The inability of Congress and President Trump to agree on a government funding bill, and the shutdown it caused, could have a severe impact on the well-being of older adults and younger people with disabilities.
While Social Security and Medicare benefits appear safe, sufficient staff may not be available to issue or replace lost cards, or address eligibility issues. Funding for programs such as Meals on Wheels is at risk, as is subsidized housing for low-income seniors. Routine nursing home inspections are suspended.
How serious are these risks? That will depend on how long the shutdown lasts and whether Trump follows through on his threat to use the impasse as an opportunity to fire large numbers of federal workers, on the top of the tens of thousands of jobs he already has eliminated.
If the agency closures end quickly, the impact should be modest. Most shutdowns do, but during Trump’s first term one lasted 35 days. Similarly, if Trump’s vow to fire more federal workers is hollow, it will do little more than add to uncertainty. If he is serious, and I suspect he is, the consequences would be substantial. One health care expert called it, “an earthquake.”
How We Got Here
We got here because congressional Democrats are demanding that a government funding bill extend subsidies for low- and moderate-income enrollees in Affordable Care Act insurance.
Republicans say they’ll negotiate a fix only after Congress approves a spending bill. Democrats say they can’t trust the GOP to follow-though. Republicans refused to address the issue in a previous spending bill or in the huge tax and immigration bill they passed in July.
Without a fix, average annual premiums would more than double to $1,900, according to the research group KFF.
Overall, 750,000 federal workers are being furloughed as a result of the shutdown. That includes about 40 percent of the staff at the Department of Health and Human Services, which manages Medicare, Medicaid, and programs funded under the Older Americans Act such as Meals on Wheels, Area Agencies on Aging, falls prevention, and respite for family caregivers.
Here is a look at what the shutdown means for federal programs for older adults and younger people with disabilities.
Social Security: Benefits remain funded. Nearly 90 percent of the Social Security staff will continue working, though they won’t be paid during the shutdown. However, some services may be delayed or suspended. Supplemental Security Income (SSI) is funded separately from the old age program but should have enough money to pay benefits through the end of the year.
One issue to watch: Social Security’s annual cost of living increase is calculated based on the October consumer price index. But the Bureau of Labor Statistics that calculates the CPI is shuttered for now, so the cost-of-living adjustment could be delayed.
Medicare and Medicaid: Providers still will be paid
The Older Americans Act: OAA programs face two risks. Nearly half of the HHS staff that manages these programs was fired by the Trump Administration earlier this year. Some were brought back temporarily, then fired again. Now, nearly all the remaining staff has been temporarily laid off due to the shutdown.
How will this affect seniors? Take Meals on on Wheels, perhaps the best known of the OAA programs. About 90 percent of its local operators receive federal dollars and 60 percent get at least half their funding through the federal government.
Officials at Meals on Wheels America, the group that represents providers, estimate a typical local organization probably can continue services for a few weeks without major disruptions. But these groups generally have few cash reserves and likely would have to delay or suspend deliveries, or put more seniors on waiting lists, if the shutdown is prolonged.
Federal grants to these local organizations generally are for a year or two and must be regularly renewed. However, with HHS staff furloughed and funding suspended, renewals may now be impossible. That would leave some providers, and the older adults who rely on them, with no federal funding.
Senior housing: Many low-income older adults rely on rent subsidy programs such as Section 8 and Section 202. Rental assistance probably could continue with existing funding for a month or two but then would end. Except for deals close to closing, new projects in process likely would be halted.
The law firm Nixon Peabody estimates that during the 35-day government shutdown in 2019, 1,000 housing contracts expired and were not renewed until the government re-opened. At that time, developers were allowed to use reserves to cover shortfalls and later reimbursed by HUD. But since HUD has been silent about how it plans to handle the current shutdown, it is not clear what would happen this time.
Longer term, Trump’s 2026 budget proposed slashing the HUD staff by more than 40 percent. It would be a prime target if he uses the shutdown to fire more federal workers.
It is impossible to predict how long this episode will last but it feels like it could be a while. One possible inflection point: Over the next few weeks, ACA enrollees will learn how much their 2026 premiums will increase, absent those subsidies.
Already, several Senate Republicans are looking for a way to save the premium assistance. Those notices will add to the pressure to reach some agreement. But will enough GOP lawmakers be willing to buck Trump? And what would happen to federal assistance for older adults and their families if they won’t?
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