Among the numerous cuts in the Trump administration’s proposed federal budget are critical services that are used to support older Americans. As leaders who, respectively, safeguard the health and well-being of 620,000 residents in Baltimore, and represent the interests of the 50-plus community and their families across Maryland, we are deeply concerned how the proposed budget’s significant cuts will devastate the health and well-being of older adults.
In Baltimore city, there are over 100,000 residents over the age of 60. One-in-six of these residents live below the poverty line. For older adults of color, that ratio is two-in-five. The proposed federal budget will worsen rampant disparities and will be disastrous to our city’s older adults.
First, this proposed budget will exacerbate the detrimental impacts of the Affordable Care Act “replacement” and sabotage the health safety net for seniors. Seventy percent of older Americans will require long-term care services, which include family caregiving, nursing facilities, and home health aides. Medicaid provides coverage for 60 percent of nursing home care and 40 percent of long-term care services and supports.
If Medicaid benefits were not available, millions of older adults would depend on their loved ones to care for them, even if they do not have the ability or the time to do so; millions more would be condemned to die alone. Medicaid also ensures the availability of health care services not covered by Medicare, including eyeglasses, hearing aids, and prescription drugs. These important services are now also in jeopardy.
Seniors not on Medicaid will find their insurance premiums increase by as much as 750 percent. Projections done by nonpartisan groups such as the Congressional Budget Office have found that the suggested plan will in fact cause the greatest premium increase in our country’s low-income older adults.
Second, the proposal decreases funds for two critical nutrition programs: home meal delivery and congregate meals. In Baltimore, these programs would lose nearly $1.25 million.
Through a partnership with Meals on Wheels, the Baltimore City Health Department provides more than 187,000 meals annually directly to seniors in their home. This is an important resource for home-bound older adults who are either permanently or temporarily unable to obtain their own groceries and cook their own meals.
Similarly, the congregate meal program provides daily meals to approximately 5,000 low-income older adults in Baltimore. The meals are delivered to senior centers, churches, senior housing facilities and community centers so that older adults can receive essential nutrition while preventing social isolation. The plan cuts the funding by half, meaning thousands of seniors currently served will be without the basic life necessity of food.
Aging in place
Third, the Trump administration’s budget decreases the ability of older adults to age in place. It eliminates the Low Income Home Energy Assistance Program, which provides funds to pay bills as well as repair or replacement of heating and A/C equipment. Its cuts to the Department of Transportation will impact senior transportation programs. Perhaps the most dramatic impact is the $6.2 billion reduction to the Department of Housing and Urban Development. This is the most severe cut since the 1980s and will put low-income seniors at immediate risk of eviction and homelessness.
Furthermore, the plan puts senior centers in jeopardy through a loss of more than half a million dollars to Baltimore City alone. Senior centers serve as the hub for older adults to find community resources and linkages to essential services such as legal and housing assistance, nutrition, and physical fitness. Transportation and mobility can be huge barriers, but senior centers provide a connection so that older adults and their caregivers can receive the same support services that would otherwise be out of reach. The proposal cuts nearly a quarter of the funding for senior center operations and will place Baltimore’s valued senior centers on the chopping block, thus further reducing opportunities for older adults to stay engaged and age in place.
Fourth, the budget eliminates several programs that help with employment and volunteerism for older adults. This includes the end of the Senior Community Service Employment Program, which provides job training to low-income job seekers over age 55.
It also completely cuts support for two volunteer programs that save Baltimore more than $2 million in employment costs. The loss of the Retired Seniors Volunteer Program means that the city would lose out on nearly 80,000 workforce hours. In Baltimore, nearly 200 older adults volunteer at 30 sites to assist with a number of programs — everything from front office support to assistance with the meal delivery program. The loss of the Senior Companion Program means that 66 retired adults, known as home companions, can no longer provide in-home voluntary care and support for 101 home-bound seniors. These home companions provide more than 153,000 workforce hours in service of their peers in need.
We cannot afford to place these inappropriate and illogical budgetary burdens on the backs of a generation of Americans who have already sacrificed so much for our country. Too many of our seniors are already spending their golden years trying to make ends meet. They are not retiring because they are still living paycheck to paycheck, worrying about health care costs, maintaining their aging homes, and figuring out where their next meal is coming from.
This budget sends the message that America’s seniors are facing these issues on their own now. This is unjust, unscientific, and simply bad policy.
Congress must harness its power of the purse to pursue health parity, and equity, for our older adults. It is the least they—and we—can do.
Dr. Leana Wen is the commissioner of health in Baltimore city and can be reached on Twitter at @DrLeanaWen and @BMore_Healthy. Hank Greenberg is the AARP Maryland State Director and can be reached on Twitter at @AARPMD.