Yesterday, May 23rd, the Trump Administration released its proposed FY2018 federal budget. The budget, entitled “A New Foundation for American Greatness,” would have a wide-ranging and devastating impact on the nation’s safety net programs. It is not a foundation for a caring society. As noted by the New York Times, it “would cut deeply into programs for the poor, from health care and food stamps to student loans and disability payments, laying out an austere vision for reordering the nation’s priorities.”
The budget includes dramatic cuts that will harm older people, people with disabilities, and families, including the following:
The budget assumes the massive cuts to Medicaid in the House-passed American Health Care Act (AHCA) are enacted into law, and then adds to those cuts, totaling almost $1.3 trillion in Medicaid cuts over 10 years. Nearly 11 million low-income seniors rely on Medicaid for their health and long-term care. Though the budget claims to leave seniors out of drastic cuts, this could not be further from the truth. By destroying the Medicaid program as we know it, millions of seniors who rely on Medicaid for long term services and supports will be stranded, desperately in need of quality care and coverage.
The devastating Medicaid cuts outlined in the budget undermine the purported goal of AHCA, namely that the Medicaid per capita caps are designed to promote state flexibility and improve care to those enrolled in Medicaid. These proposed budget cuts expose the truth: the objective of the per capita caps is to provide a mechanism for essentially eliminating the Medicaid program, disregarding the pain, suffering and possible deaths that will result. The cuts will ravage low-income seniors and people with disabilities who are already struggling to stretch their modest incomes to cover food, medications, and other health care needs.
Medicare State Health Insurance Assistance Program (SHIP)
The Trump budget completely eliminates federal funding for the only program that provides free, unbiased direct support to Medicare beneficiaries to help navigate the complexities of enrolling in Medicare and ensuring that beneficiaries obtain access to the benefits for which they are eligible, such as low-income cost-sharing assistance. The budget states that individuals will be able to obtain this help online and through 1-800-MEDICARE. This is not true. Those avenues do not provide the critical help and education offered by the SHIPs.
The Trump budget cuts over $74 billion from Social Security’s programs, including Social Security Old-Age, Survivors’, and Disability Insurance as well as Supplemental Security Income. The budget proposes to cut up to $64 billion from Social Security Disability Insurance (SSDI). Despite misconceptions and misinformation on this issue, SSDI is a social security benefit that beneficiaries pay into, just as they do with Social Security Old Age insurance. Limiting funding for SSDI, the program that enables individuals under age 65 who have severe disabilities to obtain Medicare coverage, blocks Medicare access to these individuals. Based on this proposal, some individuals with severe disabilities may no longer be eligible for the Medicare benefits for which they are currently eligible.
In 2016, over 16% of the Medicare population – over 9 million people – are under age 65 and have very significant disabilities. As described by the National Academy of Social Insurance (NASI), almost 9 million working-age adults receive Social Security benefits due to a disabling condition that makes them unable to work. Most people receiving SSDI benefits are in their 50s or early 60s. Three-fourths of SSDI beneficiaries are over age 50, and one-third are over 60. Before becoming eligible for benefits, two-thirds of these workers had unskilled or semi-skilled jobs. Fewer than one in six have a college degree. While benefits are modest, they are of vital importance to the families that receive them. Over half of SSDI beneficiaries in their 50s and 60s rely on SSDI benefits for 75% or more of their total income.
The Budget’s sliding scale for multi-recipient Supplemental Security Income families that cuts SSI if recipients live together – including families – is particularly cruel. SSI’s benefits average only about $540 per month, or $18 per day, and are the only personal income for over half of adult recipients. The maximum federal SSI payment for an individual ($735 per month in 2017) is less than 75 percent of the federal poverty guideline for a single person. Nevertheless, SSI lifts roughly half of recipients out of deep poverty. This “Sliding scale” proposal would result in $9 billion in to cuts to SSI over 10 years. This punishing cut would devastate the poorest and most vulnerable individuals.
In addition to all the cuts discussed above, the budget would also make changes to Medicare appeals, making it even harder for beneficiaries to access needed coverage and care. One recommendation in the budget calls for eliminating the right to a hearing in instances where no material facts are in dispute. This would take away the right to a hearing for a broad range of coverage cases and would fundamentally harm an individual’s opportunity to plead his or her case, including when the decision makers who determine that a material fact is in dispute are wrong about the law. Center for Medicare Advocacy attorneys have represented individual beneficiaries in these kinds of appeals for decades. We often find that material facts are at issue, the law has been misapplied, and a hearing is fundamental to justice for the individual. Beneficiaries prevail in most ALJ appeals. Eliminating hearings would curtail Medicare beneficiaries’ due process rights.
Make no mistake, the Trump budget would cause great pain for families throughout the country. Despite misleading statements to the contrary, this budget is an all-out assault on the basic health care needs of seniors and people with disabilities – and on long-standing American values.
Despite the bad news, the work continues…
Center Submits Written Testimony to Congressional Committees
On May 16, 2017, the Senate Finance Committee held a hearing on “Examining Bipartisan Medicare Policies that Improve Care for Patients with Chronic Conditions.” The hearing focused on the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017. The Center submitted testimony for the record focusing primarily on barriers to full implementation of the Jimmo v. Sebelius settlement and coverage of maintenance level of care and services for individuals with chronic conditions.
On May 18, 2017, the House Ways & Means Health Subcommittee held a hearing on “The Current Status of the Medicare Program, Payment Systems, and Extenders.” The hearing focused primarily on proposals offered and analysis performed by the Medicare Payment Advisory Commission (MedPAC). The Center submitted testimony for the record focusing on, among other things, the current fiscal challenges facing Medicare beneficiaries, wasteful and inappropriate Medicare Advantage payment, and the need for Congress to address (and achieve savings through) prescription drug costs.
Center Works to Make Access to Speech Generating Devices Permanent
On May 16, 2017, Representatives Cathy McMorris Rodgers and John Larson, and Senators Bill Cassidy and Amy Klobuchar introduced the Steve Gleason Enduring Voices Act, which builds upon the successes of the Steve Gleason Act of 2015. The Steve Gleason Enduring Voices Act permanently fixes the Centers for Medicare and Medicaid Services (CMS) policy that previously limited access to speech generation devices for people who need them to communicate.
- The Act makes permanent the valuable changes made by the Steve Gleason Act of 2015.
- It allows Medicare payment for communication devices.
- It maintains the payment category for these personalized devices and lets people keep them for as long as they need them, regardless of care setting.
- It also provides coverage for the accessories needed to allow the devices to work effectively.