On May 7, the Trump administration launched yet another attack on low-income individuals. In a notice on the Federal Register, the administration proposed a change to the Census Bureau’s Official Poverty Measure (OPM) calculation that will effectively block millions of Americans from receiving critical services that promote health security and financial well-being. The suggested change is to switch the current inflation rate used to calculate the OPM to a calculation with a lower annual adjustment. This change will lower eligibility for government programs and, over time, result in fewer low-income individuals and families qualifying for assistance. As it stands, the poverty line is too low.
The current Federal poverty guidelines for 2019 are set at $12,490 for a single individual (just $1,040 per month) and $25,750 for a family of four. Willfully choosing a metric that lowers this threshold will define individuals and families “out” of poverty with no change to their actual economic standing. It is clear that the administration’s intention is not to make the measure more accurately reflect the reality of living on a low income or to address the systemic issues that lead to poverty, but rather to push people off life-saving services. This draconian measure meant to punish low-income people for their poverty stands in stark contrast to this administration’s generosity to big corporations and the wealthy through tax breaks and lenient regulation.
What is the impact?
To say that this decision will harm a significant percentage of the country’s population is an understatement. According to a U.S. Census report in 2012, just over one-fifth of the U.S. population participated in a means-tested government program. The two programs with the highest rates of participation? Medicaid and the Supplemental Nutrition Assistance Program (SNAP); Programs meant to ensure the health and well-being of millions of low-income older adults, women, children and individuals with disabilities. This seemingly “technical” change, made entirely of this administration’s own volition, will ripple across our entire spectrum of services, with life and death consequences. Federal agencies with programs that base eligibility on the poverty guidelines include the Department of Health and Human Services, Department of Agriculture, Department of Energy, Department of Labor and the Department of the Treasury. States, charitable organizations and even some private companies also use these guidelines to determine eligibility for services. Programs that have scaled eligibility or subsidies for individuals making up to 150, 200 or 300% of the poverty line will also see people lose eligibility for vital assistance.
Why does this matter to health advocates?
In the short term, this proposed change to the OPM would reduce access to income-based health programming including Medicaid, CHIP, the ACA and Medicare premium assistance. This imperils older adults and individuals who are dually eligible for Medicare and Medicaid (nearly 11 million Americans), the 7.5 million people who use the Qualified Medicare Beneficiary (QMB) program to pay for their Medicare coverage and the 39% of our nation’s children who receive health care through Medicaid and CHIP. For those who rely on ACA coverage through Medicaid expansion or premium tax credits, coverage could be lost as eligible income thresholds lower. Access to programs that support the social determinants of health will also be reduced. Low-income pregnant women may lose the critical services offered by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which serves about half of all infants born in the United States. Families may also lose access to programs that help them maintain safe and healthy housing, like the Low-Income Home Energy Assistance Program (LIHEAP) and Weatherization Assistance for Low-Income Persons. Eliminating access to these services will only raise health care costs for low-income people and further strain their already limited financial resources.
In addition to these short-term impacts, reducing access to these services will have generational health consequences. Research has shown that growing up “poor” can have long-term impacts on a child’s educational outcomes, physical health and brain development. Poverty and poor health outcomes are linked in a “negative feedback loop”. Having a low-income means that you cannot afford the health care you need, leading to poorer health outcomes that limit one’s ability to work. Restricting access to these vital services will only worsen health outcomes and economic opportunity for low-income individuals and families in the years to come.
What do we do about it?
It is incredibly important to push back on this proposal. Strong advocacy efforts have successfully thwarted previous attempts to make similar changes to the Poverty Measure and the Cost of Living Adjustment for Social Security. We have until June 21 to collect and submit comments on this notice. Sign up for Community Catalyst alerts to find out how else you can take action on this issue.