How Trump’s planned Medicaid cuts would hurt older women

Since many more beneficiaries receiving Medicaid-covered long-term care are women, they would be most affected by cuts to Medicaid.

Senator Elizabeth Warren wore a bracelet with beads that read “I [heart] Medicaid” during a visit to the Cambridge Health Alliance Revere Care Center in Revere on May 27.Brett Phelps for The Boston Globe

Harry S. Margolis is an elder law attorney in Wellesley and author of the Risking Old Age in America Substack at okayboomer.substack.com.

The approximately $700 billion in Medicaid cuts in President Trump’s “Big Beautiful Bill” passed by the House on May 22 would hit older women especially hard because they are generally more financially vulnerable than older men, and thus more dependent on governmental support.

As Cindy Hounsell, president of the Washington, D.C.-based nonprofit Women’s Institute for a Secure Retirement, told me, “women have less money than men and need more because they live longer.” And Black and Hispanic women often have fewer financial resources than white women, after lifetimes of lower pay and fewer benefits, such as contributions to 401(k) plans.

Since women on average live longer than men, they are more likely to have to stretch their more meager savings and retirement income over more years. There are 123 women for every 100 men at or over age 65 — an imbalance that increases to 184 women for every 100 men at or over age 85, the age at which people are more likely to need elder care.

More women than men age 65 and older are low-income, meaning their income is below 200 percent of the federal poverty threshold: 32 percent of women, compared to 25 percent of men, according to the nonprofit health policy organization KFF. (Across the board, poverty rates are higher among people of color age 65 and older than among white people of the same age.)

Since women live longer than men, they are also more likely to suffer the ailments of age. According to the Alzheimer’s Association, almost two-thirds of Americans with an Alzheimer’s diagnosis are women. They are less likely than men to be living with a spouse who can provide care, so family members and home health aides must step in. Without that support, they are likely to end up in nursing homes, where about 7 out of 10 residents are female.

This brings us to Medicaid, the main public program paying for long-term care. According to KFF, Medicaid accounts for 61 percent of total spending on long-term care services and supports in the community and institutions, such as nursing homes. Nationally, Medicaid is the primary provider of coverage for 63 percent of nursing home residents, though the number varies from state to state. (In Massachusetts, 62 percent of nursing home residents are covered by MassHealth, our version of Medicaid.)

Since many more beneficiaries receiving Medicaid-covered long-term care are women, they would be most affected by cuts to Medicaid. The Congressional Budget Office has estimated that the anticipated cuts would result in 10.3 million Medicaid beneficiaries losing their coverage.

Speaking on the PBS “NewsHour,” Jennifer Tolbert of KFF explained that the bill rescinds a rule “that made it easier for seniors and people with disabilities who also have Medicare coverage to enroll in Medicaid, which will then pay for their premiums and cost-sharing, as well as provide them access to supplemental benefits that Medicare doesn’t provide, including long-term care, dental benefits, as well as vision care.”

It could also mean many more seniors being forced to move to nursing homes. As Howard Gleckman, a senior fellow in the Urban-Brookings Tax Policy Center at the Urban Institute, explained to me, while Medicaid coverage of nursing home care is mandatory, coverage of home health care is discretionary.

So to save funds, states are likely to cut back on the discretionary services they now cover. Without home health care assistance, many more families would have to make the difficult choice of placing parents and grandparents in nursing homes, where the quality of care would be likely to deteriorate as states reduce what they pay providers.

This would also adversely affect women who are caregivers, both paid and unpaid. While the statistics vary, up to two-thirds of family caregivers and 4 out of every 5 care workers are women; many of them are older themselves.

Further, many family caregivers would be likely to be thrown off Medicaid themselves under the expanded work requirements in the House Republican bill. According to KFF, 12 percent of adult beneficiaries are not working because of their caregiving duties. While the bill includes exemptions for “community engagement” in lieu of paid work, it’s unclear whether that would include family caregiving. In addition, the House bill would require that Medicaid recipients verify their community engagement twice a year, adding to the red tape necessary to maintain Medicaid eligibility — red tape that often results in qualified individuals not receiving benefits.

All these funding reductions are meant to reduce a federal deficit that is projected to balloon with more than $4 trillion in tax cuts over 10 years — cuts that would largely benefit the wealthiest Americans. In other words, the plan would transfer wealth from the poorest to the richest Americans, and many of the poorest are older women, especially women of color.

Fortunately, the Republicans may not have the votes to put this devil’s bargain through. Even Senator Josh Hawley, writing in The New York Times, finds this approach “both morally wrong and politically suicidal.” America’s older women certainly deserve better.