What the Trump Budget Would Mean For Seniors

While most proposals in President Trump’s newly released 2019 budget are unlikely to become law, the fiscal framework does show the White House’s priorities for government over the coming year. And those apparently don’t include support for older adults, younger people with disabilities, or their families.

For example, the budget would:

  • Restructure the Medicare drug benefit to reduce costs for some beneficiaries but raise them for others.
  • Reduce overall Medicare spending by $236 billion over 10 years.
  • Freeze most funding under the Older Americans Act.
  • Eliminate key federal block grants that states use to fund programs for seniors.

Today’s Massive Budget Deal Makes Big Medicare Changes

The huge two-year budget agreement reached by Congress early this morning will, for the first time, allow Medicare to pay for some long-term supports and services. Medicare managed care plans, called Medicare Advantage (MA), can now include non-medical services, such as home-delivered meals or rides to a doctor, in their benefit packages.

The bill includes other changes to Medicare, including relief for seniors in the drug benefit’s infamous donut hole and the death of a government panel aimed at controlling program costs. It may also set the stage for raising Medicare premiums for high-income seniors and reduce funding for a public health program aimed at addressing conditions such as diabetes, and heart disease.

What We Don’t Know—But Should—About Assisted Living Facilities

Here’s a word association game: I say, “long-term care” and you will probably respond, “nursing home.” But the truth is that there are nearly twice as many assisted living (ALF) and other residential care facilities (more than 30,000 in 2014) in the US than nursing homes (about 15,000). And there are more than 800,000 people living in residential care facilities, almost equal to the roughly 1 million living in nursing homes.

Many of these ALF residents have high care needs. About 40 percent have dementia—many living in separate “memory care” units of larger facilities. Half are age 85 or older and more than half need help dressing or bathing. It is more than a cliché to say that assisted living is the new nursing home.

A New Public/Private Long-Term Care Financing Plan

Two years ago, the Long-Term Care Financing Collaborative proposed a public catastrophic long-term care insurance program. In effect, people would use private insurance, savings, or home equity to pay for the first few years of their care needs, then the government would pick up costs for people with true catastrophic needs. Today, two highly-respected long-term care experts offered an important refinement to that basic structure: A plan that ties the time period before insurance benefits are available to a person’s income. As a result, lower-income people could access new benefits sooner than higher-income people.

Are Medicare Managed Care Plans Steering Members To Low-Quality Nursing Facilities?

Last year, a friend with complex medical needs had multiple stays at a skilled nursing facility (SNF). He was a member of a Medicare Advantage managed care plan and, as a result, could choose among only a handful of in-network facilities within a reasonable distance of his home. The care he received at the available facility was poor and since observing his experience, I wondered whether it was typical for a Medicare Advantage member. A new Brown University study suggests it might be.

What Medicaid’s Work Requirement Means For Frail Seniors, People With Disabilities, And Their Caregivers?

The Trump Administration announced last week that it will allow states to require Medicaid recipients to work, take job training, or do community service to stay eligible for the program, which provides both medical and long-term care services for people with low incomes. Ten states have asked to make this change, and the administration has given the greenlight to the first—Kentucky.

What will the requirement mean for older adults, younger people with disabilities, or their family caregivers? In general, older Medicaid recipients (starting between the ages of 50 and 65, depending on the state) would be exempt from the work requirement—as  would children under 19 and pregnant women. Thus, an 85 year old widow with dementia will not have to get a job in order to keep her nursing home benefits.

Giving Family Caregivers A Seat At The Policy Table

When Congress and the White House develop health or long-term care policy, they hear plenty from providers, drug or medical device makers, and scores of other lobbyists and advocates for various interests. But they rarely hear from family caregivers—those people in the trenches who struggle every day to assist their loved ones. On Monday night, Congress passed a bipartisan bill that may give family caregivers a seat at the table.

What Do We Call Aging Baby Boomers?

Are you ready for a new debate over what to call old people? This happens every few years:  We’ve tried senior citizens, seniors, the elderly, elders, retirees, and even gerontos. Lately, “older adults” seemed to be catching on. That’s the phrase I mostly use though it is not entirely satisfying either. Older than who?

Then there are the euphemisms for old age itself: Three decades ago, the British historian Peter Laslett created the phrase “Third Age.” Later, the marketer Ken Dychtwald spun it into the age wave. Actress Jane Fonda (who is 80) has a Ted Talk called “life’s third act.”  

In The Coming Debate Over Medicare, Remember How Much Seniors Pay

House Speaker Paul Ryan (R-WI) promises that 2018 will be the year Congress attempts to reduce spending on big federal programs like Medicare. As that debate unfolds, keep this in mind: A 65-year old woman will need to have put aside $95,000 to have a just a 50/50 chance of paying her Medicare premiums and prescription drug costs over her remaining lifetime. If she wants to 90 percent chance of paying her Medicare bills, she’d need $147,000. The estimates are from the Employee Benefit Research Institute.

What the GOP Tax Cut Will Mean For Older Adults

Congress is nearing passage of a $1.5 trillion tax cut that would mostly benefit businesses and high-income households. For older adults, the effects are complicated. Some will receive large tax cuts. Some will be no better off and a few will be worse off. But beyond the immediate tax changes in the bill, the measure sets the stage for what promises to become a major battle in 2018 over critical programs such as Medicare and Medicaid, and over the way future Social Security benefits are calculated.