Congress and President Trump took dead aim at seniors and younger people with disabilities this week. First, Congress voted to cut or freeze funding for key federal senior service programs. Then the House passed its bill to replace the Affordable Care Act—a measure that would make health insurance unaffordable for many people aged 50-64, allow insurance companies to sell policies that exclude important benefits for people with chronic conditions, and slash Medicaid spending for those who need long-term supports and services.
There were also a few relatively bright spots. In a spending bill that will keep the government running through September, Congress increased spending for subsidized housing for the elderly, approved small, largely symbolic increases in senior nutrition programs such as Meals on Wheels, and saved two other programs that help local communities fund senior services. In all, while it could have been worse, it was pretty awful.
Here are the lowlights:
Health insurance: President Trump has repeatedly promised a health system that would cover all Americans, but congressional Republicans had a different idea: to lower premiums for private insurance as much as possible. The House bill would do that by directly boosting prices for those 50-64, thus driving many of them out of the insurance market and cutting costs for those who are younger and healthier. It would also give states the authority to let insurance companies boost premiums even more for older people or those with pre-existing conditions. States could also let insurers sell low-cost policies that provide slimmed-down benefits. For instance they could sell policies that exclude prescription drugs or rehab services, limiting their value to older buyers. The bill would give states money to run high risk pools for those who cannot buy private insurance, but these have failed in the past. It remains to be seen whether additional funding in the House bill would improve the pools.
Medicaid: The House bill would slash the federal contribution to Medicaid—the federal program that provides critical long-term supports and services to about 6 million seniors and 10 million younger people with disabilities. The House bill would cut the federal contribution to Medicaid by about $900 billion over the next 10 years. Because the cuts are phased in, by 2026 the bill would reduce the federal share of the program by 20 percent. It would give states more flexibility in the way they serve frail seniors, but without the funding the program—and those who rely on it—would be much worse off.
Senior services: At the same time the House was cutting health coverage and Medicaid benefits, Congress was also approving a budget bill for the rest of 2017. President Trump had proposed severe reductions in overall domestic spending to help fund his border wall and increases in military spending. Congress rejected most of those cuts, but not all of them. And senior services took a hit.
In the end Congress froze—but did not cut– funding for most programs, continuing a decade-long trend. However, a few suffered significant cuts. The State Health Insurance Assistance Program (SHIP), which helps guide seniors through the complexities of Medicare, Medicaid and private insurance, was cut by 10 percent. The Senior Community Service Employment Program (SCSEP), which helps unemployed older adults get jobs with local non-profits, was cut by 8 percent.
Meals on Wheels: Congress ok’d largely symbolic increases (less than one percent) in federal nutrition programs such as Meals on Wheels. You may remember the firestorm last month when Trump proposed cutting a local grant program that helped support the meals programs. In the end, Congress saved the grant program and boosted direct funding for the nutrition program, though not by enough to shrink the waiting lists in some communities.
A bit of other good news: Congress boosted funding for two important senior housing initiatives, counseling assistance and the Section 202 subsidy program, which helps private developers finance housing for low-income seniors. The Sec. 202 program got $70 million more than last year, about a 16 percent increase. The other good news: The Senate is likely to scale back some of the most draconian provisions of the House health bill.
And now the bad news: Pressure on federal spending will only rise in the coming year, especially if Congress and President Trump get the huge tax cut they are pushing. While Congress saved most senior services programs this year, they will be under even greater pressure next year.