Being charged higher premiums for health insurance or possibly not being able to access affordable health coverage at all if you are in your early 50s to mid 60s is just the tip of the iceberg of what older people can expect from President Donald Trump’s proposed health care agenda. 

The Republican plan to repeal the Affordable Care Act is a sucker punch to the gut for this vulnerable and hard-to-insure age group, especially because it will no longer require big companies to provide a group plan and will raise the ceiling on how much older workers can be charged. But Trump’s budget announced Thursday delivered a second blow for older people. While funding for Defense, Homeland Security and Veterans Affairs is to increase, multiple programs that directly assist seniors are on the chopping block: 

1. The Low-Income Home Energy Assistance Program.

This program provides short-term aid to pay heating and cooling bills for 6.7 million people. Nearly one-third of households receiving this help have a member who is age 60 or older. LIHEAP is slated for elimination, literally leaving the poor out in the cold.

LIHEAP provides energy assistance to vulnerable households who suffer short-term financial difficulties due to illness, job loss or other unanticipated expenses. The budget proposal shows “a dangerous lack of understanding about the critical nature of this program,” said Michael Bracy, director of the Campaign for Home Energy Assistance, a Washington, D.C.-based group that advocates on behalf of LIHEAP. 

Bracy called the Trump administration’s plan to eliminate the program “nothing short of appalling.”  

2. Senior Community Service Employment Program.

This program trains and places low-income, unemployed seniors in unsubsidized jobs within the community. It is the only federal program that targets older workers in this way and it will be wiped out if the budget is passed as proposed.

For workers who are 55 years or older earning less than $20,000 per year, the jobless rate is three times higher than for older workers who earn above that threshold. And older workers take twice as long as younger workers to find employment. The toll of long-term joblessness on the emotional and financial well-being of older men and women has been well-documented. Those looking for work for six months or longer are more than three times as likely to be suffering from depression as those with jobs. 

SCSEP participants have provided more than 40 million hours of community service as they receive on-the-job training. 

3. Health professions and nursing training programs.

As the Baby Boomer generation ages, the supportive health care fields are going to become increasingly critical: whether nursing, physical therapy or home care.

In 2014, the latest year for which data is available, 46.2 million people in America were 65 years or older. They accounted for 14.5 percent of the U.S. population, about 1-in-7 Americans, according to the Department of Health and Human Services. By 2040, people 65 or older are expected to account for 21.7 percent of the population ― more than 1-in-5. And they will need help.

Trump’s budget would cut more than $400 million earmarked for medical training programs: His administration claims they don’t work. The American Nurses Association says the U.S. is “in dire need” of more than 1 million new nurses by 2022 to provide care for the aging population. Decreasing funding by $403 million will “significantly cripple” recruitment and training efforts for nurses to practice in rural and medically underserved communities, ANA president Pamela F. Cipriano said.

4. Section 8 housing for seniors.

The Department of Housing and Urban Development’s rental assistance program known as Section 8 will be reformed, according to the administration. HUD pays landlords the difference between what the household can afford and the rental cost of the unit. This is known as a Section 8 voucher. About 1.4 million households receive Section 8 housing assistance. Seniors account for 1-in-6 recipients of this aid.

Trump’s budget proposes a $6.2 billion cut from HUD next year ― a 13.2 percent decrease from this year’s funding level. HUD is expected to cut hundreds of thousands of vouchers from the program. Some public housing agencies have decided not to reopen waiting lists for Section 8 vouchers because of the uncertainty surrounding funding. 

More than half of all recipients who lived in federally subsidized housing in 2015 were elderly or disabled, and more than one-quarter of all households had a working adult, according to the Center on Budget and Policy Priorities. This is a real sticking point for the GOP, which has repeatedly opined that HUD rental assistance programs, such as Section 8 vouchers and public housing, actually obstruct upward mobility. Republicans say they should be aligned with cash assistance for “work-capable” recipients to “encourage” them to move toward jobs and economic independence.

5. Amtrak’s long-distance train service.

Trump wants to slash the Department of Transportation’s budget by 13 percent, which would, among other things, completely eliminate funding for Amtrak’s long-distance routes. 

The money is expected to be diverted toward making desperately needed repairs to Amtrak’s Northeast Corridor line which services far more people than the long-distance train lines. But this move will not serve older people.

Amtrak operates 15 long-distance routes across the nation, which are the only Amtrak service in 23 of the 46 states the company serves and as the AARP notes, older travelers make up as many as two-thirds of Amtrak’s long-distance riders.

6. Meals on Wheels may be dinged, but not eliminated.

The president’s budget cuts $3 billion in Community Services Block Grants and $1.2 billion in Community Development Block Grants, money that, in part, is used to support the popular Meals on Wheels program where volunteers deliver hot meals to shut-in individuals, many of them elderly. 

This is the only program not at risk of being eliminated ― no thanks to Trump’s budget, though. The grants that are being cut do help fund Meals on Wheels America, but aren’t its sole support.  The 5,000 home-meal delivery organizations around the country that operate under the Meals on Wheels umbrella get about 35 percent of their funding from the federal government, allocated by the Older Americans Act and distributed by the Administration on Aging within the Department of Health and Human Services. 

Early news reports that Meals on Wheels was in jeopardy led to a 500 percent surge in volunteers and 50 times more donations.

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