The best that can be said about President Trump’s 2018 budget and older adults: It could have been worse.
In a fiscal plan focused on historic domestic spending cuts, programs for older adults were hit by substantial reductions, though not slashed as deeply as other domestic programs.
Medicare was largely untouched. So was Social Security for seniors, although Trump would tighten eligibility and reduce some benefits in the Social Security disability program. Spending for most senior services programs was frozen for yet another year while subsidies for low-income senior housing were increased.
The budget would also consolidate several Alzheimer’s disease-related programs into a single initiative, an effort that could provide more efficiency and flexibility to these grants.
However, Trump also targeted important senior services and other programs for deep cuts or even elimination. The Supplemental Security Income (SSI) program was trimmed. As he signaled in the “skinny” budget he released earlier this year, Trump proposed killing the State Health Insurance Assistance Program (SHIP), which helps older adults navigate the complexities of Medicare and other insurance. He’d eliminate the Labor Department’s $438 million Senior Community Service Employment Program, which helps older adults find jobs with local governments or non-profits. He’d also cut funding for the National Institute on Aging (part of NIH) by $294 million, or more than 20 percent.
In his preliminary budget, Trump created an uproar when he proposed killing a block grant program that helps local government run Meals on Wheels and other senior nutrition programs. The White House responded to the push-back by retaining Social Services Block Grant, though he’d slash its budget by 80 percent and eliminate the Community Development Block Grant program. The budget would keep, but effectively freeze spending, on the meals programs themselves.
On top of all this, the budget calls for an annual two percent across-the-board cut for all federal domestic spending except for Medicare and Social Security. That would result in deep reductions in all these senior services programs.
Then, there is Medicaid. The Trump budget would cut Medicaid spending by $610 billion, apparently on top of the nearly $850 billion cut in the House-passed health bill. Combined, by 2027 the federal share of Medicaid would be slashed nearly in half. It would give states more flexibility to operate the program, which by itself could improve services to beneficiaries. But the spending cuts would be catastrophic.
While most Medicaid beneficiaries are young parents and children, most of the program’s money is spent to care for young people with disabilities and frail older adults. In 2014, state and federal Medicaid spent $150 billion on long-term services and supports for people with functional limitations.
Slashing that funding would mean lower payments to providers, many of whom would likely drop out of the program, or cuts in services to beneficiaries. It could especially damage the home and community-based care programs in many states. All this would happen, of course, as the population of older adults is growing rapidly.
Congress is not going to pass this budget. But it does make it easier for lawmakers to make big cuts in federal spending. Think of it as a frame for the coming spending debate: At one end is holding spending at current levels. At the other are Trump’s major cuts. Congress is likely to end up somewhere in the middle.
While Trump’s cuts to federal programs for older adults would be severe, he’d slash services for low-income families with kids even more deeply. I suppose seniors should be thankful that it wasn’t worse.