Photo: Care worker Mabel and her patient Loreen at their doctor’s office in Los Angeles. (Photo by Louis Kravitz)
The stakes could not be higher for older adults in 2017, as President Donald Trump promises to unveil his health care plan in March and congressional leaders grapple with how exactly to repeal and replace the Affordable Care Act (ACA).
While the number of people 65-plus in the United States continues to rise, new leadership in Washington, D.C., is promising to dramatically reform and reduce the safety net on which so many seniors rely.
In the coming year and beyond, the new administration and Republican leaders in Congress have pledged to change programs essential to the wellbeing of elders in health care (ACA, Medicaid and Medicare), economic security (Social Security and Supplemental Security Income, or SSI) and social services (the Older Americans Act, Supplemental Nutrition Assistance Program and more) mostly in the form of budget cuts.
Cuts to any of these programs and services would increase the number of seniors living in poverty. What’s more, the cumulative effect would be even more devastating to older individuals.
Would Seniors Survive Cuts?
For instance, if Washington reduced Medicaid services, how would lower-income seniors survive, if they also found they had to pay even more for Medicare, and live on a smaller Social Security check? How will many get along with fewer Meals on Wheels, or fight an eviction notice without assistance from a legal services lawyer?
Millions of seniors living below or near the federal poverty line would face real harmif Congress and the White House weaken their health care or income security safety net programs. Seniors of color will be particularly impacted.
Higher rates of poverty and less overall wealth among black, Latino and other ethnic seniors mean they have fewer resources to fall back on in the event of cuts to programs like Medicaid, Medicare, SSI and Social Security. The official poverty rate for whites over 65 is 7.5 percent, while the level for older blacks and Hispanics are 18.4 percent and 17.5 percent, respectively.
The hottest domestic policy debate in Washington right now is the fate of the Affordable Care Act (ACA). An underreported element of the debate is the devastating impact that its full repeal would have on older adults and their families. ACA provided numerous direct and indirect benefits to older adults, which would all be at risk if the law is repealed without a replacement that includes those benefits.
ACA has expanded insurance coverage to 4.5 million adults ages 55-64, provided protection to seniors with pre-existing conditions and limited how high health insurers could raise premiums based on age. Those in the 50s and 60s may also face a hike [http://tinyurl.com/z8aecj6] in premiums for plans they bought on the ACA marketplaces.
Also called Obamacare, the law already allows insurers to charge older people up to three times the amount of premiums for younger people. New GOP proposals would permit a rate hike for older policy holders of five times.
Eldercare Innovations Threatened
ACA expanded the availability of programs enabling people to age at home and in their communities, rather than in nursing facilities, and it protects spouses of elders receiving Medicaid-funded home and community-based services from impoverishment.
In addition, the ACA launched a wave of innovative programs aimed at better integrating and coordinating care. Within Medicare, the ACA closed the burdensome prescription drug “donut” hole, forcing elders to spend thousands of dollars many didn’t have to continue getting their medications. The program also added free disease-prevention services, all while managing to extend the solvency of the Medicare trust fund. These benefits for older adults are now at risk.
It is important to note that repealing the ACA is only one of the current health policy debates in Washington. Other proposals would dramatically alter Medicare [http://tinyurl.com/jnmroc8] and Medicaid as well.
One such proposal would set federal spending caps on Medicaid through either a block grant to each state or per capita spending limits allowing just so much per person. Under either proposal, the federal government would contribute less money to the cost of Medicaid—a primary support for eldercare--and would impose fewer consumer protections for those who rely on the program.
The proposed change would provide states more discretion to limit Medicaid eligibility and to reduce or eliminate services. These proposals would slash as much as $1 trillion in federal Medicaid funding over 10 years, a funding decrease of nearly 25 percent over 10 years. percent. Because 22 percent of Medicaid spending helps older adults, there is no way a cut of this size would not impact their access to services.
Cuts of this magnitude would lead to new restrictions on eligibility, cuts to services and reduced payment rates to health care providers, whichwould mean fewer services and worse health for seniors most in need, especially older women and ethnic elders.
More Proposed Safety-Net Holes
While much of the domestic policy conversation since the election has focused on health care programs, it is likely that the new Congress will propose changes to other safety-net and social-insurance programs important to seniors. In December, a bill was introduced in Congress that would dramatically curtail Social Security benefits. [http://tinyurl.com/j9l7kwb] It didn’t pass, but expect it or similar bills to be back before too long.
In recent years, leaders in Congress have proposed numerous reductions to SSI [http://tinyurl.com/heomv47] and the Supplemental Nutrition Assistance Program [http://tinyurl.com/hzv2sdw] (formerly known as food stamps) benefits. The SSI program in particular is a critical safety-net program that provides a very basic income to those with few or no other resources.
Over half of the seniors receiving SSI benefits are family caregivers, who had less time in the workforce; were among the working poor; or were in seasonal, low-wage employment, such as farm work or domestic work—all jobs disproportionately performed by people from ethnic minorities. And more than two-thirds of seniors who collect SSI are women.
Remember “sequestration,” the automatic cuts Congress imposed on itself a few years ago when it couldn’t agree on a federal budget? Unless the new Congress acts to avoid its return in 2018, mandatory reductions will shrink many programs important to seniors, such as those for affordable housing, Meals on Wheels, elder-abuse prevention programs, legal assistance and more.
In the tough policy environment we’re facing today, it’s tempting to expect little and ask for nothing from policymakers. However, now is the time for advocates to advance an alternative vision to the current one in Washington, a new vision of justice and compassion that says we must take care of society’s most vulnerable, that says everyone should have the opportunity to age in dignity. It’s time to press the case for expanding the safety net so that all older adults have access to quality healthcare and sufficient income to meet their basic needs.
Kevin Prindiville is the executive director of Justice in Aging, a national legal advocacy nonprofit with offices in California and Washington, D.C.