The Senior Citizens League (TSCL) Monthly Washington Update for the end of February 2025
Unless you don’t watch, read, or listen to the news, you know things are happening in Washington at a dizzying pace. Not all the news pertains specifically to seniors, but much of what has been happening in Congress does.
Last month, we explained how Medicaid affects so many seniors in America, and it has been in the spotlight for the previous two weeks as Congress has worked on a new budget for the 2026 fiscal year (FY). But before they get to that, they must pass a budget for the remainder of the 2025 fiscal year. We cover those issues below, and our information is as up-to-date as possible.
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FY 2025 Federal Budget Still Up in the Air
Congress was supposed to have finished passing a budget for the 2025 fiscal year by the end of September of last year. As is usual, no matter which party is in control, they didn’t get it done. Instead, they have passed a series of “CRs,” continuing resolutions, which have kept the federal government open and operating at the same funding level as in FY2024, but with a number of exceptions.
The CR that has kept the government open will expire on March 14. Unless Congress can pass either another CR or a bill to fully fund the government for the rest of the fiscal year, the government will shut down.
The latest information coming out of Congress is not encouraging. There were three shutdowns during President Trump’s previous administration, including the longest one in history.
Both parties are trying to blame one another for a shutdown if it occurs, but the fact remains that Republicans control both houses of Congress. However, there are deep divisions among them, primarily about how deep the cuts in government spending should be. That means it is likely that Republicans will need the votes of a few Democrats to pass the needed legislation. Despite that, Republicans don’t seem to want to make a deal with Democrats and agree to some of the policies the Democrats are asking for in return for the votes.
The Constitution specifies that Congress controls all matters pertaining to government spending and that the job of the President is to see that “the Laws be faithfully executed.” Democrats view the cuts that President Trump has been making as a violation of the constitutional separation of powers through unilateral moves such as shutting down agencies and mass firings of federal workers. They want assurances that President Trump will implement the spending bill as Congress writes it.
Republican leaders in Congress have floated the idea of a long-term CR that would fund the government at current levels through the end of September, while leaders in both parties on the committees that deal with appropriating funds are seeking a short-term extension that would give them more time to finish the funding bills. President Trump endorsed the long-term extension on Thursday night of last week.
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Medicaid – On Chopping Block or Not?
In our update last month, we explained what Medicaid is and who it helps. Briefly, Medicaid is a joint federal and state program that provides health coverage to over 72 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Medicaid is the single largest source of health coverage in the United States.
Millions of seniors and older Americans rely on Medicaid coverage. Approximately 7.2 million Americans over sixty-five are enrolled in Medicaid, and more than 11 million Americans aged 50 to 64 have health coverage through Medicaid.
Nearly 6 million older adults live below the federal poverty level. Medicaid is a lifeline for millions of seniors and older Americans on fixed incomes.
Medicaid funds nearly half of long-term care nationwide. As seniors age, long-term care services become more essential, serving about 70 percent of seniors who will need some form of long-term care in their lives.
Medicaid pays for about 62 percent of long-term care residents in nursing homes. In 2019, this totaled over $50 billion. The median private nursing home room cost over $100,000 yearly in 2024.
Approximately 12 million seniors who are covered by Medicare also have Medicaid coverage. Nearly 8 million of the dual eligible Medicare-Medicaid beneficiaries are “full benefit” Medicaid enrollees who have access to a range of Medicaid benefits not otherwise covered by Medicare, such as transportation to medical appointments and medical equipment.
Seniors and older adults depend on Medicaid for affordable, comprehensive care. Older Americans often have more complex health issues, requiring additional medical attention that is costly and would be out of reach if not for Medicaid. Nearly half of dual enrollees are seniors of color, and over half of dual enrollees suffer from long-term disabilities.
Before 2014, Medicaid was restricted primarily to those who were pregnant, disabled, or seniors aged 65 or older. In 2014, it was expanded as part of the Affordable Care Act, which resulted in more than twenty-one million adults being added to the program.
Some Republican critics have pointed to what they say is unanticipated runaway Medicaid spending. And while it’s true that certain states have seen unexpected surges in Medicaid costs in recent years, it was in part because many Americans delayed care during the coronavirus pandemic.
However, other Republicans are supportive of Medicaid. Republican Senator Josh Hawley of Missouri has filed an amendment to a Senate budget resolution prohibiting cuts from Medicaid. After his state expanded the program in 2021, more than 300,000 low-income residents joined the rolls.
Former Democratic senator Jon Tester from Montana said that Medicaid cuts could have a more sweeping effect on rural America than urban areas because the program sustains impoverished areas with few health care providers.
A survey of Virginia's 200 federally qualified health centers found that all of them would be forced to close if they lost access to Medicaid reimbursements, which in some cases account for over 70% of their revenue.
Every time a baby is born in Louisiana, where Republican House Speaker Mike Johnson handily won reelection last year, there’s more than 60% chance taxpayers will finance the birth through Medicaid. In Republican Rep. David Valadao’s central California district, six out of ten people use Medicaid to pay for doctor visits and emergency room trips. And one-third of the population is covered by Medicaid in GOP Sen. Lisa Murkowski’s Alaska, one of the nation’s costliest corners for health care.
The move to pare back the federal government’s financial commitments to Medicaid could profoundly reshape how it shares responsibility with states to offer health care to some of the poorest Americans and the providers and nursing homes that care for them.
Why is there a push to cut Medicaid?
President Trump has told Republicans that, among other things, he wants to extend trillions of dollars in expiring tax cuts that were initially passed during his first administration but are set to expire this year.
However, extending the individual and estate tax elements of the 2017 President Trump tax cuts would reduce federal revenue by $3.9 trillion or up to $4.8 trillion if coupled with related business tax changes.
To offset the loss of revenue to the federal government caused by those tax cuts and without adding to the national debt, Republicans need to make cuts in current programs. One option being considered is to squeeze up to $880 billion from federal programs over 10 years, including Medicaid.
The reality is that lawmakers will be hard-pressed to find program cuts large enough to offset the loss of revenue caused by the tax cuts without touching either Medicare or Medicaid or both.
While we support efforts to eliminate waste, fraud, and abuse from every federal program, TSCL is opposed to using a chainsaw to make cuts in Medicaid instead of using a scalpel to carefully review each aspect of the program and make sure that those cuts do not harm those who need Medicaid. Seniors not on Medicaid today could eventually need it to pay for their nursing home care. That’s why TSCL believes it is important to preserve and strengthen Medicaid.
If you agree, we urge you to contact your Senators and your Representatives and let them know you oppose the proposed massive cuts to Medicaid.
