Every American is affected by who serves as president, but experts expect Donald Trump's presidency to have an especially big impact on older citizens. More than 46 million Americans are 65 or older. That's 14.5 percent of the U.S. population, or one in seven people, according to the Census Bureau. Based on campaign promises and other public statements, here's how seniors' lives could change with Trump in the White House.
Trump promised tax cuts throughout his campaign, and with Republicans controlling the House and Senate, massive, across-the-board cuts are almost certainly on the horizon. Like all taxpayers, seniors could benefit from this, at least in the short term -- especially those nearing the end of their earning years. The larger impact, however, will likely be felt in the ways Congress decides to pay for those tax cuts.
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Already under pressure for at least a decade, the Older Americans Act is likely to be in the crosshairs when it comes time to pay for sweeping tax cuts in a country with a growing population dominated by aging baby boomers. Enacted in 1965, the act supports a range of services designed to improve the lives of senior citizens. Among the most important is Meals on Wheels, a nutrition program that targets the increasing population of elderly, frail Americans who are no longer self-reliant.
Repealing the federal estate tax, dubbed the "death tax" by many Republicans, has long been a priority for the GOP. Trump has vowed to eliminate the measure, which taxes inheritances over $5.45 million for individuals and $10.9 million for couples. Democrats say a repeal would benefit only the super-rich. Republicans argue it's a burden for farmers and small-business owners who want to pass businesses on to their children. Either way, it's likely to go, and its repeal would affect how much money and property a small minority of seniors can pass on to their heirs.
More than 4.6 million low-income senior citizens get at least part of their medical care through the Medicaid program. The federal government paid about 63 percent and the states paid 37 percent of Medicaid costs in fiscal 2015, according to the Kaiser Family Foundation. Republicans want to shift that responsibility -- and control over who can get it and how -- in favor of the states, a move for which Trump has stated support. To compensate for the reductions in federal funding, states would be able to force non-disabled adult recipients to work, seek work, or train for work. States also may choose to charge premiums or copays, now the rare exception for Medicaid recipients.
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Repealing the Affordable Care Act, President Barack Obama's signature health care legislation, has been a priority for Republicans since its inception. Trump has unambiguously stated his support for immediate repeal. Millions of seniors are covered under Obamacare, as the act is known, through its expansion of Medicare and the Part D prescription drug program. Medicare Part D closed the so-called "doughnut hole" that exposed many seniors to higher prescription drug costs. The ACA also entitles seniors enrolled in Medicare to free preventive services and screenings.
As part of his so-called "penny plan," Trump aspires to reduce discretionary spending by 1 percent each year with the exceptions of Medicare, Medicaid, defense, and Social Security. This would trim spending on all domestic and social programs, including those that affect seniors, even as the population expands and ages.
Advocates for seniors worry that penny plan cuts will hit low-income housing particularly hard, especially in project-based rental assistance, Section 8 housing, and public housing. More than 900,000 seniors live in housing sponsored by the Department of Housing and Urban Development. Trump has tapped former political rival Ben Carson to run HUD, which has a budget of $47 billion. It's unclear what changes Carson would make or how he would deal with a reduced budget, but he has repeatedly said he does not believe in programs that encourage dependency.
Michael Korbey, the man leading Trump's Social Security transition team, is a lobbyist who has advocated cutting and privatizing Social Security for decades. House Speaker Paul Ryan and other Republicans have pushed to privatize the longtime safety net program as well. Trump has vowed that he will not cut Social Security, which one in three seniors says is their primary source of income. The government could, however, raise the age of retirement that makes seniors eligible to collect, or alter the cost-of-living index.
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The National Institutes of Health is a $32 billion federal agency tasked with biomedical research. Much of its funding goes to diseases that disproportionately affect seniors, such as Alzheimer's and cancer. The NIH has long enjoyed bipartisan support and, as of now, Trump doesn't seem to have immediate plans to change the organization's structure or funding. His pick to run the Department of Health and Humans Services, which governs the NIH, has also indicated support for federal funding for medical research -- but that doesn't make it exempt from budget cuts.
The Department of Labor adopted a rule last year that requires financial advisers and their firms to act as fiduciaries when dealing with the 401(k)s and IRAs their clients will live off in retirement. That means they are required to act in their clients' best interest and avoid or report conflicts of interest. Many in the financial industry, including financial professionals now advising the Trump administration, resisted this as government overreach. Trump has not yet made guarantees either way on the rule, which is set to take effect in April.