03-05-2025
When it comes to Social Security and Medicare, this is what the nation's top experts on aging worry about
At the most recent annual conference of the American Society on Aging, the topic on the minds of the nation's leading experts on aging was the future of Social Security, Medicare and Medicaid in the current political environment.
Their insights, which are vitally important to anyone in or near retirement, mostly ranged from dour to downright bleak.
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'This is nothing like anyone's ever seen before,' said Amy Gotwals, chief of public policy and external affairs at USAging (formerly the National Association of Area Agencies on Aging). 'There's an incredible amount of disruption.'
The anxiety-filled On Aging conference came near the end of President Donald Trump's first 100 days back in the White House, a period that has featured dramatic changes, proposals and staffing cutbacks for Social Security, Medicare and Medicaid — programs that provide benefits primarily to older Americans. Many of those actions have been decided on and carried out by Elon Musk's Department of Government Efficiency, or DOGE.
'For the first time in a long time, Congress is looking to cut some of those mandatory programs,' said Gotwals.
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There was a sliver of good news about Social Security, which turns 90 in August: None of the experts I heard from believe benefits will be cut any time soon for current beneficiaries or people close to claiming Social Security. Nor did they think the president and Congress will raise the full retirement age from the current 67.
But they agreed that changes to Social Security will be needed at some point before 2033, when the program's trust fund is projected to be depleted.
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Although Trump has vowed to protect Social Security, the conference analysts were outraged by the efforts of DOGE to cut the Social Security workforce by roughly 12% and to close or merge offices.
About 40 field offices have lost at least 25% of their staff, and others have seen even larger workforce reductions, according to NPR.
'If this is protecting the program, what does it look like when they're not protecting a program?' asked National Council on Aging Chief Executive Ramsey Alwin.
These and likely future cutbacks to customer service, the experts said, will pose worsening problems for people who need assistance from the Social Security Administration or who are just looking to receive benefits they're due.
'Now some people have to drive five or six hours to go to a Social Security office, and you need an appointment,' said Ryann Hill, founder and CEO of Indigo Hill Strategies, a government affairs, public policy and lobbying firm.
'There has already been a longstanding customer-service crisis at Social Security, following decades of underfunding of its operating budget,' said Rebecca Vallas, CEO of the National Academy of Social Insurance, an organization made up of experts on social insurance.
Average call wait times at the Social Security Administration have more than doubled since August. That's happening as the number of calls has soared — from 6.5 million in November 2024 to 10.4 million in March.
Before Trump began his second term, the average Social Security wait time for callers was an hour. Now it's an hour and 39 minutes.
My check of the Social Security Administration's website on the morning of April 29 found there were 4,349 people on hold and 12,919 waiting for callbacks. Only 39% of callers are now able to reach a representative, down from 71% in May 2024.
Wait times are typically shorter in the morning, later in the week and later in the month, the site advises.
In mid-April, the Social Security Administration launched restrictions on what kind of help people can receive from the agency over the phone. The reason, officials say, is to crack down on fraud by people calling to apply for benefits.
There's now a new phone verification system, although the administration hasn't offered many details. 'There's a lot of confusion about the antifraud verification,' Vallas said.
And if the DOGE team winds up incorrectly putting your name into Social Security's 'death master file,' prepare for trouble.
Landing on that list could harm your ability to get credit, Vallas said, because the Social Security Administration sends the names on its deceased list to consumer credit-reporting agencies.
Another Trump administration change that's roiling advocates for older people is its rollback of President Joe Biden's clawback rules for people who received overpayments of their monthly Social Security benefits.
Biden capped the clawbacks at 10% of benefits per month. The Trump administration initially said it would withhold 100% of benefits until the amount is repaid, but it then backed off and switched to 50% withholding, effective April 25.
The experts at the OnAging conference were generally less concerned about big potential changes to Medicare than to Medicaid.
'Medicare is much more sacrosanct than Medicaid in many ways,' said David Lipschutz, co-director of the Center for Medicare Advocacy.
Lipschutz shared the comforting news that the Congressional Budget Office now says Medicare's Hospital Insurance Trust Fund won't be depleted until 2052 — 17 years later than it predicted a year ago.
When it comes to Medicare, the chief immediate worry among experts concerns the nation's State Health Insurance Assistance Program, known as SHIP.
SHIP provides free, nonpartisan assistance to state residents, explaining how Medicare works, the differences between traditional Medicare and private insurers' Medicare Advantage plans, Part D prescription-drug plans, Medigap policies, how to appeal Medicare denials and who qualifies for Medicare subsidy programs.
SHIP isn't an expensive government program, relatively speaking: It has an annual budget of $55 million. But it was part of the Administration on Community Living, a federal agency the Trump administration is eliminating.
Pieces of ACL are moving to three other agencies, but the administration hasn't yet said what the future holds for the SHIP program.
'We need people to help explain how Medicare works and to find the best programs for people,' said Gotwals. Unlike SHIP staffers, agents and brokers get paid by Medicare Advantage insurers and can sell plans that are in their own interest rather than the best interests of beneficiaries.
Gotwals said a leaked draft budget from DOGE calls for eliminating federal funds for SHIP. If that happens, SHIP would only continue through contributions from states and community-based organizations.
As of now, experts think SHIP will keep running through the upcoming Medicare enrollment period from Oct. 15 to Dec. 7, 2025. Beyond that, however, is anyone's guess.
The Medicare experts also said the Trump administration is very supportive of Medicare Advantage plans, which now have more members than traditional Medicare.
In early April, the administration announced a higher-than-expected payment increase of 5.03% to Medicare Advantage plans for 2026.
Trump, they noted, also halted Biden administration restrictions on the marketing of Medicare Advantage plans.
'We expect less emphasis on consumer protection in this administration,' Lipschutz said.
He also told On Aging attendees that the Centers for Medicare and Medicaid Services may be working on proposals to make Medicare Advantage the default enrollment choice. Currently, traditional Medicare is the default.
Medicaid, the federal-state health program for low-income Americans, which accounts for 12% of federal spending, is most likely to see quick and possibly devastating changes, the conference speakers said.
'We are in a critical moment now for the future of the Medicaid program,' said Lipschutz. 'This is crunch time.'
If Medicaid funding is reduced significantly — we're likely to know how much by Memorial Day — people in long-term care and their family members could face serious financial challenges. That's because Medicaid, unlike Medicare, covers some expenses for nursing homes, assisted-living care and home care.
Roughly half the money spent on long-term services and support is provided by Medicaid.
The budget resolution passed recently by Republicans in Congress instructs the House Energy and Commerce Committee to cut spending by $880 billion over 10 years, and Medicaid looks like a target to achieve that goal.
'The Congressional Budget Office says it's impossible for the Trump administration and Congress to reach its spending targets without deep cuts to Medicaid,' said Lipschutz. He believes home- and community-based long-term-care services paid for by Medicaid are especially at risk.
Read: $880 billion in Medicaid cuts would be 'devastating' for nursing homes and their residents
Rural health clinics could also close, because they receive significant funds from Medicaid. Congress might cut funding to states that expanded Medicaid coverage under the Affordable Care Act, too.
Dental care will also likely take a hit, since it is often cut when money is tight.
Reflecting the mood of the conference, American Society on Aging President and CEO Leanne Clark-Shirley told the audience: 'What felt safe and secure before now feels under threat. The landscape of public funding for aging services, research and health initiatives is changing by the day — sometimes by the hour.'
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