What A Trump Administration Means For Older Adults

FLORIDA, USA – NOVEMBER 6: Republican presidential candidate Donald Trump makes an election night speech at Palm Beach Convention Center (Photo by Brendan Gutenschwager/Anadolu via Getty Images).
Donald Trump’s return to the White House and Republican control of Senate and potentially House, could lead to much reduced government involvement in providing care to frail older adults and individuals with disabilities.

Trump’s planned mass deportations is set to exacerbate an already acute shortage of care workers and increase family caregiver burden considerably.

Trump himself has shown limited concern for health-related matters; however, many of his past and current advisers remain deeply committed to making major reforms to health and long-term care systems. For instance, Project 2025 written by an informal group of first-term Trump advisors would reform federal health policy fundamentally.

Here’s an in-depth exploration of some key issues:

Social Security: In spite of Social Security’s rapid march toward insolvency within 10 years, President Donald Trump remains staunchly against benefit cuts or payroll tax increases. Instead, his proposed exemption of Social Security benefits from income tax could increase benefits for higher-income retirees subject to this levy.

My colleagues at the Tax Policy Center estimate this measure would boost after-tax incomes by an estimated average of $3,400 among those eligible to take advantage of its tax cuts; low-income retirees would see no benefit since they already are exempted from paying this tax.
As those taxes currently fund retirement systems, repealing them would drain $1.5 trillion over 10 years from Social Security and Medicare trust funds.
Trump may find it challenging to gain congressional approval for this idea due to complex budget rules in Congress; even with complete GOP control.

Heath Care: Medicare Advantage managed care plans are used by more than half of enrollees currently, yet critics hold them out to be overpaid. Under President-elect Trump and Congress, some may attempt to rein in growth of Medicare payments to manage MA plans so as to lower Medicare costs while other may advocate increasing payments and loosen regulations so as to expand enrollment; Project 2025 proposed making MA the default choice within Medicare.

Congress opened up Medicare’s ability to negotiate drug pricing in 2022; manufacturers filed suits to block this initiative; Trump likely killed it; however, access may also increase for generic medications which might reduce some prices.

One major unknown: Robert F. Kennedy Jr’s place in health policy debate. Trump, during his victory speech, declared Kennedy would play an instrumental role in making America healthier – “a great guy and really sincere about making this country healthier again…we want him to pursue some initiatives which he proposes, so let him.”
Given both men’s unpredictable natures, it can be hard to gauge exactly what this will entail. Would Kennedy’s opposition to vaccines affect availability for older adults who require jabs against conditions like flu, Covid-19 pneumonia shingles RSV etc? Will Medicare still cover these? Furthermore Trump’s tariffs would increase costs associated with many pharmaceutical products produced abroad.
Trump may make significant alterations at the National Institutes for Health, the Centers for Disease Control, and Food and Drug Administration that may lead to faster federal approval for new medications – which may benefit some consumers but increase risks for others.
Long-term Care Financing. Vice-president Kamala Harris made expanding Medicare to cover home-based long-term care a central plank of her campaign for president, while President Biden attempted (but ultimately was unsuccessful in) expanding Medicaid’s home-based long-term care program. Washington State passed legislation creating public long-term care insurance and others are considering similar programs as solutions.
While the Republican platform supported expanding home-based care, its implementation never specified; and Donald Trump himself never addressed it during his campaign. What can be certain, though, is that no efforts will be taken by Trump’s new administration to increase long-term care financing via Medicare, Medicaid or public insurance plans.
Caregiving. Trumps’ top priority is deporting millions of immigrants and closing borders to newcomers, placing immense strain on health care worker supply, worsening an already severe labor shortage further and adding another load to family caregivers, especially older people and younger persons with disabilities living at home. This situation imposes considerable stresses upon their relationship, particularly as regards caregiving duties for elderly and disabled residents residing within homes of family caregivers.
Democratic efforts at creating a federal paid family leave program will fail, instead Trump has proposed offering undefined tax credits to family caregivers.
The Older Americans Act could also face funding reductions; although, unlike in his first term, Congress Republicans who wish to reduce government may take the initiative in doing so.
Nursing Facilities: When it comes to staffing standards in nursing facilities, making an easy call may not be too challenging: Trump Administration almost certainly will dismantle Biden’s attempt at mandating minimum staffing levels at nursing facilities. He could withdraw rules altogether or stop defending government against industry lawsuits intended to block them; either way he’ll prevent increased staff at these facilities from increasing.
Trump’s second term will have severe ramifications for older adults, young people with disabilities and their families – many initiatives will not benefit them or their communities.