Author, Caring for Our Parents; Urban Institute; Editor, Tax Vox, Tax Policy Center
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Articles by Howard Gleckman
Nursing Homes Can Provide Quality, Creative Care. Here’s One Original
Chelsea, MA - December 11: ALS resident Patrick O'Brien at the Leonard Florence Center for Living. (Photo by Stan Grossfeld/The Boston Globe via Getty Images) Boston Globe via Getty Images The nursing home business is tough. Few want to live in them It is hard to make money running a good one. Government regulations make creative care a huge challenge. And they have a reputation, too often deserved, of being unpleasant and even dangerous places to live and work.
How Opus Newton Makes Housing Affordable For Middle-Income Seniors
Newton, MA - December 15: Exterior courtyard of Opus Newton on December 15, 2025, an apartment complex developed by 2Life Communities specifically for middle-income seniors. (Photo by David L. Ryan/The Boston Globe via Getty Images) Boston Globe via Getty Images Many of the roughly 10-14 million middle-income older adults in the US are attracted to senior living communities and are prime candidates to move. And collectively they have hundreds of billions of dollars to spend.
Todd Blanche’s Latest Trump IRS Immunity Deal Is No Concession At All
WASHINGTON, DC - JULY 15: Acting Attorney General Todd Blanche appears at his confirmation hearing in front of the Senate Judiciary Committee. (Photo by Eric Lee/Getty Images) Getty Images Attorney General nominee Todd Blanche says he has agreed to scale back the IRS audit immunity he made on President Trump’s behalf.
How Much Would A Public Long-Term Care Insurance Program Cost?
A nurse taking care of an older man. getty Long-term care costs are rising even as families struggle to keep up with increases in their ordinary living expenses, making it tougher than ever to save for personal care needs in old age. That combination is raising interest in public long-term care insurance. But what would a public program cost? It all depends on the design, but we are learning that a well-structured benefit could be quite affordable.
Beware Of Social Security Reform Commissions
US President Franklin D. Roosevelt signs the Social Security Act, 14th August 1935. (Photo by FPG/Archive Photos/Getty Images) Getty Images In recent weeks, two bipartisan groups of lawmakers—one in the Senate and one in the House—proposed commissions aimed at addressing the impending insolvency of the Social Security Trust Fund. Both deserve credit for proposing something, since most of their colleagues are silent on Social Security reform.
New Alzheimer’s Blood Tests Are Easy. But Do You Really Want One? Original
Test tube with blood sample for Alzheimer disease test getty New Alzheimer’s Blood Tests Are Easy. But Do You Really Want One? Despite the potential value of new blood tests promoters say can identify Alzheimer’s disease long before symptoms arise, these tests raise many important issues that patients and their physicians should carefully consider before requesting or administering them.
DOJ Lets States Limit The Ability Of Frail Seniors To Live At Home
Alice Terrell, left, and her caregiver Frances McDaniel at lunch at Terrell's home in Columbus, Ohio, January 31, 2005. (Photo by Neal C. Lauron/MCT/Tribune News Service via Getty Images) Tribune News Service via Getty Images The Department of Justice’s decision to stop protecting the right of people with disabilities to remain in their homes will make it easier for states to slash home care benefits in response to deep federally-mandated cuts in Medicaid funding.
How Fully Integrating Medical And Long-Term Care Benefits Older Adults
A doctor meets with an older adult patient getty The Benefits of Fully Integrated Medical and Long-Term Care For Older Adults Participants in a relatively small program that fully integrates medical care with a broad range of personal care and other services were less likely to need to visit emergency departments, be hospitalized, or even to die during the study period, compared to similar patients enrolled in Medicare Advantage plans.
Trump Policies Could Strip Health Coverage From 3 Million Age 50-64
A portrait of a middle-aged construction worker. getty President Trump’s two biggest health care initiatives, aggressive efforts to roll back the 2010 Affordable Care Act and deep cuts to Medicaid, could strip health insurance from as many as 3 million people aged 50-64. The biggest losers of all: Middle-aged people with disabilities. ACA Cuts Start with the ACA.
Why Consumers Don’t Buy Life Annuities And What Can Be Done About It
Senior couple embracing in front of residential home getty Ask nearly any financial economist and they’ll tell you retirees ought to have at least some of their savings in a life annuity—a financial product that provides a steady source of guaranteed income over the buyer’s lifetime. Consumers also say they like the idea. But here’s the weird thing: Almost nobody buys life annuities. Even people who do purchase annuities don’t buy this kind.
Social Security Heads For Insolvency. Policymakers Will Do…Nothing
Social Security Card with cash money dollar bills. getty The Social Security trustees have estimated the nation’s retirement trust fund will become insolvent in just 6 years, during the term of the next president. If nothing changes, that means recipients would see their promised benefits cut by 22% across the board. Of course, something will change. Nobody in Congress or the White House wants to take the heat for such an outcome. But that doesn’t mean lawmakers will actually fix the problem.
Medicaid Work Rules Disqualify Many But Allow Caregiver Flexibility
Woman helping senior woman dress in her bedroom getty The Centers for Medicare and Medicaid Services’ long-awaited rule implementing the Medicaid work requirements Congress passed last summer will make it much tougher for people with disabilities to qualify for benefits. But the rules provide some surprising flexibility for low-income family caregivers who are at risk of losing their own benefits if they must reduce work hours to care for loved ones.
Medicare Now Pays Docs To Train Family Caregivers, Why Don’t They?
REEDVILLE, VA - DECEMBER 12: Doctor Emory Lewis gives a memory test to new Medicare patient, Helen Kinne, while a concerned daughter, Deborah Kinne, looks on. (Photo by Melina Mara/The Washington Post via Getty Images) The Washington Post via Getty Images Family caregivers are the foundation of our system of care for older adults and younger people with physical or cognitive limitations. But they often provide that care with great love but little skill.
Senate Democrats Vow To Develop A Long-Term Care Reform Plan
WASHINGTON, DC - JUNE 12: Ranking Member Sen. Ron Wyden (D-OR) speaks at a Senate Finance Committee hearing. (Photo by Andrew Harnik/Getty Images) Getty Images In an important symbolic step, 17 Senate Democrats announced they will work together to develop a plan to improve long-term services and supports in the US. The effort is led by the Senate Finance Committee’s top Democrat, Ron Wyden of Oregon, a long-time supporter of services for older adults and younger people with disabilities.
Blocking New Medicare Home Health And Hospice Firms Won’t Stop Fraud
A woman in her 80s sitting on a sofa at home with a health care aide. getty In its efforts to prevent alleged widespread fraud in Medicare, federal regulators have blocked for at least six months any new home health and hospice providers from participating in these federal programs. This strategy may succeed in grabbing headlines but it won’t stem corruption and may limit access to care for many who need it.
How Pausing Gas Taxes Would Be A Warning For Social Security, Medicare
PASADENA, CALIFORNIA - MARCH 30: Gas prices displayed at a Mobil gas station. The average price of one gallon of regular self-service gasoline rose to $5.99 today in Los Angeles County. (Photo by Mario Tama/Getty Images) Getty Images With fuel prices skyrocketing due to his war in Iran, President Trump says he wants to suspend the federal gas tax “for a period of time.” GOP lawmakers immediately promised to introduce bills to do just that.
What To Do About Medicaid’s Long-Term Care Benefit?
Elvira Tesarek, shown May 2, 2011 with physical therapist Tracie DelSesto, at her Warren, Rhode Island home. (Jay Reiter/Tribune News Service via Getty Images) Tribune News Service via Getty Images There seems to be a growing consensus among policymakers that there is something very wrong with Medicaid’s long-term care benefit for frail older adults and younger people with disabilities.
What A Medicare Home Care Benefit Could Look Like
MIAMI - JANUARY 06: United HomeCare Services home health aide Wendy Cerrato hugs Olga Socarras. (Photo by Joe Raedle/Getty Images) Getty Images A group of influential policy experts has designed a universal home care benefit for people with physical and cognitive limitations. In a major change from the existing system in the US, where government-funded long-term care is primarily a Medicaid benefit, they’d shift home-based care to Medicare.
Do Older Adults Need Routine Colonoscopies Or Low Thyroid Drugs? Original
Doctor doing a colonoscopy for elderly man while a nurse is comforting a patient. getty The U.S. health system often is plagued by too much of a (sometimes) good thing. Doctors order a test or treatment and then continue them for the rest of the patient’s life, whether they really need them or not. And, often, they are ongoing for no good reason, despite potential risks to patients.
Do Older Adults Need Routine Colonoscopies Or Low Thyroid Drugs?
Doctor doing a colonoscopy for elderly man while a nurse is comforting a patient. getty The US health system often is plagued by too much of a (sometimes) good thing. Doctors order a test or treatment and then continue them for the rest of the patient’s life, whether they really need them or not. And, often, they are ongoing for no good reason, despite potential risks to patients.
Do Older Adults Need Routine Colonoscopies Or Low Thyroid Drugs?
Doctor doing a colonoscopy for elderly man while a nurse is comforting a patient. getty The US health system often is plagued by too much of a (sometimes) good thing. Doctors order a test or treatment and then continue them for the rest of the patient’s life, whether they really need them or not. And, often, they are ongoing for no good reason, despite potential risks to patients.
How The Trump Administration Is Blocking Access To Home Care Original
HAVERSTRAW, NEW YORK - MAY 05: Lidia Vilorio, a home health aide, gives her patient Martina Negron her medicine and crackers. (Photo by Michael M. Santiago/Getty Images) Getty Images One of the Trump Administration’s most glaring contradictions is this one: Top officials repeatedly promise to give consumers maximum choice in the care they receive.
The Iran War Has US Consumers Paying A Massive Carbon Tax
TEHRAN, IRAN - MARCH 01: Smoke rises after explosions rocked multiple areas of Tehran. (Photo by Fatemeh Bahrami/Anadolu via Getty Images) Anadolu via Getty Images Americans hate carbon taxes. Republicans really hate them. Yet, one result of President Trump’s war on Iran is that Americans now are paying what amounts to a massive tax on fossil fuels. If Americans were asked to vote on such a tax, it would lose resoundingly.
Medicare To Pay Docs To Reduce Falls By Seniors While WH Curbs Other Efforts Original
Older adult falls at home getty In a new experimental program, Medicare soon will pay participating doctors to provide better preventive care for frail older adults and younger people with disabilities. Among the initiatives, it will encourage greater support aimed at avoiding falls. The program, called Long-term Enhanced ACO Design, or LEAD, is an important step toward encouraging medical providers to help prevent falls before they happen.
Forbes JAPAN 公式サイト（フォーブス ジャパン）
高齢者のケアについて（あるいはたいていの物事についても）語ろうとすると、AIと関連技術の話題に転じずに会話を続けることは不可能だ。特に虚弱な高齢者に関しては重要性が増すかもしれない。有償介助者と家族介護者の双方が不足しているからだ。しかもこの状況は、より多くのベビーブーマーが80代に達し、苛烈な反移民政策が利用可能な介護労働者の供給を抑え込むにつれて、悪化する可能性が高い。 技術の革新は至るところにある。私の受信箱は「AIの何か」や「ロボットの何か」の宣伝で埋め尽くされている。だが、高齢者がそれらを受け入れる動機を理解することよりも、見栄えのするガジェットを作るほうが容易であるように見える。 技術には、高齢者が自宅でより長く自立して暮らすことを可能にしたり、シニア向けコミュニティでの生活の質を高めたりする潜在力があるため、これは重要な問いである。ただし、ここでは「潜在力」という言葉が大きな役割を担っている。 選択について考える...
Indexing Capital Gains To Cut Taxes Is A Bad Idea That Won’t Go Away
BROWNSVILLE, TEXAS - NOVEMBER 19: President Donald Trump and Sen. Ted Cruz (R-TX) attend the launch of a SpaceX Starship rocket. Photo by Brandon Bell/Getty Images) Getty Images Like the proverbial returning bad penny, congressional Republicans have resurrected the idea of indexing capital gains for inflation as a way to reduce taxes for investors. And they’re asking President Trump do it on his own, without legislative approval.
Democrats Would Eliminate Income Taxes For Millions. What It Means
WASHINGTON, DC - MARCH 4: Sen. Cory Booker (D-NJ) speaks during a news conference on March 4, 2025. (Photo by Tierney L. Cross/Getty Images) Getty Images Two new plans offered by Senate Democrats would eliminate federal income taxes for millions of middle-income households. One especially is fiscally dubious. But both raise key questions about the relationship between government and those who would no longer have a role in paying for much of it.
Understanding How Older Adults Think About AI And Related Tech
Excited senior couple using a Virtual Assistant at home getty It is impossible to have a conversation about caring for older adults (or most anything else for that matter) without pivoting to AI and related tech. It may be especially important when it comes to frail seniors, given the shortage of both paid aides and family caregivers—a situation likely to worsen as more Baby Boomers reach their 80s and draconian anti-immigrant policies curb the supply of available care workers.
The Meals On Wheels Budget Wasn’t Cut, But More Seniors Will Go Hungry
Critical food programs for older adults, such as Meals on Wheels, avoided major reductions in federal support when Congress finally approved a spending plan last month. But for the third year in a row, lawmakers froze funding for these efforts. And after taking into account rising costs and a growing population of frail older adults, no increase in funding inevitably will result in reduced services and increasing numbers of hungry seniors.
How Would Trump’s Retirement Savings Idea Work For You?
In his State of Union address, President Trump said he’d propose expanding an existing federal government contribution to retirement savings plans. But what would that really mean? While the White House offered no details, Trump said this, “I’m announcing that next year my administration will give these oft-forgotten American workers, great people, the people that built our country, access to the same type of retirement plan offered to every federal worker.
Trump Says Tariffs Can Replace The Income Tax. They Can’t.
In his State of the Union Address, President Trump repeated a frequent, and dramatic, promise: “As time goes by, I believe the tariffs, paid for by foreign countries, will, like in the past, substantially replace the modern-day system of income tax, taking a great financial burden off the people that I love.” Trump often has said he wants to return to a 19th century revenue system that was built on import duties. But he is profoundly wrong when he claims his own tariffs will get him there.
One-Third Of Income Tax Revenue Goes For Interest On Government Debt
The Congressional Budget Office’s new 10-year fiscal forecast includes plenty of headlines: The nearly $2 trillion federal budget deficit will grow to more than $3 trillion in a decade. The national debt is now greater than the total output of the entire US economy. But those numbers are too big to comprehend. Instead, let’s focus on something more understandable: How much of the federal income tax paid by individuals and corporations does government spend on interest on its enormous debt?
You Need To Save $135,000 For Long-Term Care. But Many Will Pay More
On average, 65- year-olds need to put aside $135,000 to pay for long-term care in their old age, according to a new report by the actuarial firm Milliman Inc. But beware of the average: About 43% of older adults will need no paid personal care at all. But about one of every five will need paid care for three years or more, with required savings of $300,000 and up. And 10% will require support for at least five years. They’ll need to set aside an average of $665,000 to pay their long-term care bills.
2026 Spending Bills Protect Federal Senior Services, Reject Trump Cuts
Volunteer John Sines loads coolers onto a bicycle trailer as part of the 'Meals on Two Wheels' program, Austin, Texas, (Photo by John Anderson/The Austin Chronicle/Getty Images) Getty Images The fiscal 2026 spending bill approved by Congress this month preserves federal funding for most senior service programs. Perhaps surprisingly, the GOP majority on Capitol Hill rejected many deep program cuts proposed by the Trump Administration.
What Seniors Should Know About The Future Of Medicare Advantage Plans
Medicare advantage in a clipboard. Health care insurance concept. getty To the shock of the big insurance companies that run most Medicare Advantage managed care plans, the government has proposed boosting payments to plans by just 0.09% in 2027. That would be a fraction of the annual increase plans received in the past and far below what they, and their investors, expected. Share prices plummeted and plan executives darkly warned of future benefit cuts. What would it really mean for enrollees?
The White House Promises Big Tax Refunds. You May Be Disappointed
1040 income tax form and w-2 wage statement with a federal Treasury refund check. Closeup with selective focusing. getty With the official kick-off of tax filing season, the Trump Administration and congressional Republicans are touting what they predict will be an average $1,000 increase in tax refunds this year. But many taxpayers, and those hopeful politicians, may be sorely disappointed.
As Numbers Of Older Adults Grow, The Supply Of Doctors Isn’t Keeping Up
Male doctor talking with senior man in exam room getty Twenty-five years ago, there were about 35 million Americans age 65 or older and about 10,000 board certified specialists in geriatric medicine to care for them. Today, there about 60 million older adults in the US. And the number of geriatricians has fallen to about 7,300. Perhaps more troubling, it appears that physicians are going into other specialties, such as oncology or cardiology, with less training in geriatric care than in past years.
Trump’s Latest Tariff Threat Raises The Stakes For The Supreme Court
NUUK, GREENLAND - JANUARY 17: People gather in front of the U.S. consulate to protest against President Donald Trump's announced intent to acquire Greenland. (Photo by Sean Gallup/Getty Images) Getty Images President Trump’s on-again, off-again tariff threats against European nations that oppose his efforts to acquire Greenland are exactly why the Supreme’s Court’s pending import tax decision is so important. And why a quick decision is essential.
What Medicare’s New TEAM Hospital Payment Model Will Mean For Seniors
Home healthcare nurse checks a patient's vital signs. She is recovering at home from a recent surgery. getty Medicare’s new hospital payment experiment, which it calls TEAM (Transforming Episode Accountability Mode), may have profound effects on patients, their families, and providers such as nursing homes and home health agencies. While the acronym signals the virtues of collaboration and shared goals, its outcomes are far less certain.
2026 Tax Stories To Watch: Filing Season, ACA Tax Credits, And Tariffs
1040 income tax form and w-2 wage statement with a federal Treasury refund check. getty The new year may not feature massive tax code changes like we saw in 2025, but there will be plenty for taxpayers to watch. Among the biggest issues: How will a diminished IRS handle the filing season that opens in just a few weeks? Will the Supreme Court restrain President Trump’s worldwide tariffs—and how will he respond if it does?
How New Medicare Payment Plans May Improve Patient Care And Save Money
WASHINGTON, DC - MARCH 14: Dr. Mehmet Oz, nominee to be administrator of the Centers for Medicare and Medicaid Services, testifies during his confirmation hearing. (Photo by Nathan Posner/Anadolu via Getty Images) Anadolu via Getty Images Our deeply fragmented health system is especially dangerous for older adults, younger people with disabilities, and their families.
It Is Time To Simplify Health Insurance In The US
RX pharmacy prescription bottle of pills on a pile of $100 dollar bills and a USA outline getty While Congress and President Trump fruitlessly debate how much the government should subsidize certain health insurance premiums, they are missing a far more important question: How could the US rationalize our eight (at least) completely separate health insurance systems? This maze-like complexity comes at a price. Dividing Americans into multiple risk pools increases health care costs.
Trump Makes Care Less Affordable For Seniors, People With Disabilities
NEW YORK CITY - JANUARY 28: New York City Fugitive Operations Team conducted enforcement operations resulting in the arrest of a Dominican national. (Photo by U.S. Immigration and Customs Enforcement via Getty Images) U.S. Immigration and Customs Enforcement via Getty Images When politicians use their favorite buzzword of the day “affordability,” they most likely are talking about housing, insurance, or beef.
The Impact Of The Economic Mistakes Trump Is Trying To Explain Away
TOPSHOT - Cranes are seen at the Port Newark Container Terminal in Newark, New Jersey on April 8, 2025. (Photo by CHARLY TRIBALLEAU / AFP) (Photo by CHARLY TRIBALLEAU/AFP via Getty Images) AFP via Getty Images President Trump is embarking on what the White House promises will be a national tour promoting his economic agenda.
How AI And Other Tech Could Wreck The Federal Tax System
SAN FRANCISCO, CALIFORNIA - NOVEMBER 06: OpenAI CEO Sam Altman speaks during the OpenAI DevDay event. (Photo by Justin Sullivan/Getty Images) Getty Images “There is only one way to make everyone wealthy–and that’s AI and robotics. My prediction is that work will be optional." - Elon Musk Muskian hyperbole aside, AI and related technologies such as robots and quantum computing could have a profound effect on human labor.
Trump May Drop Opposition To ACA Subsidies, Preserve Tax Credits
JOINT BASE ANDREWS, MARYLAND - NOVEMBER 09: President Trump gives brief remarks to members of the press after exiting Air Force One. (Photo by Tasos Katopodis/Getty Images) Getty Images After a government shutdown and months of drama, it appears that President Trump may be about to drop his aggressive opposition to extending soon-to-expire enhanced Affordable Care Act subsidies.
New Ways To Close The Care Navigation Gap For Seniors And Families
A man in his 80s with his adult son. getty Navigating the highly complex and deeply fragmented systems of medical and long-term care is one of the biggest challenges family caregivers face. How do I find a reliable home care aide? Where is a good adult day center? How can I coordinate dad's medical treatment with his personal care? Now, new care navigation services are filling the gaps, many offered by commercial businesses and health systems rather than government.
Trump May Have Won The ACA Subsidy Battle, But He May Lose The War
WASHINGTON, DC - SEPTEMBER 18: U.S. Senate Majority Leader John Thune (R-SD) at the U.S. Capitol. (Photo by Andrew Harnik/Getty Images) Getty Images Progressives are fuming over the decision by eight Senate Democrats to support a bill to reopen the federal government without an agreement on extending enhanced Affordable Care Act health insurance subsidies beyond December. Allies of President Trump are gloating at what appears to be Democratic capitulation to the White House’s hardball tactics.
Trump Tariff Cases Before The Supreme Court Are A Big Deal. Here’s Why
WASHINGTON, DC - FEBRUARY 21: People leave the U.S. Supreme Court. (Photo by Kevin Dietsch/Getty Images) Getty Images Does President Trump have unlimited power to unilaterally impose tariffs, and perhaps other taxes, without consent of Congress? That is the question before the Supreme Court this week. The justices will hear oral arguments in two cases involving President Trump’s broad imposition of tariffs on, well, on the whole world.
Pols Fear Social Security Reform, But Experts Lean In With Solutions
Several Social Security Cards on a US United States $100 bill. getty Even as most policymakers continue to ignore the looming insolvency of Social Security—and the 23% reduction in benefits it will produce in seven years—policy experts across the political spectrum increasingly are leaning into the challenge, often in creative new ways.
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