Unwinding the Safety Net

Normally, the annual American Society on Aging (ASA) On Aging conference is a peppy assembly where the nation's aging experts share their achievements in helping older Americans. The OnAging 2025 conference in Orlando, Florida, last week, however, was anything but normal.

That's because of the uncertainty cast over the conference by the ways these experts on aging think President Donald Trump's policies will affect programs on which older adults rely, from Social Security and Medicaid to elder abuse protection. They fear even more changes ahead.

When elder advocate Bob Blancato asked his OnAging Panel of Pundits for one word to describe 2025, they responded with "destabilizing," "intense" and "precarious."

"It's been a tough time," ASA President and CEO Leanne Clark-Shirley told the 1,800 attendees. "What felt safe and secure last year now feels under threat."

Amy Gotwals, chief of public policy and external affairs at USAging (formerly the National Association of Area Agencies on Aging), concurred. "It is not a normal transition," she said. "This is nothing like anyone's ever seen before. There's an incredible amount of disruption."

David Lipschutz, co-director of the Center for Medicare Advocacy, put it bluntly: "Everything is in flux."

Not everything was dour, though.

For example, numerous sessions discussed state and local efforts to help area residents age well. And Next Avenue editors Julie Pfitzinger and Amy Nelson held an inspiring session about the site's 2025 Advocates for Aging, featuring three of the five honorees: Lindsay Goldman, CEO of Grantmakers in Aging; Dan Stewart, deputy director of the Aging Equality Project at the Human Rights Campaign Foundation and Keri Vogtmann, director of strategy execution at ClearWellness, a senior care wellness service.

Here's the lowdown with the less-cheerful insights from the conference:

Concerns about Medicare were both broad and specific.

Gotwals and Lipschutz expect Medicare's budget to be part of the sizable government spending cuts expected from the Trump administration and Congress, though it's too early to know exactly how or how much. "Medicare is much more sacrosanct than Medicaid in many ways," said Lipschutz.

The Trump administration has, however, put the kibosh on some Biden administration proposals restricting the marketing of Medicare Advantage plans. Lipschutz said he has learned that Medicare may be working on proposals to make Medicare Advantage the program's default enrollment choice rather than the current system where traditional Medicare is the default.

One Medicare program already in the crosshairs is the free Medicare counseling provided through the nation's State Health Insurance Assistance Programs known as SHIP. This $55 million-a-year service has been part of the Administration on Community Living (ACL), which is being eliminated with pieces moving to other agencies.

SHIP's 12,500 volunteers and staffers help current and prospective Medicare beneficiaries understand how the federal health insurance program for people aged 65 and older works. They also help people appeal Medicare denials, see if they qualify for Medicare subsidy programs and make smart decisions about enrolling in traditional Medicare, private Medicare Advantage plans, Medigap plans and Part D prescription drug plans.

Gotwals said the 2026 draft budget from Trump's Department of Government Efficiency, or DOGE, would eliminate federal funds for all SHIP programs. If this happens, the SHIPs could only stay afloat through contributions from states and community-based organizations.

"It's still a draft budget, so stuff can change," Gotwals said.

The SHIP program appears to have enough money to continue running through the upcoming Medicare enrollment period from October 15 to December 7, 2025.

One piece of good news Lipschutz shared: The Congressional Budget Office now says the program's hospital insurance trust fund won't be depleted until 2052 — 17 years later than it predicted a year ago.

Many conference speakers said Medicaid, which accounts for 12% of federal spending and helps pay long-term care costs for low-income Americans, is almost certain to see significant budget cuts.

"Medicaid is the most at-risk major government program," said Gotwals. Added Lipschutz: "The Congressional Budget Office says it's impossible for the Trump administration and Congress to reach its spending targets without deep cuts to Medicaid."

Home and community-based services paid by Medicaid are particularly under threat, Lipschutz said. And, he noted, "a cut to Medicaid is a cut to Medicare because 30% of Medicaid dollars support Medicare enrollees."

Although Trump has repeatedly vowed to protect the program, which turns 90 in August, it is still at risk, the OnAging speakers said. The chief concern about Social Security raised by experts at the conference: worsening customer service from the Social Security Administration.

"There has been a long-standing 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. "Now we're seeing dozens of potential Social Security field office closures, threats to Social Security data privacy and security and millions falsely marked as 'dead.' "

If the Social Security Administration moves someone into its "death master file," Vallas said, "that has an effect on their ability to get credit." The Social Security Administration sends names on its deceased list to consumer credit reporting agencies.

"If this is protecting a program, what does it look like when they're not protecting a program?" asked Ramsey Alwin, CEO of the National Council on Aging.

The Wall Street Journal reports that agency officials said at a March 28 meeting that "fearmongering has driven people to claim benefits earlier." It quoted Acting Social Security Commissioner Leland Dudek saying, "I think we have a lot of customers right now that are very uneasy."

Even before Trump took office, there was an average wait time of an hour for calls to Social Security. The average wait time is now an hour and 39 minutes.

Major reductions in the size of Social Security's workforce are underway, making it harder to get help from the agency, the experts said.

"So far, there have been 7,000 jobs cut (roughly 12% of its staff), but we could see more," said Vallas.

Another concern is what will happen to Social Security beneficiaries who are told the agency has overpaid their benefits? The Trump administration is reversing President Biden's order that limited how much Social Security could "claw back" in overpayments.

Vallas also fears that Trump will make it harder to qualify for Social Security disability benefits for people over age 50.

Aaron Tax, managing director of government affairs and policy affairs at SAGE (a national advocacy and services organization for LGBTQ+ elders), expressed a particular worry for older LGBTQ+ adults.

Tax said the Supreme Court's landmark sex discrimination decision, known as the Bostock decision, provided the legal foundation for Biden administration actions to bar housing and credit discrimination based on sex.

"Trump says 'no,' and has greenlit discrimination in housing and access to credit for LGBTQ+ folks," Tax said. "Now, you can say 'I won't rent an apartment to someone because they are gay or open a credit card for them' and it's perfectly legal."

Tax also said the Trump administration is proposing to allow discrimination based on sexual orientation and gender identify when deciding if someone can go to a homeless shelter or a domestic-violence shelter.

In addition, "Trump is now greenlighting discrimination against LGBTQ+ folks in health care by rolling back the Affordable Care Act's nondiscrimination provisions for sex."

The shutdown of the ACL agency could have negative implications for two other groups of people: older workers who are also family caregivers and victims of elder abuse.

ACL has been running the federal government's program to support family caregivers. It's unclear whether that department's activities will cease or move to one of three government agencies named by the Trump administration.

"If the family caregiver support services are moved to CMS [the Center for Medicare and Medicaid Services], they will get lost and probably eliminated," said Gotwals.

The draft budget for Fiscal Year 2026 also stops funding for elder justice and elder rights support service programs.

"The safety net for the elder justice system is being loosened and there are not as many resources for people who are being scammed," said Donna Benton, a professor of gerontology at the USC Leonard Davis School of Gerontology.

The Trump administration has already been working to shut down the federal Consumer Financial Protection Bureau (CFPB), including its Office for Older Americans.

"The CFPB was one of the first casualties of this administration and one of the voices for the older-adult population," said Orion Bell, CEO of the Benjamin Rose Institute on Aging in Cleveland.

Richard Eisenberg is the former Senior Web Editor of the Money & Security and Work & Purpose channels of Next Avenue and former Managing Editor for the site. He is the author of "How to Avoid a Mid-Life Financial Crisis" and has been a personal finance editor at Money, Yahoo, Good Housekeeping, and CBS MoneyWatch. Read More