It’s hard for us mere mortals to keep track of the budget negotiations currently ongoing in Congress. But that doesn’t negate the fact that for many older adults, the ultimate legislation passed by Congress and signed into law by the President could have a profound impact on your health and well-being, especially regarding the health care you can access and the services that will be available in your communities. In earlier agebuzz posts, we’ve already touched on how government cuts to staff and budgets for Social Security and Medicaid will affect those who rely on these programs (9 out of 10 adults 65 and older receive Social Security). While politicians have vowed “there will be no cuts to Social Security, Medicaid or Medicare,” (with the proviso that they are going after “waste, fraud and abuse” in these programs) the reality is that current fiscal and budget negotiations appear reliant on cuts to these programs to achieve political goals, though this is a moving target and no one is yet 100% sure of exactly what the final bill will look like. One certain thing, however: Voters across the spectrum, including many who identify as Republican and who voted for President Trump, are not happy with the provisions currently being discussed- and the more voters are informed, the less happy they are. According to the most recent Kaiser Family Foundation polling, nearly ⅔ of the public holds unfavorable views of the currently negotiated “Big Beautiful Bill” that was narrowly passed in the House and is now being debated in the Senate. In fact, it seems the more informed voters become about the content of the bill, the less happy they are with it. As the Kaiser Foundation stated, “When people hear facts and arguments about the bill’s impact on healthcare, support shrinks and opposition grows, including many MAGA supporters.” Whether this voter unhappiness will shape the debate and outcome is unclear. But what is clear is that if you have strong feelings one way or another, now is the time to let your Congressional representatives know where you stand.

So, what are some possible ramifications for Medicare that may come out of this bill and further budget proposals from the Trump administration? As an overview, the Kaiser Family Foundation has created a chart that compares the current law as it now stands, the House version of the bill, and the current Senate negotiations of the bill. One of the biggest concerns about the current negotiations in Congress is the potential for serious deficit spending that would be generated by passage of the bill, and therefore, would trigger what’s known as the statutory Pay-As-You-Go Act, which would require automatic spending cuts of approximately $500 billion of the Medicare budget. These cuts would be automatically triggered and could lead to lower reimbursement to Medicare providers and less available and accessible health care for Medicare recipients. While it is possible that Congress could waive these automatic cuts or could otherwise offset the deficit impact of the bill, neither of those solutions is certain, given the current tenor of negotiations. 

Looming in the anticipated cuts of hundreds of millions of dollars of Medicaid spending is another provision that will deeply hurt hundreds of thousands of low-income Medicare beneficiaries. You may or may not be aware that for many Medicare beneficiaries living at or near the poverty level, the co-pays and premiums required by Medicare are simply not affordable, especially when an impoverished Medicare beneficiary also needs to pay for food, rent, utilities, and other necessities. Within state Medicaid programs, there is a program known as “The Medicare Savings Program,” which helps financially vulnerable Medicare beneficiaries afford the health care they require. While the program is a lifesaver for so many, there are still thousands who would be eligible but are either unaware of its existence or have been unable to go through the application process. The Biden administration developed a streamlined application process to essentially auto-enroll eligible Medicare beneficiaries, to get more Medicare recipients the financial support they need. However, the bill now being debated would block the implementation of this new streamlined application process (presumably to save money), thus leaving many beneficiaries out in the cold or unable to meet the cumbersome requirements of the existing process, and thus lacking the care that they are otherwise entitled to. Researchers have estimated that there could be up to 18,000 premature deaths of Medicare beneficiaries because of this decision to block the streamlined implementation. As one commentator has noted, “This is an attempt to strangle people with red tape.” For an excellent article further explaining the details of this effort to prevent Medicare beneficiaries from receiving financial support they are eligible for, click here. There are also provisions in the bill now being debated to block Medicare eligibility for documented immigrants with legal status who have paid into the system over the years but may now be denied access to Medicare benefits.

There is also the possibility, not in the bill itself but in other proposals on the horizon from the Trump administration, that may affect your choice of Medicare options going forward. According to a recent article in Market Watch, Medicare Advantage plans, which are more costly and which many recipients decide to leave after a certain point, due to a lack of access to quality care, may become the default Medicare option for new enrollees. Currently, the default is traditional Medicare, but if that changes, many new beneficiaries might be forced into plans that limit care and require burdensome prior authorizations. There are even reports that President Trump would like to fully privatize Medicare at some point. On the flip side, many Medicare Advantage programs are under scrutiny for practices that appear to pressure physicians to code for as many diagnoses as possible, thereby raising reimbursement rates for these private companies. There is word that Senate negotiators are looking at this practice as a way to save more money for Medicare, which could in turn affect the services and offerings these plans provide to current Medicare beneficiaries. 

Given the state of the world, it is unclear exactly when and under what terms this bill will finally be passed into law. But the likely outcome is that older adults, especially those who are financially and medically vulnerable, are likely to feel the impact of this legislation for many years to come.