Worcester Telegram & Gazette

Despite overwhelming voter support from older Americans, President Trump is making life difficult for them.

In its first six months, the Trump administration has threatened the benefits, social programs and health care infrastructure that support older adults. The ultimate impact will be worse health outcomes and less choice.

Due to sheer magnitude, federal spending on health care and benefits for older Americans is an easy target for an administration looking to cut costs.

Americans over 65 make up18% of the U.S. population and use more health care services than any other age group. National health care spending for this population reached nearly $5 trillion in 2023.

Though Medicare is the principal public health insurance program for older Americans, another major component of spending for them is Medicaid. It supports over 7 million older adults and serves as the primary payer for long-term supports and services, like nursing homes. It also pays for home- and community-based services like home health aides or adult day health care.

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Medicaid spent over $190 billion for these services in 2022. Without Medicaid, many older adults and their families will need to pay out of pocket — or go without.

This might become a reality.

The nonpartisan Congressional Budget Office estimates that the president’s “One Big Beautiful Bill” would kick an estimated 8 million Americans off Medicaid, including at least 2 million older adults. The bill would cut over $800 billion in federal Medicaid spending over 10 years, slashing federal matching funds to states and restricting states’ ability to collect certain taxes to finance their contributions.

As a result, states will likely have to restrict services, to the detriment of beneficiaries who remain in the program. Research shows that inadequate access to long-term supports and services can result in medication errors, becoming completely homebound, or experiencing suicidal ideation.

Social Security is also a target.

In the past, the Social Security Administration erroneously overpaid some beneficiaries. Now, the agency is ramping up the clawback of over $70 billion it paid out by mistake. The Biden administration reduced monthly payments to affected beneficiaries by 10% until the funds were recouped, but the Trump administration recently increased that to 50%.

Taxpayer money that was mistakenly overpaid should come back to the agency, but it’s critical that it minimizes harm while doing so.

For some recipients, Social Security checks make up 90% or more of their monthly income. They simply can’t survive on just half. Studies show that cuts would increase the chances of these older Americans experiencing food insecurity and homelessness.

The Trump administration has also moved to reduce or eliminate certain social services.

The Administration for Community Living, the Low-Income Home Energy Assistance Program and Community Services Block Grants assist low-income older people with home heating and cooling costs, provide hundreds of millions of meals, sponsor dementia training for health care professionals, and seek justice for older people who have been physically, psychologically and financially abused.

All three entities are on the chopping block.

Without these federal safety nets, local community organizations will face significant funding gaps, resulting in fewer — or simply no — programs like adult day health, Meals on Wheels, and transportation services. Some vulnerable older adults may no longer have the assistance they need to live safely and independently in their communities.

As a result, some may have no choice but to enter institutional care, which is more expensive than community-based care. This also runs afoul of many older Americans’ preference to age with dignity in their homes.

The last vulnerability is health care infrastructure.

First, the Trump administration has cut nearly $10 billion in biomedical research so far, eliminating dozens of studies on cancer, Alzheimer’s disease and cardiovascular disease. These are leading causes of death in America and disproportionately impact older adults.

There are also plans to eliminate grants and loans for medical school and direct care worker training programs, despite expected shortages of nearly 190,000 physicians and about 5 million direct care workers in the next decade. These shortages will occur in tandem with an aging population and the predicted doubling of dementia cases.

Physician shortages are particularly detrimental for the one in five older Americans who live in rural areas. With only 11 physicians per 100,000 rural residents, a Trump-exacerbated shortage will cripple older adults’ ability to access care in these communities.

Access to care is further threatened by an existing direct care worker shortage that promises to get worse under Trump. Shortages have resulted in about 800 nursing home closures since 2020, displacing nearly 30,000 residents. Cutting off federally funded career pipelines that sustain this workforce and keep long-term care facilities open is not in older adults’ best interest.

The Trump administration has taken an unconventional approach to governing, including a large-scale attack on the infrastructure that supports older Americans. Since this is a group that typically votes in large numbers, the fallout from decisions to slash their benefits, supports and health care coverage could have significant political effects, alongside detrimental health effects.

Katherine O’Malley is a senior policy analyst at the Boston University School of Public Health.