Senate Republicans’ try at replacing the Affordable Care Act—theBetter Care Reconciliation Act, which manymedical groups say is neither better nor provides care—could comewith side effects: the need for older Americans to work longer andto save less for retirement.

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That’s according to a MarketWatch report, which also details how hard the hammerwould fall on older Americans.

The BCRA would not only increase the number of people who areuninsured by 22 million in 2026, it would also—according to theCongressional Budget Office—result in 35 percent less spending onMedicaid by 2036 than under the ACA, a Huffington Post report says.

But wait, there’s more.

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The result of all these cuts, says MarketWatch, could mean that“older Americans may have to reduce the amount they save forretirement, or use retirement funds to pay for current health-careneeds, or keep working to age 65 if only to keep theiremployer-sponsored health insurance plan.”

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What a rosy picture. And if that’s not enough, the CBO pointsout that the increase would be disproportionately larger amongolder people with lower income—particularly people between 50 and64 years old with income of less than 200 percent of the federalpoverty level.

Under the House bill, known as the American Health Care Act, itwas bad enough, with the CBO estimating that more than five millionolder adults aged 50–64 would lose health insurance.

But under the BCRA’s “age tax” on older adults—something thatthe AHCA also imposed—even more older people, such as those whoaren’t yet eligible for Medicare but who need insurance, are alsoat risk of losing coverage, thanks to the Senate bill’s wider agebands and less generous subsidies.

A Medicare Rights Center brief is quoted saying in the reportthat “The ACA limits the premiums people 60 to 64 pay to threetimes what younger people pay, but the AHCA lets insurers chargeolder adults five times (or more if state law allows) what ayounger person pays for the same health plan.”

And their options, if that happens?

Not many, according to experts: going back to work, hittingtheir retirement accounts to pay the bills, stop saving forretirement altogether or just go without health care.

Tricia Neuman, a senior vice president with the Henry J. KaiserFamily Foundation, is quoted in the report saying, “People livingin high-cost areas and have incomes 350 percent and 400 percent offederal poverty level (FPL) will see substantially higher premiumsas a result of these changes.”

An interactive map published by the KFF that The compares county-level estimates of premiums consumers would pay under the ACA in 2020 with what they’dpay under the Senate’s BCRA shows just how bad it can be.

The report cites the example of a 60-year-old in Grant County,West Virginia, with income of $40,000 (roughly the median householdincome in that county and 320 percent of FPL), who would seeafter-tax credit premiums rise 124 percent, from $4,080 for an ACAsilver plan (10 percent of income), to $9,120 (23 percent ofincome) for a BCRA silver premium plan.

For a bronze plan, the premium increase would be evensteeper.

And author Jae Oh, who has written a book about Medicare, warnsin the report that Medicare beneficiaries who haven’t yet signed upfor Medicare Part B enrollment and who are covered by anemployer-sponsored group plan, will “definitely” want toreconsider.

Oh is quoted saying, “It has always been the case that thepremium may or may not be superior to Medicare along with either aMedigap/Part-D or Medicare Advantage plan. The BRCA adds a furtherset of factors to consider. The BRCA could potentially change thedefinition of essential health benefits, and if that is the case,then the quality and services provided by the employer-sponsoredplan may not be appropriate for the employee.”

Oh adds that in theory, an employer with employees in multiplelocations will be able to choose a state, in which an employeeresides, as the template for the entire group plan—then change thebenefits of the whole plan, which can include lifetime benefitlimitations or limitations against certain conditions.

He warns that such an action will also affect spouses,especially since lots of employers charge higher rates for thespouses of active employees.

And then there’s the BCRA’s potential effect on Medicare, whichprimarily comes from two changes that weren’t in the Housebill.

In the report, Neuman says, “The Senate bill repeals the payrolltax surcharge on people with high earnings which helped strengthenthe Medicare trust fund. Repealing this surcharge accelerates theinsolvency of the Medicare Trust Fund which means policymakers willneed to take action sooner to be sure Medicare can continue to meetits obligations beginning less than a decade from now.”

A 2016 Medicare Boards of Trustees report saysthat the Hospital Insurance trust fund, which pays for MedicarePart A (inpatient) services, is expected to go negative in 2028.From that point, without changes, the program would only be able topay 87 percent of benefits.

Neuman points out that the Medicaid changes in the BCRA willalso affect Medicare, if not directly. She is quoted saying, “TheSenate bill caps the growth in Medicaid spending, and over time,this cap is expected to rise more slowly than the actual cost ofcare. This is an issue because 11 million people on Medicare relyon Medicaid to help cover their health and long-term carecosts.”

She adds, “Only a fraction of the Medicare population havesufficient savings to cover their own long-term care costs, whichis why Medicaid plays such an important role, and why changes toMedicaid could impact a surprisingly large number of older adultsover time.”

In addition, federal funding caps on nursing homes and home careoptions—which will be changing over from the CPI-U medical(Consumer Price Index) to the regular CPI-U—will not be adequate topay for nursing home costs, increases in staff wages and anexpanded need by an aging population—many of whom will be hittingthe age of 80, just the point at which many will need moreextensive and long-term care and support.