With the presidential election in less than two weeks, consumers, advocates, and providers should pay attention to what Barack Obama and Mitt Romney would do about long-term supports and services for the frail elderly and younger people with disabilities.

It is hard to know for sure, because neither man has said much. Yet, between the lines, there are important messages. The first is no matter who wins, federal budget constraints on programs for frail elders will grow. The second is there are key differences between the two men.

Romney, who vows historic reductions in overall federal spending in an effort to balance the budget, may slash programs that support the frail elderly and younger people with disabilities while, at the same time, give states more flexibility in the way they provide many of these services. By contrast, Obama would largely preserve the status quo—perhaps supporting more modest spending reductions while retaining federal control of most programs.   

The biggest difference: Romney’s plan to cap federal spending on Medicaid would mean big cuts in that program, which funds more than 40 percent of all paid long-term care costs.

Romney has not described exactly how his plan would work, but the Center on Budget and Policy Priorities, using Congressional Budget Office data, estimates that a proposal by his running mate Paul Ryan would cut federal funding for Medicaid by one-third, or $800 billion over 10 years.  Ryan’s plan (which Romney has not disavowed) would also give governors far more flexibility to operate Medicaid than they have today. Still, it is hard to imagine states finding so much inefficiency in the program that they could manage a 30 percent cut in federal funding without slashing benefits, provider payments, or both.

It is impossible to know how governors would divide that shrinking pie but it is hard to imagine long-term care would avoid cuts.  

Similarly, Romney has proposed to reduce all federal spending to about 20 percent of Gross Domestic Product in four years, implying deep cuts in non-defense government programs. Again, he has not said exactly what he’d cut, but independent analysts estimate that to keep his promises to balance the budget while cutting taxes, increasing Pentagon spending, and protecting Medicare in the short-term, he’d have to cut planned spending for all other government programs in half by 2022.

Among the programs that could be subject to such cuts: Meals on Wheels, subsidized senior housing, and transportation—all critical to frail elders trying to live independently at home. Budgets for these programs have been largely frozen for the past three years.

Romney has said—again offering no specifics—than he supports expanding community-based care for people with disabilities. But it is hard to see how his budget agenda would make that possible since he’d likely cut the infrastructure people need to live at home.   

Obama, for his part, has sharply criticized the effects of Romney’s Medicaid cuts on seniors. But he has essentially been silent on his own agenda for the frail elderly, those with disabilities, and their family caregivers.

The president’s newly issued Plan for Jobs and Middle-Class Security never mentions long-term supports and services. While his administration abandoned the CLASS Act—the piece of the 2010 health reform law that was intended to create a national voluntary long-term care insurance program—he has never said what he’d put in its place.  Romney, for his part, has been silent on long-term care insurance.

Obama does say that, unlike Romney, he’d preserve the basic structure of Medicaid. And the 2010 health law greatly expands federal spending for the medical care piece of the program—at least for the next decade. But if Obama tackles the long-term federal deficit, as he often promises, it is hard to see how Medicaid long-term care would be immune from any cuts.

Similarly, those non-Medicaid services such as Meals on Wheels would also be on the block in any Obama long-term budget deal, though they’d probably be at less risk than in a Romney Administration.

The bottom line: Long-term care is not on the radar screen for either of these men. For an idea of how remote it is, listen to Romney’s answer to a question about long-term care funding. Both have other priorities. And that suggests that should Congress and the next administration engage in a major deficit reduction plan, long-term care needs could easily be ignored, swept away by much more powerful tides of fiscal austerity.

That’s why it is so important for consumers and providers to advocate for those government programs that work, as well as create new grass-roots tools to support highly vulnerable frail seniors, younger people with disabilities, and their caregivers.