The election of Donald Trump, along with continued Republican majorities in the House and Senate, will likely result in major cuts in federal programs that benefit older adults and younger people with disabilities.
Some of the programs that could be targeted: Medicaid, important reforms in the way health care is delivered through Medicare, and services funded through the Older Americans Act such as Meals on Wheels, adult day, information assistance. And while Trump vowed throughout his campaign to leave Social Security and Medicare untouched, congressional Republicans have targeted both programs and it is not clear whether the new president would resist their efforts to cut benefits.
It is important to note that Trump carefully avoided identifying specific spending reductions throughout the campaign. He did back a House GOP plan to cap federal spending for Medicaid, a program that benefits very poor and very sick older adults and people with disabilities, as well as low-income mothers and children. He promised to repeal the Affordable Care Act (ACA), called for unspecified cost savings in the Medicare drug program, and generally vowed to eliminate government waste. And he said he backs an old (never-enacted) congressional proposal to cut government spending by one percent a year, except for Medicare, Social Security, Medicaid, and defense.
We’ll get to that last proposal, called the penny plan, in a minute. But first one more bit of context to help explain why a Trump presidency is likely to lead to big spending cuts for programs that benefit seniors and younger people with disabilities.
Trump has proposed a $6.2 trillion tax cut, according to my colleagues at the Tax Policy Center. That’s bigger than any tax cut in modern US history, expect for Ronald Reagan’s 1981 cuts. Including added interest expense, that plan would increase the national debt by $7 trillion over the next decade. A GOP –controlled Congress will almost surely approve a very large tax cut next year and while it won’t be as big as what Trump has proposed, it will be very large. The question is: How will they pay for it?
That’s where programs for seniors come in.
The Older Americans Act has been under enormous budget pressure for a decade. Even under President Obama, funding for most of these programs was flat even though the number of older adults using benefits was growing. The result: waiting lists in some communities for programs such as Meals on Wheels.
If Congress finances these tax cuts with across-the-board domestic spending cuts—something like Trump’s penny plan—senior services will almost surely get caught in the squeeze. So may other programs important to older adults such as low-income senior housing and NIH research into dementia and other diseases of old age.
But that’s not all. Trump says that one of his first priorities will be to repeal the ACA (what he calls Obamacare). While most of the public attention on the ACA is focused on the exchanges and their rising premiums, the law also includes important changes in the way health care is delivered under Medicare. These include ways for doctors to better coordinate care, which is especially important for seniors with multiple chronic conditions. If Trump and a Republican Congress repeal the ACA (and they almost surely will) many of those reforms will die as well.
Then there is Medicaid, which provides long-term supports and services to millions of frail seniors. Trump and the House Speaker Paul Ryan (R-WI) support capping the federal contribution to Medicaid, which is funded partly by the feds and partly by the states. Such a cap would limit the amount Medicaid will have available to pay providers such as nursing homes or home health agencies and will inevitably reduce care for seniors.
Finally, there is the matter of Medicare and Social Security. Ryan and other House Republicans have been trying for years to cap the government’s share of Medicare, a step that would lead to huge jumps in premiums for seniors, and to limit Social Security benefits by raising the retirement age, change the cost of living index, or other adjustments. In the campaign, Trump said he’d oppose those changes. But I would not be surprised if he accepted changes that Congress brought to him.
It is not possible to know now how deeply Trump and Congress would cut any of these programs, or when the cuts may be enacted. But based on what Trump promised in the campaign, older adults, younger people with disabilities, and their families should prepare themselves for a very different world.