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.
- Create a new six-week family leave program, but exclude those caring for frail parents or other relatives with disabilities
- Abolish the Senior Community Service Employment Program (SCSEP)
- Cut funding for Food Stamps (SNAP) and shift the benefit from a voucher to a box of home delivered food.
Let’s take a closer look at a few of these proposals:
Medicare Drug benefit. Trump has proposed eliminating cost-sharing for seniors with very high prescription drug costs, but at the same time he’d increase out-of-pocket expenses for many others, especially those who have significant costs but have not quite reached the threshold where medicine would be free ($8,418 this year).
Other Medicare changes. The budget would reduce overall spending for the program by $236 billion over 10 years. Much of the reduction would come from cutting payments to doctors and other providers.
Older Americans Act and related programs. The White House would roughly freeze funding for the nation’s senior services programs, continuing a decade-long trend. It proposed very small increases in some areas, including nutrition programs such as Meals on Wheels, and would cut funding for others, such as falls prevention, elder rights support, and chronic disease self-management. The budget would cut funding for disability programs by about 30 percent.
Block grants. These are cash grants the federal government gives to cities and states to help support the social service programs they believe work best in their communities. The record of these programs has been mixed—they encourage creativity but also have resulted in some waste and fraud. As he proposed last year, Trump would abolish the grants.
Family leave. The idea has the support of Trump’s daughter Ivanka, Sen. Marco Rubio (R-FL), and some Democrats. But each time this proposal surfaces, it focuses only on parents of new-borns (and sometimes adoptees) but ignores the needs of families caring for aging parents and other relatives with disabilities. Families are not just parents and babies. There are millions of adult children—usually daughters–who put their paid jobs at risk by taking time off to help frail parents or disabled siblings.
Job training for seniors. The White House has, yet again, proposed killing the SCSEP program. It prepares low-income unemployed seniors to reenter the workforce, in part by getting them jobs with local governments or non-profits. Presidents Obama and Trump have repeatedly proposed ending the $400 million program but Congress has, in past years, saved it.
Food stamps. About 5 million older adults receive Food Stamps (called SNAP). Three-quarters live alone and many are disabled. Today, SNAP benefits are delivered through a debit card that people take to the grocery store. Trump would cut funding for the program by $200 billion over 10 years and require people to receive half their benefit in the form of a box of non-perishable food delivered to their homes. Direct delivery has some appeal for older adults who may struggle to get to the store. But it raises many questions, such as how it would respond to special diets and even how a widow with dementia could get the box from her doorstep to her kitchen.
Because Congress already has agreed to increase federal domestic spending by more than $60 billion in 2019, it is likely to ignore many of Trump’s proposals. But senior programs will remain under pressure for the foreseeable future.