U.S, House of Representatives
Washington, D.C. 20515
Dear Representative,
The National Committee to Preserve Social Security and Medicare, representing millions of older adults, writes in strong opposition to the House Budget Resolution, H. Con. Res. 14, because it sets the stage for massive cuts to programs critical to older Americans and their families. The Budget Resolution sets minimum spending cut targets which, when realized by the instructed Committees, would be fast-tracked through Congress with little time or opportunity for the American public to understand the impact of the cuts or to express their opposition to Congress. In particular, we strongly oppose the punitive spending cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP) that will be the inevitable results of the budgetary targets set by the Resolution.
Jointly financed by the federal government and by states, Medicaid is the nation’s largest health care coverage program, comprising 18 percent of National Health Expenditures (NHE) in 2023. As such, it is a central pillar of the nation’s health care delivery system, providing vital reimbursement for millions of jobs, and essential resources for hospitals, clinics, outpatient surgery centers and much more. It is particularly important to the long-term care sector, where the program is the largest payer. Medicaid paid more than one-half (61 percent) of total spending in the United States on all Long Term Services and Supports (LTSS) in 2022 ($415 billion as calculated by the Kaiser Family Foundation based on NHE data), followed by out-of-pocket spending (17 percent), and other public and private payers paying the remaining 21 percent.
In a long-lived society, the promise and potential of home care and aging in place — which are priorities for Republicans and Democrats alike — simply cannot be fulfilled without Medicaid. This is illustrated by the fact that Medicaid LTSS accounted for 32 percent of all Medicaid personal health care spending in 2021. The percentage of LTSS spending that pays for home and community-based services (HCBS) reimbursed by Medicaid has increased from only 10 percent in 1988 to 62 percent in 2020. By comparison, Medicare’s LTSS coverage is sharply limited, paying for some home health services (up to 90 days, but typically for much shorter periods), and up to 90 days of care in a skilled nursing facility (generally following a hospitalization, and with copayments of $210 per day for stays that exceed 20 days).
Expecting states to maintain Medicaid as a reliable source of health care and LTSS coverage if federal funding is slashed is not credible. Significant cuts to federal Medicaid funding would amount to a massive cost-shift to states, forcing them to consider dramatically raising taxes or severely cutting other parts of their budgets — particularly education. Many states would likely make draconian cuts to their Medicaid programs in the areas of eligibility, benefits, and provider and plan payment rates (the latter area already low in many cases). In turn, this will result in large numbers of people with disabilities — who have fought for decades for the opportunity to lead independent lives — without a secure source of health care coverage. This would also harm millions of older adults, many of whom need occasional or daily assistance in the form of home care as they age – and who, without access to HCBS, are more likely to end up in nursing homes, where costs are higher.
The toll on the nation’s 12.5 million dually eligible beneficiaries, who count on Medicaid to pay for (or partially subsidize) their Medicare copayments, deductibles and premiums — and which therefore allow them to access Medicare — could be catastrophic.
Finally, the impact on hospitals and other medical care providers from untreated or undertreated chronic conditions in medically vulnerable populations would likely fuel higher health care costs, defeating the goal of the Health and Human Services Secretary’s recently announced initiative to shift attention and resources to cost-effective upstream wellness-focused approaches.
Should the House of Representatives approve damaging policy that transforms Medicaid into either a fixed per state block grant program, or a per-person “per capita” or “lifetime cap” system, health care access for millions of Americans will rapidly deteriorate. Hospitals, doctors, nurses, home care aides, therapists, clinics, nursing homes, pharmacies and many more will not be able to provide care without a reliable payment source.
In addition to the cuts envisioned for the Medicaid program, the House Budget Resolution directs the Agriculture Committee to find savings within the programs in its jurisdiction that would inevitably result in massive cuts to SNAP. In addition to facilitating healthy eating for children and families, SNAP provides monthly financial aid to an estimated 7.2 million older adults according to the National Council on Aging (NCOA).
SNAP benefits help older adults maintain their independence and for some, can mean the difference between going hungry and enjoying nourishing meals without worry. Regular access to healthy food helps older adults prevent and manage chronic conditions, improve their resistance to illness, maintain strong bones, and lower their falls risk. Having SNAP benefits also frees up extra money for prescriptions, health care costs, and other expenses that improve one’s health. Cutting these benefits for seniors could easily result in higher costs for health care services rather than the budget savings envisioned by proponents.
Finally, while the House Budget Resolution will inevitably result in massive cuts to programs vital to the health and well-being of millions of older Americans, it simultaneously lays the groundwork for trillions of dollars in tax cuts that largely benefit the wealthy and large corporations. According to an analysis by the Department of Treasury on January 10, 2025, a full extension of all of the individual and estate tax provisions in the Tax Cuts and Jobs Act of 2017 (TCJA) alone will result in families in the top 0.1 percent, those with cash income of at least $3.5 million for a family of two, receiving benefits that account for 40 percent of the total cost of full extension relative to partial extension.
Partial extension would simply reverse the TCJA tax cuts for those with incomes above $400,000 and allow the business and estate tax cuts to expire as scheduled under current law. All families below the income thresholds would receive identical tax cuts under either scenario – only high-income and high- wealth families would not be benefited by the partial extension. Limiting the extension in this manner also reduces the overall revenue loss to less than one-half the cost of extending all of the individual and estate tax cuts and about one-third of the total cost if the business provisions are included.
Lavishing massive tax cuts on the ultra-wealthy and corporations at a time when seniors and their families are being told our country can no longer afford essential health care services or nutritious food is both callous and cruel.
For the sake of your constituents, we urge you to vote NO on H. Con. Res. 14, the House Budget Resolution. Passage of this budget framework will inevitably result in severe federal funding reductions in Medicaid and SNAP that would pave the way for taking health care coverage and nutrition assistance away from millions of Americans. Disenfranchising working Americans, individuals with disabilities and older adults, while using those proceeds to help finance lower taxes for wealthy persons and companies, would lead to making Americans less healthy.
Sincerely,
Max Richtman
President and CEO