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Sunday, January 21, 2018
HomeHealthThe Cruelest Cuts

The Cruelest Cuts

Poet T.S. Eliot once called April “the cruelest month.” But that was long before the Trump Administration delivered its detailed budget proposal to Congress on a day in May. The 24th, to be precise.

Trump and budget director Mick Mulvaney spared almost no one — children, women, working poor — from massive cuts in services and programs that have been called everything from “devastating” to “heartless.” The main beneficiaries are defense and not surprisingly, wealthy individuals.

The poor elderly will be among those hit hardest. For starters, the budget proposal slashes Medicaid spending by $627 billion. This comes on top of the House’s plan to cut the program by $880 billion under the American Health Care Act. Nine million older adults and people with disabilities are  “dual eligibles,” with income low enough to qualify for both Medicare and Medicaid. Medicaid helps pay for hospital costs, doctor visits, necessary therapy, medical equipment, and services that allow people to receive care at home, rather than the hospital.

Additionally, Medicaid covers more than 60 percent of all nursing home care, and it’s unclear what will happen to long-term care facilities — or their residents — if funding is so drastically curtailed.

What happens when the elderly can’t pay for needed medical care?

This budget also decimates SNAP,  the Supplemental Nutrition Assistance Program, with a $194 billion cut. Not only does SNAP help to ensure low-income kids and families get enough to eat, but it’s a lifeline for many older people as well. According to the Center on Budget and Policy Priorities, the program helped more than 45 million people in 2015 from going hungry. More than one-quarter of SNAP enrollees are older or disabled adults.

What happens when money to buy food runs out before the next social security check arrives?

Under this budget, the National Institutes of Health would see $87 billion axed. Biomedical research, including work on cancer and infectious disease, as well as food monitoring programs, would be devastated. Even The National Institute on Aging, whose mission is to foster healthy aging and extend healthy years of life, would lose $294 million. That’s less funding for research into Alzheimer’s and dementias, age-related disease, behavioral health, and social determinants of health like income and neighborhood environment. (The good news is that Congress actually appropriated $2 million more in funding for 2017, but that increase could be short-lived if this punitive budget passes).

Low-income energy assistance programs (LIHEAP ), the Agency for Healthcare Research and Quality (AHRQ), community services block grants, and health professions and nursing training programs — would all become victims of a $4.834 billion HHS retrenching. And, don’t forget about proposed cuts  to services for elderly veterans. Even some Republicans think these draconian measures are over the top.

credit: Gage Skidmore

Budget director Mick Mulvaney once tried to claim that home and community based services like Meals on Wheels don’t show any return on investment. Really?

Programs and services that benefit older adults, which help them to remain in their communities and in their own homes, offer plenty of “return on investment.” They reduce the burden on the health system, minimize hospitalizations and readmissions, reduce or avoid the need for nursing home care, and improve quality of life. Should the budget pass, these steep federal cuts mean states will be forced chop many services, forcing more older adults into nursing homes.

Cruel? It doesn’t even begin to describe this budget.

Image source:  Steve Slater, Creative Commons

Written by

Liz Seegert, MA, is the director of the Media Fellows Program at the GW Nursing Center for Health Policy and Media Engagement. She has spent more than 30 years reporting and writing about health and other topics for print, digital and broadcast media. Her primary beats currently encompass aging, Baby Boomers, health policy and social determinants of health. She edits the aging topic area for the Association of Health Care Journalists website, writing and gathering resources on the many health issues affecting older adults. She also co-produces the GW Nursing Center for Health Policy and Media Engagement “HealthCetera” podcast, diving into health issues underreported in traditional media. As a senior fellow, she will continue to report on vital public health issues, seeking out voices who offer unique perspectives on policy, health care and practice issues. As director of the Media Fellows Program at the center, she mentors early-career health journalists to build their understanding of these and other key issues within the health care delivery system.

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