Federal Cuts to Food Assistance Would Harm Older Californians

The underlying data for this Fact Sheet, including the regional county groupings for the map below, are available for download.

Federal policy changes being pursued by the Trump Administration and Republicans in Congress threaten to inflict serious harm on older adults, and the rapid aging of California’s population means that a growing number of state residents are at risk. One of the most significant threats comes from recent proposals to slash food assistance provided through the Supplemental Nutrition Assistance Program (SNAP), called CalFresh in California. Last month, the House Budget Committee approved a budget resolution that would cut SNAP by more than 20% ($150 billion) over 10 years.[1] This massive reduction in funds follows the lead of the President, who earlier this year proposed cutting SNAP by more than one-quarter (over $193 billion) over 10 years. These proposals would undoubtedly increase hunger and hardship throughout California, as CalFresh benefits currently are based on a minimal diet and provide only around $1.50 per person per meal.

These proposals also would likely undermine California’s efforts to reduce and prevent hunger among older adults. The President proposes shifting to the states roughly 25% of the cost of SNAP food assistance, effectively ending the federal government’s commitment to fully cover benefit costs for this vital anti-hunger program. The House budget resolution appears to take a similar approach, as it calls for transferring “significant authority” over SNAP to the states. Shifting benefit costs to the states would make it difficult, if not impossible, for California to continue implementing strategies to address low CalFresh participation among older adults.[2] The state would have to contribute at least $1.8 billion annually to maintain CalFresh food assistance at 2016 participation and benefit levels if the President’s proposal is approved. Enrolling additional eligible Californians would increase the state’s costs for CalFresh even more, likely scuttling efforts to boost participation.

Proposed cuts to SNAP come at a time when many Californians already struggle to put food on the table. More than one-quarter of adults age 65 or older report that they cannot afford enough food, and in some parts of the state even larger shares face hunger or the threat of hunger.[3] Given SNAP’s track record of reducing hunger and improving health, federal policymakers should focus instead on boosting SNAP funding to expand the program’s powerful effects.

Download map data, including the regional county groupings.

[1] The budget resolution requires the House Agriculture Committee to identify by October 6 at least $10 billion in cuts between 2018 and 2027 to nutrition and other programs under its jurisdiction. Most, if not all, of these cuts will likely come from SNAP, according to the Center on Budget and Policy Priorities, given that budget documents do not mention any cuts to other programs under the committee’s jurisdiction.

[2] Less than one-third of Californians age 60 or older who are estimated to be eligible for CalFresh participate in the program. Personal communication with the Department of Social Services (DSS), Research Services Branch on June 16, 2017. DSS estimated the number of older adults who are eligible for CalFresh after accounting for the fact that Supplemental Security Income/State Supplementary Payment (SSI/SSP) recipients are not eligible to participate in the program. To learn more about this SSI/SSP-related exclusion see California Food Policy Advocates, California’s Cash Out Policy (Updated April 14, 2016). Low CalFresh participation among older adults may reflect several factors, including misinformation about who is eligible, fear of stigma, inability to visit county human services offices due to a lack of mobility or transportation, and a burdensome application process. California has pursued a number of strategies in recent years to boost older adults’ participation in CalFresh. For more information see California Department of Social Services, Senior Healthy Food Access and Nutrition Education Information and Innovative Practices Webinar (Food Access Nutrition Education Outreach (FANOut) Committee: December 7, 2016) and Jared Call, State Acts to Boost Senior CalFresh Participation and Benefits (California Food Policy Advocates: April 20, 2017).

[3] California Health Interview Survey. Only adults with incomes below 200% of the official federal poverty line were asked whether they could afford enough food. Five years of data (2011 through 2015) were combined in order to ensure statistically reliable results. Data for 50 counties could not be reliably reported on their own. In these cases, the data were combined into the following regions: 1) Butte, Colusa, Del Norte, Glenn, Lake, Lassen, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, and Yuba; 2) El Dorado and Placer; 3) Alameda and Contra Costa; 4) Marin, Napa, Solano, and Sonoma; 5) Sacramento and Yolo; 6) Alpine, Amador, Calaveras, Inyo, Mariposa, Mono, and Tuolumne; 7) Monterey, San Benito, San Luis Obispo, Santa Barbara, Santa Cruz, and Ventura; 8) Humboldt and Mendocino; 9) Madera and Merced; 10) San Joaquin and Stanislaus; 11) San Francisco and San Mateo; 12) Kern, Kings, and Tulare.

Endnotes are available in the PDF version of this Fact Sheet. Also available for download are the underlying data for the maps below.

The Supplemental Nutrition Assistance Program (SNAP) — CalFresh in California — is the cornerstone of federal efforts to help struggling families put food on the table. CalFresh reaches each of California’s 53 congressional districts, though receipt is higher in certain areas (see maps below). In 2015, about 1 in 4 households received CalFresh in the 16^th District (D-Costa) and the 21^st District (R-Valadao), both of which are in the San Joaquin Valley (26.9% and 24.9%, respectively). In eight other districts, roughly 1 in 6 households received CalFresh. These are in the Sacramento Valley, the San Joaquin Valley, Los Angeles County, the southern border area, and the Inland Empire and Central Sierra.

SNAP lifts families out of poverty and improves health and well-being, especially for children. Yet President Trump’s proposed budget makes fundamental changes that would weaken SNAP:

• Shifting one-quarter of costs to states. In the 2016 federal fiscal year, which ended on September 30, 2016, California received $7.2 billion for SNAP. Under the President’s proposal, California would need to pay for 25% of these benefits by 2023. If these cuts had been in place in the 2016 fiscal year, California’s share would have been $1.8 billion.
• Allowing states to cut costs. Because many states would be unable or unwilling to cover 25% of SNAP benefits, the President’s proposal would allow states to cut benefits to reduce costs. SNAP benefits are already based on a minimal diet. In California, SNAP benefits are roughly $1.50 per person per meal.
• Tightening eligibility and cutting benefits. The President’s proposal would restrict SNAP eligibility and/or cut benefits for older adults, people with disabilities, large families, working families, and low-income adults not raising minor children. It does this by limiting state flexibility in implementing SNAP and by capping or even eliminating benefits for some groups.

In addition to increasing hunger and hardship, the President’s proposal would limit SNAP’s critical role in mitigating the effects of an economic downturn. When people lose jobs and are less able to afford the basics, SNAP eligibility and enrollment increase. In turn, households spend these benefits on groceries in their communities, generating economic activity. If states must share SNAP costs, they may not be able to boost funding to cover new enrollees during a recession. This would curtail SNAP’s role in stabilizing the economy.

If President Trump and the Republican-led Congress follow through on the proposed changes to SNAP, households in every California congressional district would face increased hardship. Given SNAP’s track record of reducing hunger and improving health, federal policymakers should instead be focused on boosting funding and expanding SNAP’s powerful effects.

Download household participation in CalFresh by congressional district.

Medi-Cal, our state’s Medicaid program, is the cornerstone of California’s health care system. Funded with both state and federal dollars, Medi-Cal provides health care services to more than 13 million low-income Californians who live in all 58 counties. Of the 10 counties with the highest shares of residents enrolled in Medi-Cal, six are in the San Joaquin Valley: Tulare (54.8%), Merced (50.9%), Fresno (49.9%), Kern (45.9%), Stanislaus (45.1%), and Madera (45.1%). However, millions of Californians — including children, older adults, and people with disabilities — would be at risk of losing Medi-Cal coverage or benefits if the US Senate agrees to the deep cuts that were recently approved by House Republicans (H.R. 1628) with President Trump’s support. These cuts include 1) phasing out the Medicaid expansion, through which California has extended coverage to nearly 4 million nonelderly adults, and 2) shifting massive — and unaffordable — costs to states by capping federal Medicaid funding. In California, this cost-shift would amount to nearly $6 billion in 2020, rising to an annual shift of $24.3 billion by 2027, according to a Department of Health Care Services analysis.

The underlying data for this Fact Sheet are available for download. These include county population data for four age groups: age 65 or older; ages 65 to 74; ages 75 to 84; and age 85 or older.

Older adults are one of the many groups facing significant threats to their social and economic well-being from federal policy changes that could be enacted by the Trump Administration and its allies in Congress. Such changes would have a major impact on California given that the state is home to nearly 1 in 9 of all adults age 65 or older in the US. Plus, the harm caused by federal policy changes would likely be magnified in coming years as California’s population ages, increasing the need for health care and other public services and supports that contribute to people’s well-being late in life. The number of state residents age 65 or older is projected to rise from nearly 5.5 million in 2016 to almost 9.1 million in 2030, an increase of two-thirds (66.1%) — more than 20 times the projected percentage growth in the population under age 65 (3.1%).[1] Even faster growth is anticipated among the oldest seniors — those age 75 or older — who tend to have greater health care needs and are more likely to face economic hardship.[2]

In some parts of California, growth in the older adult population is projected to far outpace growth statewide, suggesting that federal policy changes could have an outsize impact in certain regions. Specifically:

• Adults age 65 or older are projected to make up at least one-quarter of residents in 20 counties by 2030, up from just 8 counties in 2016 (see maps 1 and 2 below). This means that the number of counties where at least 1 in 4 people is over age 64 is expected to more than double during this 14-year period. Places with the largest projected share of older adults in 2030 include counties in the Sierra Nevada, far north, northern Bay Area, and northern coastal region. Statewide, one in five people (20.6%) is projected to be age 65 or older in 2030, up from 13.6% in 2016.
• The number of adults age 65 or older is projected to increase by at least 50% in more than half of California’s 58 counties between 2016 and 2030 (see map 3 below). In one county, Mono, the number of older Californians is expected to more than double during this period. In five counties, the older adult population is projected to increase by at least 75%, but less than 100%. These include both Inland Empire counties (Riverside and San Bernardino), two Bay Area counties (Contra Costa and Solano), and San Benito County. In another 26 counties, the number of older adults is projected to rise by at least 50% but less than 75%. These include many counties in the Central Valley and greater Sacramento region as well as all counties along the central and southern coast.

Download county population data for four age groups: age 65 or older, ages 65 to 74, ages 75 to 84, and age 85 or older.

Map 1

Map 2

Map 3

[1] Budget Center analysis of Department of Finance data. The population under age 65 is projected to increase from approximately 33.9 million in 2016 to roughly 34.9 million in 2030.

[2] Between 2016 and 2030, the number of Californians ages 75 to 84 is projected to increase by 100.0%, while the number age 85 or older is projected to rise by 70.6%. In contrast, the number of Californians ages 65 to 74 is projected to increase by 48.2%.

On May 4, the House of Representatives narrowly approved — on a 217 to 213 vote — H.R. 1628, the American Health Care Act of 2017 (AHCA). Every Democrat and 20 Republicans voted against the bill. This legislation would reverse the progress that California and the rest of the nation have made in extending health coverage to millions of people under the framework of the Patient Protection and Affordable Care Act (ACA), which President Obama signed into law in 2010.

The AHCA would make several changes that would damage the health and economic security of millions of Americans. These include, but are not limited to, 1) phasing out the Medicaid expansion, through which California and many other states have extended health coverage to millions of low-income adults under age 65; 2) shifting huge new costs for Medicaid to the states by capping annual federal funding for the program; 3) restructuring federal premium assistance — which lowers the cost of monthly health insurance payments — in a way that disadvantages people who are older and/or have lower incomes; 4) eliminating federal subsidies that reduce the cost of copays and deductibles for people with low or moderate incomes; and 5) ending nationwide protections for people with pre-existing health conditions. At the same time, the AHCA would provide massive tax breaks for the wealthy and for drug and insurance companies.

Republicans in the House approved the AHCA even though the final version of the bill had not been analyzed by the nonpartisan Congressional Budget Office (CBO), which estimates the potential impacts of proposed legislation. Today — nearly three weeks after House Republicans approved the AHCA — the CBO released its assessment of the bill.

On a nationwide basis, the CBO estimates that if the AHCA were signed into law:

• By 2026, an additional 23 million people would be uninsured compared to current law. This includes 14 million fewer Medicaid enrollees by 2026, a reduction of 17 percent relative to the number expected to be enrolled under current law. The CBO notes that the increase in the number of uninsured “would be disproportionately larger among older people with lower income — particularly people between 50 and 64 years old with income of less than 200 percent of the federal poverty level.”
• Federal spending for Medicaid would be reduced by $834 billion over the 2017-2026 period compared to what the CBO projects under current law.
• Less healthy people in states that fully opt out of certain health care regulations would face particularly difficult challenges in purchasing health coverage on the individual (or “nongroup”) market. About one-sixth of the US population lives in states that would obtain waivers — as allowed by the AHCA — to 1) narrow the scope of benefits that must be covered by health insurance and 2) let insurers charge premiums based on an individual’s health status if they fail to maintain continuous coverage. (The CBO does not indicate which states it presumes would fall into this category.) As a result of these changes, the CBO anticipates that “people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all — despite the additional funding that would be available under H.R. 1628 to help reduce premiums.” Consequently, the nongroup markets in these states “would become unstable for people with higher-than-average expected health care costs,” according to the CBO.

The CBO does not assess the potential impacts of the AHCA on individual states. However, state-level research from other organizations shows that the House-passed bill would:

• Shift nearly $6 billion in Medicaid costs from the federal government to California in 2020, rising to an annual cost-shift of $24.3 billion by 2027, according to the state Department of Health Care Services.

   

  • These massive annual cost-shifts would result from several AHCA provisions. These include 1) the substantial reduction in the federal government’s share of costs for people who sign up for coverage through the Medicaid expansion; and 2) the proposal to cap federal funding for the entire Medicaid program — through a “per capita cap” or a block grant — at a level that would fail to keep pace with anticipated Medicaid spending growth, resulting in federal funding cuts that would grow every year.
  • California’s state budget would not be able to absorb these sizeable annual cost-shifts. As a result, state policymakers would face the very real prospect of having to repeal the Medi-Cal expansion. Such an action would eliminate the only viable source of health coverage for nearly 4 million nonelderly adults, who live in every Congressional district in the state (see table below). Moreover, Medi-Cal coverage and benefits would be put at risk for the nearly 10 million additional Californians — including children, people with disabilities, and adults age 65 or older — who qualify for Medi-Cal through other eligibility pathways (i.e., not through the expansion).
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• Disproportionately harm women, according to the Center on Budget and Policy Priorities (CBPP). Women and girls comprise more than half of Medi-Cal enrollees (54 percent as of December 2016), and women “are much more likely to use Medicaid’s long-term services and supports as they age,” the CBPP notes. Medi-Cal also plays a significant role in women’s health by financing roughly half of all births in California (50.4 percent as recently as 2011). Federal cuts to Medicaid could require California to scale back the state’s investment in these and other critical services for women. In addition, family-planning services would be threatened because the AHCA would prevent states — including California — “from reimbursing Planned Parenthood for its preventive health and family planning services” for people enrolled in Medicaid, according to the CBPP.
• Hurt military veterans, according to Families USA. Medicaid is a critical source of health coverage for veterans, who are “at a higher risk than most for unique and sometimes serious or complicated health care issues as a result of their service.” Nationwide, more than 1.7 million veterans (nearly 1 in 10) were enrolled in Medicaid in 2015, with roughly 183,000 of these former servicemen and -women receiving services through California’s Medi-Cal program. (A California-specific estimate is not available.) For some veterans, Medicaid supplements the health coverage that they receive through the federal Department of Veterans Affairs; for others, Medicaid “is their only source of coverage,” Families USA notes. By cutting and capping federal Medicaid funding, the AHCA would threaten access to health coverage for tens of thousands of veterans in California.
• Increase total health costs by an average of $2,800 in 2020 for people who buy coverage through Covered California, the state’s health insurance marketplace, according to the CBPP. This increase “would be larger for people who have lower incomes, are older, or live in high cost counties,” with average increases projected to exceed $4,000 in 32 counties. This analysis does not account for “additional premium increases and benefit reductions” that could occur under the AHCA proposal to end nationwide protections for people with pre-existing health conditions.