Congress took two big steps this week that could have a major impact on seniors and younger people with disabilities. The one that got the most attention, of course, was the Senate’s failure to pass a replacement for the Affordable Care Act. The second, which was barely noticed, was a series of key decisions by House Republicans on how much money senior service programs will receive next year. These choices will have a significant impact on older adults and younger people with disabilities in 2018 and in the future.
The collapse of the Senate Republican leadership’s health bill will preserve Medicaid as it is and could hold down insurance premiums for people aged 50-64 who are buying on the health exchanges. However, their ability to buy decent, affordable coverage in the future still remains uncertain and will depend on decisions the Trump Administration and Congress make over the next few months.
The spending bills, which are on a separate track from health legislation, are a mixed bag. Funding for most senior services programs would be frozen for yet another year, following a trend that began in the Obama Administration. Other programs would see significant budget cuts and a few would be killed outright. At the same time, a handful of programs for seniors would get more money than last year.
Let’s take these one at a time:
Medicaid: Both the House and Senate replacements for the ACA would have fundamentally changed the way the federal government funds Medicaid, a program that provides $150 billion annually in supports and services for older adults and young people with disabilities. The Senate version would have effectively cut the federal contribution by as much as one-third, while giving states much more flexibility in the way they run the program.
The funding cuts are now dead for the foreseeable future. It is possible that the Trump Administration will still increase state flexibility by, for example, more quickly approving waivers for home and community care or managed care. But whatever happens to a GOP health bill in the future, Congress is unlikely to make major changes to Medicaid funding any time soon.
The health exchanges. They will survive in their current form. The GOP effort to allow insurers to raise premiums for people 50-64 to five times what they charge younger buyers is dead. So are efforts to allow carriers to charge higher premiums for people with pre-existing conditions.
But the drama has not ended for people who buy insurance on the individual market, including those 50-64-year-olds. President Trump needs to decide what he’ll do with cost-sharing subsidies that the Obama Administration paid health insurers. If he kills those subsidies, as he often threatens, the individual market could collapse. In addition, unless the ACA’s incentives are strengthened, large numbers of young and healthy buyers will stay out of the individual market, driving up premiums for those who buy insurance on the exchange. As a result, unless Congress acts to redesign those incentives, older buyers may end up paying a lot more anyway, or buying less generous coverage.
Senior services funding. While everyone was focused on health care, the House Appropriations Committee was approving its 2018 spending plan for programs important to older adults. The National Council on Aging has added it all up here. For the most part, like Trump, it would freeze spending at 2017 levels. Nutrition programs such as Meals on Wheels and low-income energy assistance would get the same money they’ve received for years, even though demand for the services has increased as the Baby Boomers age. It is the same with Aging and Disability Resource Centers (ADRCs), respite care, and senior centers.
The National Institute of Aging would get a 20 percent increase, a big bump from Trump’s proposal to cut the institute’s budget by nearly one-third.
However, some key programs for seniors still would face deep cuts. The spending panel would slash by 25 percent the Senior Community Service Employment Program (SCSEP), which helps unemployed older adults get jobs in government or at non-profits. The House would also cut key block grant programs that state and local governments often use to fund senior services. Like Trump, House Republicans would eliminate the State Health Insurance Assistance Program (SHIP) that provides consumers with advice about Medicare and other insurance.
Senior housing. At a time when most domestic spending is under enormous pressure, both Trump and the House Republicans proposed boosting funding for the Section 202 program that helps developers build housing for seniors. The House bill would increase its budget by $71 million or nearly 15 percent.
All the panel’s recommendations are likely to be rubber-stamped by the full House but many could be revised by the Senate. While efforts to replace the ACA seem off the table, at least for now, the battle over funding senior services in 2018 is just beginning.