Elders and Technology

Trump's Budget and Medicare

(This is wonkier that usual in some places but I think it's important to know and I've tried to keep confusion to a minimum.)

Remember when, during the presidential campaign, Donald Trump repeatedly promised that he would never allow cuts to Social Security, Medicare and Medicaid? He said so at nearly every rally.

If you are still harboring a belief in any of Trump's promises, you must be part of his entrenched base, and in the case of his Medicare promise, he broke it “bigly” in his FY2019 budget proposal released on 12 February. You can read the entire budget here.

There are many good reasons not to like this budget but today's post is devoted primarily to Medicare, a program which, with my diagnosis of pancreatic cancer last year, is no longer theoretical.

Since then, there never once was a question of whether any procedure, surgery, treatment or care would be covered. Everything was. Or, to be clear, they were covered by Medicare along with my supplemental policy which takes up the slack of the 20 percent Medicare does not cover.

So well does this combined insurance work that already, eight months in, I have personally paid much more for medications under Medicare Part D than for medical care.

Now, as I get into the Trump budget Medicare particulars, keep in mind that the budget hasn't a chance of passing Congress. However, it is important for two reasons:

  • Essentially, it is a “values statement” from the president – what his priorities are for the people of the United States.

  • As we have seen on past issues and this week on gun control, the president's values are fungible. What he promotes one day can be withdrawn or condemned the next leaving no way to know what he will support.

So let's take the proposed budget as a starting place to keep in mind when later this year Trump and Congress try to craft a real 2019 budget and we will need to petition our individual representatives to do the right thing.

Trump's budget makes significant cuts to Medicare and Medicaid, $266 million from Medicare (mostly by reducing payments to physicians and skilled nursing facilities) and $1.1 trillion from Medicaid, both over 10 years. Among the changes are these:

Freezes most funding for the Older Americans Act (OAA) which supports home and community-based services that help keep elders in their homes and as independent as possible. This involves nutrition programs, in-home services, transportation, legal services, elder abuse prevention and caregivers support.

It also cuts funding for falls prevention, elder rights support, and chronic disease self-management.

Abolishes certain federal block grants that states use to fund social service programs they believe are beneficial for elders including Meals on Wheels.

Restructures the Medicare drug benefit [Part D] to reduce costs for some beneficiaries but raise them for others. This is complicated and not worth the effort of the details right now.

It is enough to say that the sickest patients would pay nothing after they reach the “catastrophic” threshold ($8,418 this year) while less ill beneficiaries would pay more than they do now before they reach the catastrophic level at which they pay five percent of drug costs.

No one knows how these changes would affect Part D premiums so let's be grateful this is unlikely to pass Congress.

Kills the Senior Community Service Employment Program (SCSEP) which prepares low-income, unemployed, older workers for re-entry into the workforce partly through jobs with local governments and non-profits.

In addition, the Trump budget proposal would gut the Supplemental Nutrition Assistance Program (SNAP) – also known as food stamps - by $17.2 billion which is equal to about 22 percent of the program's 2016 cost.

As the Washington Post noted, this would ”...bring a fundamental change to a program that for the past 40 years has allowed recipients to use SNAP benefits at grocery stores as if they were cash. SNAP provides an average of $125 per month to 42.2 million Americans.”

In place of about half the SNAP benefit, the Department of Agriculture would buy and deliver a package of food called “America's Harvest Box” which would include “shelf-stable milk, juice, grains, cereals, pasta, peanut butter, beans, and canned meat, fruits and vegetables.”

White House Budget Director and rich white guy, Mick Mulvaney, has compared this new program to Blue Apron. (Yeah, right.)

All these cuts and reductions come on the heels of the massive tax cut bill passed not long ago that primarily benefits rich people. CEO Warren Buffet announced this week that his investment firm, Berkshire Hathaway, gained a windfall of $29 billion dollars from doing absolutely nothing – just from the tax bill changes.

To people in Buffet's economic range, the cuts enumerated here today are too miniscule to even take note of. But to recipients, they can be life savers.

Nancy Altman is president of Social Security Works and America's leading expert on Social Security along with other government social programs. She wrote this in response to Trump’s FY19 budget proposal:

“Despite Donald Trump’s numerous promises during his presidential campaign to not cut Social Security, Medicare, or Medicaid, he proposes to cut all three in his just-released budget. And not just by a little. He proposes cuts of over $1.8 trillion to the three programs.

“On top of that, he proposes to slash Meals on Wheels, home heating assistance, and other programs on which seniors rely. It is noteworthy that Republicans just passed, for almost the same price tag, a huge tax giveaway to their donors.

“So that’s the Republican plan: save money by gutting programs for the elderly and transfer the savings to the billionaire class.”

As I said above, the presidential budget proposal has a long history of irrelevance and will not get through Congress. But pieces of it might and it is worth knowing this stuff to understand how many ways the federal government is willing to leave elders out in the cold – literally in some cases.


"...and Congress try to craft a real 2019 budget," - may we be working with kinder, stronger, smarter folks due to a 2019 party turnover in one or two chambers by then.

As you mention and we must not for a moment forget, this is a REPUBLICAN plan, not just that of our bleach-blonde boondoggie . Mr. Ryan and McConnell will speak of opposition, but will ACT by supporting his immensely cruel, Republican-serving policies in the end and bit-by-bit.

We must stand and support one another, regardless of our personal needs or lack thereof. For those who cannot and for our own spiritual health and survival.

Today's column is all too real, not wonky. I volunteer for Meals on Wheels, and yesterday during my delivery to people who are housebound, I had to call 911 for a woman who was panicked, hysterical, and in a great deal of back pain. She was all tangled in her oxygen lines, and in her agitation she had apparently fired her caretaker. She could not make her new phone work, so she was waiting for the M on W lady (me) to show up and help her. Another man on my route, a veteran, told me that he had just recently gotten a place to stay after a year of being on the streets. He has epilepsy and COPD. One can barely imagine how he survived that year, but he is now lined up for medication and supplemental oxygen.

I am 77 years old, have COPD myself, and recently recovered from a major health event that involved hospital stays and months of treatment. Medicare took care of the doctor/hospital/rehabilitation costs.

The reality is that the two people I saw yesterday, and myself, would not be alive today without the supplemental governmental services of medicare/aid, Meals on Wheels, Veteran's services, and many more. One has to acknowledge that cutting these services drastically reduces the longevity of old people who have serious chronic illness. Is that the real point?

This a comment on just one aspect of this very important (and no, not too wonkish) issue - the "America's Harvest Box". Similar to Blue Apron? It is to laugh.
When I read the published description, I immediately recognized it as exactly the same thing as the old tribal commodities, officially known the Food Distribution Program on Indian Reservations. On Feb. 25 this was finally addressed in the media by NPR on Weekend Edition, how Native Americans know all too well "How Might Trump's Food Box Plan Affect Health". (Granted, that particular program has seen some improvements over the years) But it was nasty, and avoided only if you had absolutely no money for groceries.

How immoral must you be to enrich yourself by cutting food and medical benefits to people who need them to survive?

Having just gone through my first major negative health experience-3 months of hospitalizations, doctors visits, and staying in bed for weeks trying to get well, this horrifies me.

Like you said, Ronni, much of this is covered by my supplemental and medicare but the Plan D meds have equaled my co pays some months.

My doctor prescribed a $349.99 a month medication-it wouldn't cure anything but 'may make you feel better'. I can't pay $350.00 to 'feel better' if it has no actual value to my conditions. If I want to feel better I'll get a massage!

But does not surprise me.

A food box plan instead MoW-how stupid these out of touch with reality people are.

Again it seems that it's criminal to be poor.

I am not surprised by any of this.

Thank you for laying out the scope of these proposed cuts. We're all going to need to make our voices heard to our elected officials to make sure these cuts don't come to pass. Broken promises, indeed.

As in everything related to low income people, the real message from Trump and all the GOPers is "just die."

Great information and comments.

On a personal note (and I think Ronni knows me well enough to understand)
Seeing a post about man in WH, Medicare, politics etc is such a good sign. It means Ronni is feeling better and ready to “tell it like it is”. That makes me happy!

They have the gall to call the low income "takers" and resent any help they (and we elderly ) get. `Jan is right - they want the low income and elderly to just die and leave their Lilly white wealthy country.

All of these cuts are infuriating, but the America's Harvest Box leaves me especially livid. In 1969, when my husband and I were newly married and living at Ft. Benning, GA, where he was in training with the Army, his pay was fouled up one month and he received practically nothing. During that month, I'm not sure how we would have survived had it not been for what were then called surplus commodities (same as Jackie discusses above). As she says, they were mostly nasty. We lived mostly on powdered milk (and this was in the days when it was even more unpalatable) powdered eggs, processed cheese and peanut butter, and were very thankful when the next payday rolled around at the end of that month. It is beyond insulting that the government is reverting to this plan again for those needing help with food. Oddly enough, I was going through some old papers recently and found a copy of an article from almost thirty years ago revealing massive fraud and corruption in this surplus commodities program. Fraud and corruption committed by those administering the program -- not those recipients lining up on the sidewalk for two hours in the early morning dark before food even began being distributed.

I am thoroughly disgusted with those who are making vast amounts of money for doing nothing, especially those who resent anything given to help their fellow human beings. Together, just a few of these businesses realizing windfalls in the billions of dollars could probably provide all sorts of help to small and mid-size cities which have been struggling since the demise of manufacturing, especially since the Great Recession. What a difference they could make in the quality of life for millions of people in need.

I can only hope the leader’s supporters, for whom many are needy recipients of the benefits and services slated for cuts and abolition, read this or other itemized facts describing any budget proposals.

Whatever, we all need to act to express our opposition to such budget proposals through voting out of office, at every opportunity, the proponents of these punitive measures. Prior to election time we must actively voice our protests to our Representatives, Senators, and pertinent officials.

Thanks for continuing to bring truthful facts to the forefront countering the con man misleading rhetoric to which we’re subjected on these budget matters, Medicare and Social Security.

Hope you’re continuing to gradually rebuild your body’s reserves and strength from the ordeal to which it has been subjected. Patience — when we’re older, more time to reacquire such residuals is required. I can personally attest that adequate sleep with rest as needed is a vital investment, so don’t deprive yourself of those zzz’s either.

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