Hearings Spotlight Inflation, Opioids, and Other Challenges Facing Older Adults

April 22, 2025 | Catherine Jones

As of 2023, there were approximately 59.2 million adults aged 65 and older in the United States, representing nearly 18% of the total population. Around 10% of Medicaid beneficiaries are in this age group, and 14% of older adults live in poverty. With total Medicaid enrollment reaching approximately 79 million individuals as of November 2024, this translates to roughly 7.9 million older Americans (OA) relying on Medicaid for critical health services. In addition, the estimated average monthly Social Security retirement benefit for January 2025 was $1,976. Together, these figures underscore the difficult financial challenges facing millions of older adults and highlight the urgent need to address their financial, health, and wellness needs. Encouragingly, the 119th Congress has already held four hearings focused on OA, covering issues related to economic security, health care, loneliness, and post-acute care (PAC) access.

Inflation

In January 2025, the Senate Special Committee on Aging, chaired by Senator Rick Scott (R-FL), held a hearing, “Making Washington Work for Seniors: Fighting to End Inflation and Achieve Fiscal Sanity,” which focused on the disproportionate impact of inflation on OA. It underscored the necessity for balanced fiscal strategies to stabilize the federal budget to protect Social Security, Medicare, and Medicaid. Witnesses stressed that unchecked government spending, regulatory burdens, and welfare expansions contribute to inflation, which in turn disproportionately strains older adults’ fixed incomes.

Both sides agreed that older adults are facing mounting financial pressures but offered sharply different solutions. Republicans focused their attention on fiscal reforms, deregulation, work requirements, and increasing domestic production incentives. Democrats stressed safeguarding the social net for older adults, lowering prescription drug prices, addressing long-term care needs, and maintaining adequate funding for food programs (i.e., SNAP and Meals on Wheels).

The Opioid Crisis

A 2021 study estimated that nearly one million individuals aged 65 and older are living with opioid use disorder (OUD) in the United States. ​Notably, even though overall rates of overdoses declined for the first time in 2023, adults aged 65 and older experienced the largest percentage increase, with an 11.4% rise from 13.2 to 14.7 deaths per 100,000. In February, the Senate Special Committee on Aging held another hearing, “Combating the Opioid Epidemic,” focused on the crisis among older adults. The hearing emphasized the devastating impact of OUD on American families and communities, with special attention to the older demographic being victims as well as becoming caregivers to their grandchildren when their own children are in treatment for addiction.

Testimony and questioning underscored the necessity for a comprehensive approach to tackle the opioid crisis, involving expertise and participation from law enforcement, public health officials, health care professionals, policymakers, and affected families and communities. The hearing emphasized prevention, treatment, and the importance of community support systems to mitigate the epidemic's impact. ​Witnesses commented on the potentially devastating effects of decreased Medicaid funding for evidence-based substance and OUD treatments, barriers to accessing care (particularly in rural areas), effective and compassionate law enforcement strategies, strengthened border control, and more attention to overprescribing pain killers. They collectively emphasized the importance of taking action to reduce the number of overdose deaths among OA and recommended a set of strategies for Congress to consider. Suggestions included supporting and funding community care options, expanding drug awareness education, modernizing the medical workforce to include more addiction experts, and changing Medicare to provide bundled payments for holistic addiction treatment options. Comorbidities and compounding concerns, such as chronic disease, dementia, fall risk, pain management, and barriers to transportation, exacerbate the issue.  

Post-Acute Care Access

In March, the House Ways and Means Committee, chaired by Vern Buchannan (R-FL), held a hearing, “After the Hospital: Ensuring Access to Quality Post-Acute Care,” which showed that without making urgent reforms to staffing investments, leveraging technology (i.e., telehealth, hospice-at-home, skilled nursing-at-home), modifying Medicare to streamline access and funding (i.e., preauthorization denials), and sustaining Medicaid protections, America’s PAC system risks collapse, especially for older adults and people with disabilities. Lawmakers across both parties emphasized the need for reforms, including coordinated patient-centered care, payment innovation, and workforce upgrades to strengthen post-hospitalization care. Republicans proposed the elimination of nursing home minimum standards and incentivization of workforce development through training programs and public-private partnerships. Democrats voiced concerns that proposed Medicaid cuts would devastate access to nursing homes, home health, community-based services, and other such services. A panel of experts from the home health and rehabilitation hospital industries outlined critical pain points in the current PAC system. Forty percent of Medicare beneficiaries require PAC following hospitalization to improve outcomes and prevent costly readmissions and emergency department visits. require PAC following hospitalization to improve outcomes and prevent costly readmissions and emergency department visits.

Loneliness

Also in March, the Senate Special Committee on Aging held another hearing, “Breaking the Cycle of Senior Loneliness: Strengthening Family and Community Support,” which emphasized the pervasive concern of loneliness among OA and explored strategies to enhance social connections through family and community-based initiatives. One in four OA report being socially isolated, and 43% feel lonely. The panel of witnesses called loneliness a public health crisis, urged the passage of the Social Engagement and Network Initiatives for Older Relief or SENIOR Act, and advocated for more funding for the Older Americans Act as well as community health innovation. They emphasized the need for improved broadband access, telehealth coverage, transportation, food security, caregiver support, and Medicare screening for loneliness. They also touted the evidence-based success of assisted living communities and affordable housing initiatives for older adults in reducing loneliness and subsequent health deterioration. In addition, the hearing showcased YMCA as a lifeline for older adults with measurable impacts on health and wellness through partnerships with CDC (i.e., diabetes prevention and education programs and fall prevention) and private industry, and heralded senior centers throughout the country as playing a critical infrastructure role for aging in place.

Both sides agreed on the importance and tangible benefits of addressing loneliness and social isolation among older adults, recognizing its severe health impacts. Republican Senators highlighted legislative efforts (e.g., the SENIOR Act and bipartisan National Slam the Scam Day) to combat loneliness and protect older adults from scams, especially online. Chair Rick Scott (R-FL) questioned the future of the “forgotten middle,” 16 million Americans in the coming decades who do not qualify for Medicaid but cannot afford current assisted living options. Democrats emphasized strengthening federal funding for programs under the Older Americans Act (the 2020 reauthorization included language on social isolation), home-delivered meals, and intergenerational initiatives.

Continued Monitoring of Legislation on Challenges Facing Older Adults

These four recent hearings, along with legislation numerous representatives are currently drafting and reintroducing, provide a snapshot of the current systems for health and community services for older adults. As the reconciliation process advances, proposals to cut Medicaid and other efforts to reduce healthcare and public health spending are likely going to be on the table. ASTHO will closely monitor the legislative process, prioritizing the protection and expansion of evidence-based programs that safeguard the health, safety, and quality of life for older adult populations.