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 Substitute Concurrent Budget Resolution, H. Con. Res. 14, because it sets the stage for massive cuts to programs critical to older Americans and their families. Members of the National Committee come from all walks of life and every political persuasion. What unites them is their passion for protecting and strengthening Social Security, Medicare, Medicaid, and the other programs that are so vitally important to older Americans.
Both sets of instructions in the Substitute Concurrent Budget Resolution lay the groundwork for devastating cuts to programs relied upon by millions of Americans. Once they are realized by the instructed Committees, the legislation 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. The reasons for this haste are clear: the American people strongly oppose gutting critical programs such Medicaid and the Supplemental Nutrition Assistance Program (SNAP) in order to pay for President Trump’s massive tax giveaway which will primarily benefit the wealthy and big corporations. Despite the denials by the President and Congressional leadership, these cuts are inevitable considering the spending cut targets the committees are pressed to achieve.
The Congressional leadership is clearly aware of the public’s opposition to enacting this massive transfer of wealth from the poor and middle-class to the ultra-wealthy, so a smokescreen has been devised to hide the true costs of the tax cuts from the American people. Utilizing a ‘current policy’ baseline is designed to hide the true costs of the tax cuts by pretending that making the cuts permanent will cost zero dollars, thus allowing those who support the Resolution to claim they are being fiscally responsible. This is a lie. Pretending that cutting revenue will not actually cut revenue is a fantasy created by those who profess to insist on fiscal responsibility while adding over $30 trillion to the federal debt – over 12 percent of GDP – by 2054. According to the Congressional Budget Office, making permanent the full panoply of tax cuts in the Tax Cuts and Jobs Act (TCJA) will cause debt held by the public to reach 250 percent of GDP by 2054 if interest costs are included. These stratospheric and unsustainable numbers only represent making the 2017 Trump tax cuts permanent; they do not include the long-term cost of the additional $1.5 trillion in tax cuts allowed to the Senate Finance Committee in the Concurrent Resolution.
Many Americans are rightfully concerned that the ultimate goal underlying such a dramatic increase in debt is to starve the nation of revenue as a means of justifying later legislation to cut the earned benefits Americans have paid for throughout their working lives: Social Security and Medicare. Elon Musk himself has called Social Security a Ponzi scheme, and cutting and privatizing this critical program, along with Medicare, have long been a goal of fiscal conservatives. Claiming the nation can no longer afford these critical programs becomes more believable once the artificial economic crisis caused by massive tax cuts becomes a reality.
It is important to emphasize that the decision whether to enact tax cuts need not be a binary choice. Proponents have claimed that if the full range of Trump tax cuts are not made permanent, lower- and middle-income taxpayers will suffer increases in their tax liability. However, this need not be the case. Congress could easily allow the tax cuts enjoyed by high income taxpayers and large corporations to expire, while making the remainder permanent. The fact that this option appears not to be under consideration by the Congressional leadership is a clear indication of the priorities of the President and the Resolution’s supporters.
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 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.
To help rationalize these tax cuts and contribute to the fiction that those who vote for H. Con. Res 14 are fiscally responsible, the reconciliation instructions for both the House and Senate committees of jurisdiction set the stage for massive cuts to programs critical to older adults. Despite professed assurances by President Trump and tax cut proponents, the spending cut targets simply cannot be met by eliminating so-called ‘waste’ and ‘fraud’. They will inevitably result in devastating cuts to both Medicaid and SNAP.
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 Congress 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 instruction to the House Agriculture Committee to find savings within the programs in its jurisdiction 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.
Despite historic restrictions on reconciliation changes to one of America’s most cherished programs, Social Security, concerns remain that the recent reductions being imposed on the Social Security Administration will be amplified. Recently the agency has reduced staff, already at a 50-year low while the number of beneficiaries continues to increase. Field and hearing offices have closed or are slated to close in many communities, which are critical for older adults and disabled individuals to access benefits, especially considering that certain critical Social Security, Supplemental Security Income (SSI), and Medicare requests are required to be in person. These cuts are already leading to long wait times and delayed services for constituents across the country. Those who are eligible for SSI, a critical part of the Social Security system that provides modest financial assistance for older adults who do not have sufficient income and resources to meet their basic needs, will face the greatest difficulties interacting with the agency.
Instructions for both the House and Senate also call for additional cuts across programs that support and empower older adults and their families. These programs include homelessness prevention, home-delivered and community meals, transportation access, falls prevention, chronic disease management, resources on Alzheimer’s disease and related dementia, support to long-term care ombudsman and adult protective services addressing maltreatment, and many more. We are further concerned about cuts to critical funding in the Social Services Block Grant (SSBG) and the Prevention and Public Health Fund (PPHF). These programs are flexible by design to allow states to operate effectively and efficiently. Cuts or elimination of these block grants would be devastating for many programs and result in fewer services. With fewer supports older adults are more likely to need a higher level of care at a higher cost.
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 Substitute Concurrent 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 large companies, would lead to making Americans less healthy.
Sincerely,
Max Richtman
President and CEO