The president-elect and the future of Medicare, Medicaid


alnorman_headshotBy Al Norman

In October of 2016, before Donald Trump became president-elect, The Atlantic magazine published an article called “Trump’s Graying Army.”

“Senior citizens are his strongest demographic,” The Atlantic wrote. “In polls, voters over 65 tend to be the only age group he wins…Despite the stereotype of the Trump supporter as a prime-aged working man, Trump’s campaign has actually been fueled primarily by support from the elderly.”

The Nov. 8 election exit polls suggest that 53 percent of voters age 65-plus voted for Trump, 8 percentage points higher than the 45 percent who said they voted for Hillary Clinton. The numbers were basically the same for voters between the ages of 45 and 64, with 53 percent voting for Trump.

So what can these older voters expect from President-Elect Trump and the Republican leadership regarding the key issue of health care?

Trump has stated that he will act to “modernize Medicare.” This phrase refers to proposals like “premium support” (giving people a voucher) and raising the age of Medicare eligibility. Last June, House Republicans in Congress proposed the voucher idea – giving seniors a check and a list of private healthcare plans. Premium support aims to reduce the growth in Medicare spending by increasing competition among private health plans and providing a stronger incentive for beneficiaries to be cost-conscious in their plan selection. Basically it’s a way to “privatize” the Medicare program. If President Trump repeals the Affordable Care Act, it could affect the improved preventive and drug benefits and numerous Medicare savings proposals in the law.

Trump also has said he wants to convert Medicaid, the largest health plan for low-income people of all ages, from an individual entitlement into a capped block grant. Trump would offer states a choice between a Medicaid per capita allotment or a capped allocation. There are 1.9 million people on Medicaid (MassHealth) in Massachusetts. The commonwealth is one of the states that exercised its option under the Affordable Care Act (ACA) to cover most residents with incomes up to 138 percent of the federal poverty level. Five hundred thousand new enrollees joined the program between 2013 and 2016.

MassHealth represents nearly 40 percent of the state’s budget ($13.7 billion in 2015), and brings in more than 90 percent of the federal funds received by the state ($9.79 billion). MassHealth is the essential health safety net for low-income state residents, providing health care for more than one in four Massachusetts residents. If Obamacare is repealed, half a million Baystate residents could lose their MassHealth card.

The philosophy behind all of these “reform” plans is to: 1) lower spending on health care by capping costs; 2) shift the financial burden onto the backs of consumers; and 3) privatize the insurance plans that provide benefits under Medicare and Medicaid.

I don’t know if the seniors who voted for or against President-Elect Trump had any idea of what impact their vote would have on their own health care. Seniors were told that Obamacare was unaffordable. Now they will find out if Trumpcare is underfunded and inaccessible.

    Al Norman is the executive director of Mass Home Care. He can be reached at or 978-502-3794.