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Adding Life to Years
by Dr. Lawrence J. Weiss
National Budgets and Program Cuts to Seniors
As Congress works to finalize funding for this fiscal year, the Trump Administration is requesting supplemental funding, mostly for defense and to start work on a border wall. To offset the cost, the Administration is expected to propose $18 billion in cuts to non-defense spending. These cuts would include eliminating the Senior Community Service Employment Program, nearly eliminating the Medicare State Health Insurance Assistance Program (SHIP) with just $3 million left, and cutting Senior Corps, the Community Services Block Grant, and Low-Income Home Energy Assistance Program. It is unclear at time of this writing whether Congress will consider and approve these proposals.
The Trump administration and House Republicans have signaled that tax reform will be their next goal after failing to repeal the Affordable Care Act (ACA or Obamacare). If they enact large-scale tax cuts, a big question will be how to pay for them. It’s possible that lawmakers will again look for savings from programs seniors rely on, such as Medicaid and other non-defense discretionary programs. Medicaid was slated for a $880 billion cut under the ACA repeal bill, and efforts to turn it into a block grant have been proposed for many years. Expect to see Medicaid targeted again in the future.
In addition, the Trump administration’s budget blueprint would eliminate other key senior programs such as the Corporation for National and Community Service, Social Services Block Grant, and Supplemental Nutrition Assistance Program (SNAP). The Older Americans Act was not mentioned in the blueprint, but the Administration’s detailed FY18 budget should be released in mid-May. That detailed budget is expected to include more proposed cuts that impact seniors.
The ACA is alive for now, but the fight is not over. The repeal bill failed in Congress, but there are regulatory and legal hurdles ahead. The Trump administration could choose to defund parts of the law, such as cost-sharing reduction payments that pay the deductibles and cost-sharing for some low-income enrollees. It also could choose not to promote or enforce other provisions, such as the individual mandate. Additionally, the Centers for Medicare and Medicaid Services (CMS) has already signaled an interest in allowing increased flexibility in state Medicaid programs. For example, CMS may allow states to impose work requirements or increased premiums and co-payments on their Medicaid beneficiaries. Times, they are a changing.
The federal budget debates remain contentious despite nearly $5 trillion in deficit reduction achieved in recent years. More than 75 percent of this has come through spending cuts, particularly in non-defense discretionary programs such as those of the Older Americans Act, Falls Prevention, Housing Counseling, Section 202 Housing for the Elderly, and the Low-Income Home Energy Assistance Program.
Despite a budget deal that was supposed to provide relief from spending caps for FY16 and FY17, we’re still seeing significant cuts in key programs. The Senate Appropriations Committee has proposed eliminating all funding for State Health Insurance Assistance Programs (SHIP) and cutting the Senior Community Service Employment Program funding by $34.4 million. The House Committee level-funds these programs and makes investments in a number of Older Americans Act programs.
Here are more details:
Medicare SHIP: We need to understand the A, B, C, and Ds of Medicare, which is often an overwhelming process. This process can also be a very isolating experience because seniors and people with disabilities don’t know where to get help. SHIPs provide local, in-depth insurance counseling and assistance to Medicare beneficiaries, their families, and caregivers. SHIP provided over 94,000 public education presentations last year. The Senate Appropriations Committee has proposed to eliminate all funding for SHIP for FY17. The House Committee has proposed level funding of $52.1 million.
Senior Community Service Employment Program (SCSEP): SCSEP is the nation’s oldest program to help lowincome, unemployed individuals aged 55+ find work. It matches eligible older adults with part-time jobs for community service organizations. Participants build skills and self-confidence, while earning a modest income. For most, their SCSEP experience leads to permanent employment. The Senate Appropriations Committee has proposed a $34.4 million, or 8 percent, cut in SCSEP for FY17. The House Committee has proposed level-funding of $434.4 million.
Falls Prevention: One in three Americans aged 65+ falls each year. In 2014, 2.8 million nonfatal fall injuries among older adults were treated in emergency rooms, with more than 812,000 of these hospitalized. Among older adults, falls are the leading cause of injury death. In 2013, $34 billion in direct medical costs was spent treating older adults for the effects of falls, with 78 percent of these costs reimbursed by Medicare. Both the Senate and House Appropriations Committees have proposed level funding for Falls Prevention for FY17: $5 million to the Administration for Community Living and $2.1 million to the Centers for Disease Control. Future funding is threatened by proposals to repeal the Affordable Care Act (ACA), and with it, the Prevention and Public Health Fund that makes the investment for falls prevention in the Administration for Community Living.
Chronic Disease Self- Management Education (CDSME): Chronic diseases account for more than 70 percent of deaths in the U.S. Older Americans are disproportionately affected by these conditions, which account for more than 75 percent of all health expenditures and 95 percent of health care costs for older adults. Over 90 percent of older adults have at least one chronic disease, and twothirds have two or more. CDSME is a low-cost, evidence- based disease prevention intervention that utilizes stateof- the-art techniques to help those with chronic diseases manage their conditions, improve their health status, and reduce their need for more costly medical care.
Social Services Block Grant (SSBG): Of particular concern is the threatened elimination of the Social Services Block Grant, the nation’s largest pot of human services funding ($1.7 billion) for states to serve vulnerable elders, people with disabilities and children. SSBG is the only federal funding going to adult protective services (APS) for responding to elder abuse. In 2014 (most recent data), 34 states used SSBG to fund state and local APS. As Chairman of the Budget Committee, Speaker Ryan proposed SSBG’s elimination. At a January confirmation-related hearing for HHS Secretary Nominee Price, when asked by a Senator about his past support for SSBG’s elimination, Price said there is “likely a better way to provide those services in a much more efficient, effective and economical way.”
Corporation for National and Community Service (CNCS): Each year, millions of individuals of all ages and backgrounds help meet local needs through a wide array of service opportunities through the CNCS's core programs. They are AmeriCorps, Senior Corps, and the Social Innovation Fund. These programs and others, such as the Volunteer Generation Fund, support projects in six priority areas: disaster services, economic opportunity, education, environmental stewardship, healthy futures, and veterans and military families. Here at the Center for Healthy Aging we have 3 AmeriCorps Volunteers in Service to America (VISTA) which provides full-time members to nonprofit, faith-based, and other community organizations, and public agencies to create and expand programs that bring low-income individuals and communities out of poverty. Senior Corps funds RSVP, Senior Companions, and Foster Grandparent programs.
Disregarding overwhelming public support and eight decades of strong bipartisan legislative support for national service, the Administration’s Fiscal Year (FY) 2018 budget calls for the elimination of the CNCS. Elimination of the CNCS would devastate more than 1,100 faith-based and community organizations, put 80,000 AmeriCorps members out of work, and prevent 270,000 Senior Corps members from providing vital service to their communities.
Your voice is needed more than ever as compromises are worked out to finalize FY17 and FY18 funding. We need to AGE OUT LOUD to our congressmen and women. What better way to add life to years!
Lawrence J. Weiss, Ph.D. is CEO of the Center for Healthy Aging. Dr. Weiss welcomes your comments on this column. Write to him at firstname.lastname@example.org or c/o Center for Healthy Aging, 11 Fillmore Way, Reno, NV 89519.