BEYOND THE NUMBERS
In May the Office of Management and Budget (OMB) requested comment on a proposal to update the Census Bureau’s poverty thresholds using an alternative, lower measure of inflation. That would mean lower poverty thresholds than under the current measure, with the gap between the two growing each year. And because the Census thresholds serve as the basis for the Department of Health and Human Services’ poverty guidelines, which help determine eligibility and benefits in many health care, nutrition, and other basic assistance programs, the proposed change would lower the income limits for all of these programs, cutting or eliminating assistance to hundreds of thousands of individuals and families in the coming years.
By the tenth year, for example, more than 250,000 seniors and people with disabilities would lose or receive less help from Medicare’s Part D Low-Income Subsidy Program, more than 300,000 children would lose comprehensive coverage through Medicaid and the Children’s Health Insurance Plan, and hundreds of thousands of low-income households would lose eligibility for federal nutrition assistance, according to CBPP analysis.
Opposition came from a wide range of stakeholders, including health care providers (e.g., the American Medical Association and American Hospital Association); health plans (e.g., America’s Health Insurance Plans and the BlueCross BlueShield Association); advocates for seniors, people with disabilities, and others with serious health needs (e.g., AARP, the American Heart Association, and the Consortium for Citizens with Disabilities); policymakers (e.g., the National Governors Association and 21 states’ attorneys general); and service organizations (e.g., the United Way and Catholic Charities).
They raised several serious concerns, explaining that the proposal would:
- Reduce the number of people with health coverage. America’s Health Insurance Plans wrote, “Changes that would eliminate eligibility or make it difficult or impossible for people to afford coverage conflict with a core national priority, and a central goal of AHIP and its members, of improving health by increasing access to health care. It can cause many vulnerable Americans to avoid obtaining health coverage and seek care only when an emergency develops. This would reduce their use of necessary preventive and primary care services, vaccines, and prescription drugs.”
- Make it harder for people to meet basic needs. The Leadership Council of Aging Organizations wrote, “It is clear that proposals to change the inflation measure to shrink the [official poverty measure’s] annual rate of increase would incorrectly define even more low-income older adults and people with disabilities as not living in poverty. But changing the definition would neither change the needs of these populations, nor eliminate their struggle to pay for essentials. Without careful study, any change to poverty measures could result in many being left ineligible for the critical public benefits that enable them to put food on the table, keep the heat on, afford their medications, see the doctor, and live with independence and dignity.” Additionally, AARP wrote, “[M]illions of Americans, including older Americans, rely on the Supplemental Nutrition Assistance Program (SNAP) to meet their basic nutritional needs. SNAP participation is linked with reduced hospital and nursing home admissions among older adults, as well as overall reduced health care costs. Moving to a [lower inflation measure] will result in . . . [m]ore people facing hunger and food insecurity, unable to access SNAP.”
- Pass costs on to state and local governments. The National Association of Counties wrote, “[S]tates and counties could also face several unintended consequences. . . . By changing the federal poverty threshold, this may result in fewer individuals accessing [Temporary Assistance for Needy Families] support services, and counties may face increased demands for assistance from these individuals and families. In addition to funding and administering programs like TANF, counties are also mandated to provide some level of health care for low-income, uninsured or underinsured residents – care that is often not reimbursed with costs falling directly to counties. Changing the poverty threshold may limit eligibility for certain federal health programs, such as Medicaid, leading to more under and uninsured individuals and families for whom counties are providing uncompensated care.”
- Make the poverty line less accurate. A coalition of 26 patient organizations including the American Cancer Society Action Network, American Heart Association, and United Way, wrote, “The current Official Poverty Measure (OPM) is based on an old formula that already does not fully capture those living in poverty and does not accurately reflect basic household expenses for families, including by underestimating child care and housing expenses. The proposed changes to the inflation calculation would reduce the annual adjustments to the poverty measure and therefore may exacerbate existing weaknesses, putting vulnerable Americans – including those with serious and chronic diseases – at great risk. Further lowering the poverty line would also give policymakers and the public less credible information about the number and characteristics of Americans living in poverty.”
Moreover, the Administration’s process for considering the proposed change may be unlawful. As 21 states’ attorneys general wrote, “OMB has not advanced a basis for its considered changes. Indeed, OMB made clear that it intends to disregard relevant data. By declining to seek comment on the poverty guidelines and their application, OMB has artificially limited the scope of the information it would consider in determining the appropriate measure to use. . . . If OMB were to take any action to change the poverty threshold without considering its effect on the poverty guidelines and the many government programs that rely on those guidelines to determine eligibility for benefits, such action would necessarily be unlawful.”