Best and Worst Impacts of Trump's First Term on Seniors

The most controversial and divisive president in modern American history, Donald Trump won 53% of the vote among people 50 and older in 2016, according to AARP, although older voters also helped Democrats secure some down-ballot seats. According to the New Yorker, he'll have to retain the older vote to win again — but many polls show this key voting block slipping away from the president. Here's a look at how Trump's first-term policies have helped and hurt the demographic that helped bring him to power and that could decide the election for him again in the fall.

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In 2018, an unusually bipartisan Congress passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act. The president signed the law, widely regarded as the biggest change to Medicare since President George W. Bush signed Medicare Part D into law in 2003 — including major updates to Medicare Advantage. Under Congress' new law, those plans can cover non-medical benefits such as wheelchair ramps and bathroom grab bars for beneficiaries with disabilities, as well as coverage for such things as healthy meal deliveries and expenses related to service animals.

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As of mid-August, about 167,000 Americans had died of COVID-19. According to the CDC, people 65 and over account for roughly 80% of all coronavirus deaths. That's about 133,600 dead American seniors. Trump has blamed culprits ranging from China to the media, but the buck stops with the president, and these deaths happened on his watch.

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Trump issued an executive order that compelled the Centers for Medicare and Medicaid Services to expand and improve telehealth services for Medicare beneficiaries — not just now, but beyond the COVID-19 emergency. Telehealth services are critical to seniors, who are the most vulnerable to fatal coronavirus complications, because they don't involve physical contact. Beyond the COVID crisis, telemedicine is an important part of senior care because getting to and from medical appointments is especially challenging for many older Americans.

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Trump campaigned on repealing the Affordable Care Act. So far, he and his Republican backers have not been successful, but not for a lack of trying. The Supreme Court will hear its third challenge to Obamacare in the fall. If Trump gets his way, the ACA — and its protections for people with preexisting conditions — would be a thing of the past. Despite repeated promises, Trump has yet to put forward a replacement plan. According to a recent report from Senior Voice, 86% of people over 55 have preexisting conditions. Without the ACA's protections, insurance companies would be able to consider those conditions when setting their premiums, just like they did before Obamacare.

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Trump's administration launched an initiative called Fostering Innovation and Rethinking Rural Health. It targets the tens of millions of Americans who live in sparsely populated areas where hospitals are fewer, poverty and uninsurance rates are higher, and populations tend to be sicker — and older. Among other things, the initiative includes proposals to give rural hospitals money to attract talent and expand technologies such as telemedicine in rural areas.

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According to the Center on Budget and Policy Priorities, "Older Americans are among the many groups that President Trump's proposed 2021 budget would seriously harm." The budget, which has not yet been passed by Congress, includes deep cuts to:

• Medicaid, which provides essential care for 7 million seniors

• SNAP, which provides food assistance to millions of seniors

• Social Security Disability Insurance

• Rental and heating assistance

• The Social Services Block Grant, which finances special programs for vulnerable seniors including Meals on Wheels and programs to prevent elder abuse

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Under the Trump administration, the CMS allocated $81 million in CARES Act funding to be distributed to states for increased inspections of nursing homes. That infusion of cash represents a 6% increase in the so-called "survey and certification" budget, which had remained flat since 2014. Nursing home residents have proven to be among the most vulnerable populations since the outset of the crisis.

Related: Are Your State's Nursing Homes Equipped to Handle COVID-19?

The fiduciary rule is an Obama-era regulation that required financial advisers, brokers, and insurance agents to disclose if they were being paid to sell certain financial products. The goal was to protect people's retirement accounts from unscrupulous or uninformed financial professionals from acting in anything but the account holders' best interests. Trump killed the rule, according to the Los Angeles Times, under the guise of empowering investors to "make their own financial decisions." The move had the opposite effect, flooding the market with shady, complicated, and risky investments such as fixed-indexed annuities, which have the potential to cost retirees billions of dollars in savings.

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In April, the Department of Health and Human Services announced it was dedicating nearly $1 billion in CARES Act funding to grants for older Americans and people with disabilities. The COVID-related grants are earmarked to fund things such as respite care, meal delivery, in-home care services, and support to families and caregivers.

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Trump has insisted on a cut to the payroll tax as part of any economic recovery stimulus and promised to end the payroll tax outright if reelected. The payroll tax pays for Social Security, the safety-net program that provides a basic income to tens of millions of seniors. Social Security is already under enormous strain and simply can't survive if payroll tax-derived funding dries up. Trump has said that under his plan, the general fund will pay for Social Security instead. According to an Associated Press Fact Check, "That claim has little basis in reality."

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