Biden's 2025 Budget: What Changes Could Impact Medicare, Family Leave, and Medicaid Home Care?

Major initiatives focused at assisting older persons are included in President Biden's 2025 budget plan, which will also serve as his platform for the presidential election. It would create a federal family leave program for parents of both older persons and children, tighten regulations and inspections of nursing facilities, boost taxes to help pay Medicare, and expand government assistance for Medicaid home-based care. It doesn't specify how it will increase Social Security's solvency, only that it will.

None of Biden's comprehensive plans will be enacted by a severely divided Congress in the remaining days of this election year. But anticipate them to be part of Biden's governing agenda beginning the next year, along with a larger suite of new social initiatives. That is, if he wins reelection.

Even if Biden prevails and the Democrats seize total control of Congress, the task will be to figure out how to cram all of these audacious plans into an already sizable and expanding fiscal deficit. Eventually, some expensive priorities will be dropped.

Biden's Proposed Budget

Medicare prescription medications. He would expedite Medicare's capacity to bargain for lower medication costs. Congress granted Medicare the authority to bargain for costs in 2022, but only for ten pharmaceuticals beginning in 2026, and then increasing the number by 15 to 20 every year from 2027 to 2029. In an effort to prevent the 2022 law from allowing for even modest price talks, the pharmaceutical industry has launched many lawsuits. Additionally, Biden would set a $2 cap on Medicare beneficiary co-pays for a 30-day supply of some generic medications.

The sustainability of Medicare. By 2031, the Part A hospital insurance trust fund under the scheme is expected to run out of money. By increasing taxes on high-income workers and dedicating a portion of another tax's proceeds to the federal health program, Biden would strengthen the government's coffers. For those earning more than $400,000, he would increase the Medicare tax rate from 3.8 percent to 5 percent on wages and unearned income.

Closing this loophole would prevent some wealthy company owners from having to pay Medicare taxes, and he would transfer money from the 2010 Net Investment Income Tax to the HI trust fund. Currently, the general fund of the government receives such income. Additionally, he would contribute to the hospital insurance trust fund any Part B and Part D savings resulting from the Medicare prescription drug changes.

Medicaid at-home assistance. Over a ten-year period, Biden would boost government spending for Medicaid Home and Community-Based Long-Term Care Services by $150 billion (HCBS). Early in his administration, Biden suggested the federal government provide up to $400 billion more for Medicaid HCBS; but, in 2021 and 2022, a Democratic Congress did not adopt any of the plans, nor a more limited version. Medicaid expenditures are often shared by the federal government, states, and both.

Medicaid home health care support. Biden would increase government funding for Medicaid Home and Community-Based Long-Term Care Services by $150 billion over a ten-year period (HCBS). Biden proposed early in his presidency that the federal government increase funding for Medicaid HCBS by up to $400 billion; however, a Democratic Congress did not approve any of the plans, not even a scaled-back version, in 2021 and 2022. Medicaid costs are frequently split between the federal government, the states, or both.

Nursing homes. Biden promises more inspections of nursing homes. Beginning in 2026, the federal government would pay for all mandated state surveys in full, strengthen financial sanctions for underperforming institutions, demand more information regarding nursing home ownership, and intensify inspections of establishments with grave safety flaws. Several states are still behind schedule in clearing their increased backlog of inspections caused by the outbreak. Biden is not, however, requesting a significant increase in financing for the nursing home projects.

Older Americans Act. The majority of older adult non-Medicaid assistance would see a budget boost of almost $70 billion. Meals on Wheels and other senior nutrition initiatives would get an approximate $83 billion, or 8%, boost in funding. Almost all other Older Americans Act programs would have their budgets cut or remain at current levels.

Social Security. Biden would enhance Social Security's administrative budget, which should enhance the organization's capacity to assist applicants and recipients. Furthermore, he promises to raise payroll taxes on individuals with high incomes; however, the budget materials that were made public yesterday do not specify how.