Policy Institute.

The bill to repeal and replace the Affordable Care Act caps spending on Medicaid and cuts $772 billion in federal Medicaid spending, shifting costs to states, state taxpayers and families. AARP estimates Hawaii would lose $1.9 billion in total federal and state Medicaid funding from FY2020 to FY 2026.

The legislation contains an age tax, which allows insurance companies to charge older consumers five times more for the same health coverage as a younger person and reduces tax credits that help lower- and moderate-income people pay for insurance. It will make insurance unaffordable for many older residents. AARP estimates a 60-year-old Hawaii resident making $30,000 annually could pay up to $4,450 a year in additional premiums and $1,276 more each year in deductibles, coinsurance and copayments. Premiums for a 60-year-old earning $55,000 in Hawaii could rise to as much as $8,661 more each year.

About 268,116 Hawaii residents are between the ages of 50 and 64 and a little more than half of them, 54 percent, receive tax credit assistance under the Affordable Care Act.

“The Senate health care bill means consumers will have to pay more for less coverage. It will not reduce the cost of health insurance for older residents,” said Barbara Kim Stanton, the AARP Hawaii state director. “The Medicaid cut would place a huge burden on lawmakers and taxpayers to either raise state taxes, cut health care services to Hawaii residents who need it the most, or cut services elsewhere. It threatens hospitals, especially on Neighbor Islands and in rural areas, which will have to absorb the cost of providing care to the increased number of uninsured.”

The AARP state analysis estimates that one out of every eight Medicaid beneficiaries, about 43,000 people by 2026, would have to lose coverage to maintain the same level of service for remaining beneficiaries.

The bill would also hurt kupuna in nursing homes and providers who care for people in nursing homes and at home, who could see reduced payments because of the Medicaid cuts.

Payments to nursing facilities accounted for about 75.5 percent of Medicaid long-term services and support payments in 2014. Home and community based services are optional in Medicaid and could be more vulnerable to cuts.

But cutting home and community-based services could have the unintended consequence of increased hospital admissions and increased use of more expensive services that will ultimately cost the federal government more.

Even people who get their insurance through their employer face higher costs because the bill allows states to weaken important consumer protections that ban insurance companies from capping how much they will cover annually, or over a person’s lifetime. States could also weaken or waive requirements that protect consumers from high annual out-of-pocket spending, such as deductibles and copays.

The bill would also affect about 44,237 Hawaii residents ages 18 to 64 who leave or lose their jobs and who may have to buy coverage on the individual market.

About 190,634 Hawaii residents, 73 percent of those 50 to 64, get their insurance through their employer. About 20,098 Hawaii residents ages 50 to 64, get coverage through the Health Exchange.

The bill also allows states to weaken or waive Essential Health Benefits in the Affordable Care Act as well as limits on consumers’ annual out-of-pocket spending. About 93,366, or 34 percent, of 50 to 64-year-old Hawaii residents have a pre-existing condition.

The bill also reduces Medicare’s solvency by repealing a 0.9 percent payroll tax on higher-income workers. It increases Medicare premiums by removing nearly $26 billion in required payments from pharmaceutical companies over 10 years from the Part B trust fund.

In Hawaii last year, Medicare covered 224,880 Hawaii residents, about 16 percent of the state’s population. Most – 91 percent – are over age 65 and 9 percent are people with disabilities under age 65.

“AARP Hawaii thanks Sens. Brian Schatz and Mazie Hirono for their steadfast opposition to this bill,” Stanton said. “We urge the Senate Majority to dump this special interest bill that gives billions to insurance and drug companies by charging consumers, especially older Americans, higher costs for reduced benefits and strips away critical consumer protections. We need the bill to start from scratch and put consumer health needs first.”

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