(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 What he promotes one day can be withdrawn or condemned the next leaving no way to know what he will support.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.