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Wednesday, August 23, 2017

Reprinted with permission from Alternet.
By Kathleen Romig, Edwin Park, Michael Leachman, Tazra Mitchell / Center on Budget and Policy Priorities

 

(Editor’s note: President Trump’s 2018 budget destroys America’s social safety nets. It would badly hurt seniors and people with disabilities, roll back children’s health care, slash already stingy anti-poverty programs for single mothers and shift costs to states that cannot afford them—all while ludicrously saying it is compassionate. What follows are 20 specifics excerpted from blogs by economists at the Washington-based Center on Budget and Policy Priorities on how his budget would impact these people and programs.)

Hurting Older Americans

During the campaign, Trump repeatedly promised not to cut Social Security, Medicare, or Medicaid, which serve tens of millions of seniors. But the President has broken his promise to protect those programs and has proposed cutting or eliminating other critical supports for older Americans. Many seniors already struggle to afford the basics; the Trump budget would make it much harder for them to get by, while showering large tax cuts on the nation’s wealthiest people and profitable corporations.

1. Proposed Medicaid cuts.These threaten health care for older Americans — especially their ability to age in their homes and communities rather than institutions. Medicaid is the nation’s main payer for long-term care, including both nursing home care and home- and community-based services. The budget would cut Medicaid by up to $1.3 trillion over the next decade. That’s even more than the House-passed Obamacare-repeal health care bill, which would raise the number of uninsured by 23 million, according to the Congressional Budget Office (CBO). Facing steep cuts in federal funding, states would likely curtail essential services that enable seniors to remain in their homes, forcing many into institutional care.

2. Insurance premiums skyrocket.The House-passed health care bill, which the budget adopts, would hit older Americans who aren’t yet eligible for Medicare particularly hard. Premiums would skyrocket for many — for example, a low-income 64-year-old who buys insurance in the exchanges would face a 700 to 800 percent premium increase. Many wouldn’t be able to afford those steep premiums. The House bill would more than double uninsured rates among low-income 50- to 64-year-olds, CBO estimates.

3. Hunger among seniors would grow.The budget cuts would cause more elderly people to struggle to put food on the table. Under SNAP, or food stamps, households with an elderly member receive $128 in benefits each month, on average, helping them to pay for groceries. The budget would cut more than $193 billion — over 25 percent — from SNAP over the next decade. It would also end SNAP’s minimum monthly benefit of $16, cutting benefits for 1 million households with seniors.

4. Cuts in Social Security Disability Insurance (SSDI). Workers pay into Social Security to protect themselves and their families if they retire, become disabled, or die leaving family members to support. Most SSDI beneficiaries — nearly 6 million — are age 55 or older and can’t keep working until their full retirement age due to serious illness or injury. Though the President repeatedly promised not to cut Social Security, his budget cuts SSDI by tens of billions of dollars.

5. Cuts in rental and heating assistance.The budget’s deep cuts in rental assistance for low-income families would mean that more than 250,000 fewer households, roughly 60,000 of which include seniors, would receive housing vouchers. The budget would also eliminate the Low Income Home Energy Assistance Program (LIHEAP), which helps low-income people pay their heating and cooling bills. Some 40 percent of LIHEAP-eligible households include at least one person aged 60 or older.

6. Fewer social and community services. The budget cuts include the Social Services Block Grant, which helps states meet the specialized needs of their most vulnerable populations, such as helping seniors stay in their homes and preventing elder abuse. Another program facing cuts is the Community Service Employment Program, which connects 70,000 low-income, unemployed people aged 55 or older with part-time work each year. Yet another is Medicare’s State Health Insurance Assistance Program, which helps older adults with their Medicare benefits and doctor bills.

Hurting People With Disabilities

Trump’s 2018 budget would make it harder for millions of people with disabilities to afford the basics — food on the table, a roof over their heads, and access to health care. It cuts $72 billion over ten years from disability programs, including Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). And it would gut Medicaid, food assistance, and housing vouchers, compounding the hit to people with disabilities.

7. Social Security benefit cuts.The President repeatedly promised not to cut Social Security, but the budget cuts tens of billions from Social Security’s disability benefits. One proposal would halve retroactive benefits that disabled workers may receive — hurting, for example, a worker whose career is cut short by a car crash and who applies for benefits after struggling to return to work. Under current law, she can receive up to 12 months of retroactive benefits — a critical lifeline that can prevent bankruptcy or homelessness — but the Trump proposal would cut that payment in half. A beneficiary who would have qualified for 12 months of retroactive benefits could lose about $7,000 in earned Social Security benefits.

8. Pushing people into poverty and hardship. SSI protects the most vulnerable people with disabilities, including children. Most SSI recipients qualify based on a severe disability; 1.2 million children receive SSI for conditions such as Down syndrome, cerebral palsy, autism, intellectual disability, and blindness. One proposal in the budget would cut nearly $1 billion a year from SSI. It would cut benefits for the 1.4 million SSI recipients who live in households where more than one family member has a disability — hurting, for example, a family with children who share a genetic disorder. Some 70 percent of poor families caring for more than one child with disabilities already struggle to meet basic needs, and these cuts will make their lives even harder.

9. Unspecified cuts under “new approaches.” Two-thirds of the cuts to disability programs come from a vague proposal to “test new approaches to increase labor force participation,” which would slash nearly $50 billion from people with disabilities over five years. The proposal assumes that after five years of experimentation, the Social Security Administration (SSA) will find large savings. However, SSA has undertaken many demonstration projects over the years to test new ways to encourage beneficiaries to return to work, and they have consistently shown limited results or proved not cost-effective. Given disability beneficiaries’ severe impairments, their high death rates, and the struggles even rejected applicants face in supporting themselves, dramatic increases in work leading to large savings for Social Security seem very unlikely. Enabling people with disabilities to work to their full potential would likely cost, not save, money. For example, it would mean more Medicaid spending for things like the long-term services and supports that many people with disabilities need to work — not dramatically less. Slashing vital supports only makes it harder for people facing severe illnesses and injuries to get back on their feet.

10. Medicaid, food, housing cuts.Medicaid, another program the President promised not to cut, is essential for people with disabilities, but his budget would cut it by more than $600 billion on top of the already severe $800 billion in Medicaid cuts in the House-passed health care bill that would cause more than 20 million Americans to lose coverage. These cuts would make it harder for many people with disabilities to qualify for Medicaid, threaten the home- and community-based services that keep them out of institutions, and cut school funding for children with disabilities.

Deep SNAP, or food stamp, cuts would harm people with disabilities. The budget would cut more than $193 billion — over 25 percent — from SNAP over the next decade. It would shift costs to states and let them cut benefits for people who need help paying for groceries. More than one-fourth of SNAP participants have a disability, according to a forthcoming CBPP analysis, so these deep cuts would inevitably mean more hunger and hardship for people with disabilities. Housing cuts will mean about 110,000 people with disabilities would lose vouchers that help them pay the rent. The budget proposes deep cuts in rental assistance for families. More than 250,000 fewer households would receive housing vouchers, likely including 110,000 with people with disabilities. Eliminating vouchers will increase homelessness and worsen hardship for people with disabilities.

Millions of children would face the risk of losing their health coverage or going without needed care under the harmful changes to the Children’s Health Insurance Program (CHIP) and Medicaid that President Trump proposes in his budget. While proposing just a two-year extension of federal CHIP funding, the budget would immediately shift significant costs to states, reduce benefits and raise out-of-pocket costs for near-poor older children, and eliminate tools that help states enroll more eligible children. That’s on top of the large and growing cuts to children’s coverage that states would undoubtedly make over time due to the federal Medicaid funding cuts under the House-passed bill to repeal the Affordable Care Act (ACA) — which the budget not only incorporates but significantly increases.

11. Uninsured or higher out-of-pocket costs.The budget would repeal the requirement that states maintain their existing Medicaid and CHIP children’s eligibility levels through 2019 and not make their enrollment procedures for children more restrictive. That change would let states cut children’s eligibility in Medicaid and CHIP, or make it harder for eligible children to enroll. To be sure, some children losing their coverage could become eligible for subsidies to buy coverage in the ACA’s health insurance marketplaces. But some families may not be able to afford the higher premiums and other out-of-pocket costs that they’d generally face in marketplace plans as compared to CHIP. Of particular concern, a substantial number of children now on CHIP wouldn’t be eligible for marketplace subsidies at all due to the “family glitch” — under which the children and spouse of an employee with access to employer-based coverage are ineligible for marketplace subsidies, even if the employee can only afford employer-offered coverage that’s limited to him or her and doesn’t include other family members.

12. Shift significant costs to states.The budget would eliminate a 23-percentage-point increase in each state’s federal CHIP matching rate that’s scheduled to remain in place through 2019. That translates to about a $3.5 billion cut in federal financial support for state CHIP programs. The budget would also reduce federal CHIP funding for children in families with incomes above 250 percent of the federal poverty line. (States would receive only the regular Medicaid matching rate — 57 percent, on average — rather than the regular CHIP matching rate of 70 percent for such children, assuming that the 23-percentage-point increase ends.) That would affect the 28 states and Washington, D.C. that now provide CHIP coverage to some children above that income threshold. States would have to bear a much greater share of the cost of their CHIP programs. Consequently, they’d either have to contribute more of their own funds or, likelier, scale back their CHIP programs.

13. Reduce benefits and raise costs for older children. Before the ACA, some states covered near-poor children under age 6 in Medicaid, with older children in families above the poverty line covered through separate state CHIP programs. Thus, some families had children of different ages covered though two separate programs, and many families had to transition their child’s health care from one set of health care providers to another after the child’s sixth birthday. To simplify coverage for children, the ACA required states to provide Medicaid coverage to all children. As a result, the near-poor children who now receive CHIP-funded Medicaid coverage also get more comprehensive health benefits like Early and Periodic Screening, Diagnostic and Treatment (EPSDT), face no premiums, and likely pay lower out-of-pocket charges than they would in separate state CHIP programs. The budget would repeal this requirement and let states move these older near-poor children back to separate state CHIP programs.

14. Complicate state efforts to enroll children.States now have an option, known as Express Lane Eligibility, to use the eligibility information they’ve collected and rigorously verified to establish eligibility in other programs (e.g., SNAP) to streamline the enrollment of eligible children in Medicaid and CHIP. This option, enacted in the 2009 CHIP reauthorization and adopted by nine states, can boost enrollment and reduce administrative costs, as both a federal evaluation and the Government Accountability Office have found. The budget would let this provision expire.

Targeting Welfare for Single Mothers

Trump’s budget would cut the Temporary Assistance for Needy Families (TANF) block grant and Contingency Fund — which provide funds to states for short-term income assistance, work programs, and other crucial supports for poor families with children — by $22 billion over ten years. Such cuts conflict sharply with the stated goals, as stated in the budget, of reducing poverty and providing work opportunities to poor families.

15. Women and kids hit by GOP war on poor.Now, just 23 of every 100 poor families with children receive cash benefits through TANF, down from 68 of every 100 poor families in 1996 under the old Aid to Families with Dependent Children program, which TANF replaced. TANF would reach even fewer needy families under the President’s budget, putting families and children at risk of much greater hardship. The President claims that his TANF cut mirrors his decision to eliminate the Social Services Block Grant (SSBG), another flexible funding source that helps states meet the specialized needs of their most vulnerable populations. The SSBG is a $1.7 billion-a-year grant whose value also has eroded over time. It has lost 73 percent of its value since 1982, the first year of its implementation, due to inflation, funding freezes, budget cuts, and sequestration. When states faced budget shortfalls during the recession, a number of them diverted funding from cash assistance and other core services like employment assistance and child care to backfill state budget holes — even though the need for assistance increased.

16. Poverty and all its problems will deepen.The President claims that his budget lays a foundation for “American Greatness,” but cutting programs for low-income families with children, like TANF, misses the mark. Poverty conditions can harm children’s cognitive development, but even small income boosts can have a positive effect on the long-term outcomes of very poor children. TANF block grant cuts mean that fewer children will receive those critical resources that could help them thrive now and in the future. Rather than cutting programs for the neediest Americans to help pay for tax breaks for the wealthy, lawmakers should reinvest in TANF to ensure that low-income families have access to a minimum level of support to meet their basic needs.

Massive Cost Shift to States

Trump’s budget would shift massive new costs to states by cutting federal funding for health care, food assistance, and many other areas. States can’t afford to assume these costs without raising taxes significantly so, instead, they’d very likely cut many key investments and public services.

17. Medicaid cuts would ripple. Since Medicaid is jointly funded by the federal government and states, states would have to raise their own revenue to offset the lost federal funds or, more likely, curtail Medicaid eligibility and health care services to low-income seniors, children, parents, adults, and people with disabilities. (Here are state-specific estimates of the cost shift under the House Republican health bill.) The budget would also impose hundreds of billions in additional Medicaid cuts over ten years, shifting even more costs to states.

18. States would scramble for funds.The federal government has always paid the full cost of SNAP (formerly food stamp) benefits, which help ensure that low-income families have enough to eat even when a parent is laid off or otherwise can’t keep food on the table. The budget, however, would ultimately transfer 25 percent of SNAP benefit costs to states — a cost shift of $116 billion over ten years. If the 25 percent state contribution were in effect today, Texas would need to find $1.3 billion, which is roughly the state’s share of the annual salary of 64,000 teachers. States would have to pick up the tab or cut these critical supports to families.

19. Either higher taxes or parallel state cuts. The budget would shift costs to states for a wide range of other programs and services that the federal government now supports. It would eliminate a number of grants to states and localities in non-defense discretionary (NDD)spending, including home heating assistance to low-income households, grants to improve teacher quality, and funding for after-school programs. And it would eliminate the Community Development Block Grant and Community Services Block Grant, both of which improve conditions in low-income communities, as well as some housing programs.

These and other discretionary grants — as well as NDD programs as a whole — already have endured significant cuts due to the 2011 Budget Control Act’s tight annual funding caps and sequestration. The budget would cut overall NDD funding by another $1.6 trillion over ten years; by the tenth year, funding would be 41 percent lower than the 2017 level, adjusted for inflation. Grants to states and localities comprise a sizeable share of NDD spending, so those grants would likely be cut by hundreds of billions of dollars over the next decade, shifting even more costs to states.

20. A colossal wrecking ball across government. States are in no position to assume the massive additional costs that the Trump budget would impose. Many are still recovering from the Great Recession. State funding for higher education per student, for example, is still down 18 percent from before the recession and, in a number of states, K-12 funding per student also is still far below pre-recession levels. Meanwhile, state revenues are currently lower than expected in many states, leaving sizeable gaps in their ability to fund existing services — let alone the billions in additional costs they’d face under the Trump budget.

All This To Cut Taxes For The Rich

Illness and disability can happen to anyone — especially with advancing age. Serious illnesses or injuries push many people — including families caring for children with disabilities — into poverty, and many more struggle to afford basic needs. The President’s budget will make it much harder for seniors, people with disabilities, single parents and children to get by, even as he calls for extremely large tax cuts for the nation’s wealthiest people and profitable corporations. Moreover, it will massively shift costs to states, where there has been little indication that leguslatures and governors are inclined to raise taxes to maintain these safety nets.

 

Kathleen Romig is a Senior Policy Analyst at the Center on Budget and Policy Priorities.  She works on Social Security, Supplemental Security Income, and other budget issues.

Edwin Park is Vice President for Health Policy at the Center on Budget and Policy Priorities, where he focuses on Medicaid, the Children’s Health Insurance Program, and issues related to federal health reform.

Michael Leachman is Director of State Fiscal Research with the State Fiscal Policy division of the Center, which analyzes state tax and budget policy decisions and promotes sustainable policies that take into account the needs of families of all income levels.

Tazra Mitchell joined the Center in 2016 as a Policy Analyst in the Family Income Support Division.  Previously she worked as a State Policy Fellow and Policy Analyst with the North Carolina Budget & Tax Center.

 

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