Trump has murky plans for Social Security, raising fears of a public health crisis

Ned Barnett lives in Las Vegas, Nevada, meaning he resides in one of the seven swing states that Donald Trump swept in the 2024 presidential election. LIke a majority of voters on Election Day, Barnett is primarily concerned about economic issues like inflation. That is why he cast his ballot for Trump; he explained that he has simply suffered too much from the rising prices under President Joe Biden’s economy.

“When I heard [Vice President] Kamala [Harris] on the View saying she wouldn't change a thing, I knew I couldn't survive four more years of Bidenomics,” Barnett explained. In one sense, Barnett’s experience is consistent with the polls, which found American voters primarily concerned with economic issues like inflation. Yet Barnett also brings up an economic issue that was not widely discussed during the campaign: Social Security.

Barnett is fearful that Trump’s plans for Social Security will deprive him of the little money he has left to survive. According to experts who spoke with Salon — both about the agency’s long-term solvency and about why it is essential to public health — Barnett and the millions of other Social Security beneficiaries like him are correct to keep a close eye on the program.

“My wife and I depend on Social Security — it is our lifeline to the future,” Barnett said. The couple was “wiped out” during the economic crash that began in 2008; Barnett’s wife lost her half-million dollar retirement fund in nine days in 2009, and the spouses later filed for bankruptcy in 2011-12. Like many hardworking Americans, Barnett gradually rebuilt his finances, thriving in the mid-to-late 2010s by ghostwriting and performing consulting work. Yet the two depended on Social Security to survive, as it bridged the gap between Barnett’s income and what they needed to survive.

Then came the high inflation of the post-COVID economy. Now the Barnetts cannot afford to fix their car or use Uber more than sparingly, leaving them effectively housebound. Barnett’s consulting and ghostwriting services “dried up with so much of the rest of the economy,” with the pair relying on charity and programs like Meals on Wheels, as well as plenty of oatmeal.

“We are hopefully optimistic that the economy will turn around, but until it does, Social Security is all that's keeping us (barely) afloat,” Barnett said.

The Social Security program, as it exists in the United States, was created in 1935 under President Franklin D. Roosevelt as part of his liberal New Deal policy package. Over nearly nine decades it has been considerably amended, and today it guarantees that U.S. citizens who have worked and paid Social Security taxes for at least 10 years will receive financial support if they are disabled or become a senior citizen (defined in this context as 62 years old). The program is funded primarily through payroll taxes called the Federal Insurance Contributions Act (FICA) or Self Employed Contributions Act (SECA), and as of 2022 provided essential support for more than 70 million Americans.

Trump’s 2025 agenda has some people concerned that Social Security will be targeted. He plans to cut trillions from the federal budget, — a speculation bolstered by evidence in March when he told CNBC that “there is a lot you can do in terms of entitlements, in terms of cutting and in terms of also the theft and the bad management of entitlements. There's tremendous amounts of things and numbers of things you can do.”

While Trump later backpedaled by claiming he was only referring to “waste,” his subsequent tax cut proposals raise the specter of defunding the program, with there being no evidence to support Trump’s assertion that the difference could be made up through high tariffs. Such tariffs would in turn force Social Security recipients to make cost-of-living adjustments. Even the Trump campaign’s promises — such as pledging to cut all taxes levied on Social Security income — come with the risk that doing so would likely further deplete the Old-Age, Survivors and Disability Insurance (OASDI) fund. Finally, the Social Security program is threatened by Trump’s promise to fire thousands of federal employees and replace them with political loyalists, who may or may not be best qualified to competently perform their duties.

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Consequently, one key to figuring out the future of the program under Trump is to ascertain how exactly he plans on doing the two most essential things: Paying for the program short-term and long-term, then implementing it effectively for those who need it.

“At this point, I think we know very little for sure about what will happen to FICA and Social Security taxes,” Timothy J. Moore, an economist at Purdue University, told Salon. Trump has focused less on answering those questions than on promising financial rewards to current beneficiaries through the aforementioned tax cuts. Moore added that Trump’s pledge to not tax Social Security benefits “is unlikely to affect older Americans who depend on Social Security as their only source of income or beneficiaries getting the average amount from Social Security or less or Americans who are in the bottom half of the distribution in terms of their lifetime earnings,” adding that these groups often “overlap substantially.” Because there are already federal tax breaks for Social Security income, those groups already do not pay income taxes.

“You might also note that most states provide tax breaks for Social Security income that mean most Social Security beneficiaries do not have their benefits taxed,” Moore said. “In 2020, the Congressional Research Service reported that 30 states and the District of Columbia exempt Social Security income from state income taxes and another seven states have no income taxes. The remaining 13 states’ tax apply discounts similar or larger than those applied to federal taxation.”

This is not to say that Trump’s proposed tax relief will fail to provide any help to Social Security beneficiaries, at least in terms of giving them a little more money for heating, medical care and family support. In terms of the overall amount of revenue that ends up in beneficiaries’ pockets, however, “we would not expect observable changes in objective health outcomes or life expectancy.”

Moore used the phrase “objective health outcomes or life expectancy” because, regardless of the political considerations, there are public health consequences to reducing the assistance provided by social welfare programs like Social Security Insurance (SSI) and Social Security Disability Insurance (SSDI). The concept behind social security is not simply to provide relief to the needy, but also to maintain America’s overall economic viability by providing a floor to the health scourge known as poverty. When Roosevelt signed the act into law in 1935, he did so not only to help o30 million recipients at the time, but to “take care of human needs and at the same time provide the United States an economic structure of vastly greater soundness,” Moore said.

“SSI/SSDI offers vital support to those facing health challenges and disabilities by providing income and health insurance,” Jeremy McCauley, an assistant professor in economics at the University of Bristol, told Salon. “Increased income and health insurance access are known to have health benefits, including reduced mortality rates.”

Recipients of these programs experience  increased  food, housing and medical security, but also the mental health benefits of alleviated anxiety about their survival. McCauley expressed concern that the programs could unintentionally discourage peopel from working, social interaction and physical activity, but “despite this trade-off, the health benefits of SSI/SSDI likely outweigh any potential negative impacts for most recipients, especially those with high-cost conditions like cancer.”

Eric French, an economist at the University of Cambridge, explained that we know for sure that life expectancy in the United States has risen dramatically since the Social Security Act was passed in 1935, especially among senior citizens. Although life expectancy has started to fall again in recent years, this is largely due to obesity and diseases of despair (drug overdose, alcoholism and suicide, for example) that Social Security can actually help ameliorate.

“We also know that high income people live longer than low income people (four to nine years, depending on approach),” French added. The causal relationships are somewhat murky — for example, people with lower incomes may succumb more to diseases of despair like substance use disorder or overeating. “Of course, those who are healthy find it easier to work, raising their income. So it is not obvious which way the causality runs.”

According to Yue Li, an economist at the University at Albany, SUNY, “there has been evidence showing that when social security was first introduced, it caused mortality to fall.” At the same time, the data has its nuances: “That period features very low income levels. It is questionable whether this can be generalized to the current period.” Li also said that, when Sweden raised its Social Security program’s retirement age, it had basically “no effect” on health and mortality, suggesting that although Social Security provides a floor for survival, throwing more and more money into the program does not as a consequence lead to similarly constant improvements in public health outcomes. The challenge in preserving Social Security lies in maintaining its solvency and the quality of its services without harming current recipients.

“The evidence that benefit cuts are bad for kids is a lot stronger than the evidence that benefit cuts are bad for those in retirement. Retirees can look after themselves — kids can't,” French said.  Regardless of how those benefits are cut, though, experts agree that mass economic suffering will ensue unless those cuts are targeted toward those most capable of affording them.

“My research indicates that significantly reducing Social Security benefits would likely have adverse effects on recipients' health, particularly for those with costly medical conditions,” McCauley said. “While reforming the system to reduce work disincentives could potentially improve overall health outcomes, sharp cuts to benefits would likely increase mortality rates.”

Martin O'Malley, the commissioner of the Social Security Administration, empathizes all too well with the human suffering that necessitates the program’s existence. A former governor of Maryland, O’Malley visited field offices whenever he could and recalls the wide variety of problems his agency exists to alleviate. He recalled widows who described themselves as “survivors” because they needed to apply for survivor benefits for the first time. He met grandmothers raising disabled children who needed a redetermination of their supplemental security income, and people on SSI who were part-time working and “jumping through all of the hoops to prove that they're not earning too much, coming in with their pay stubs every week. Those are all the human stories that I saw.”

O’Malley was also concerned with the morale of the employees who serve the beneficiaries. Appointed by President Biden in July 2023 and confirmed five months later, O’Malley inherited an agency that had lacked a permanent Senate-confirmed head since July 2021. Internal surveys found employee morale had plummeted from a high during the Obama administration to a nadir over the previous three years.

“The legacy was a totally demoralized workforce,” O’Malley told Salon. “It had staffing driven down to 50 year lows as customers because of Baby Boomers like me, who have swelled our ranks to every day a new all time high in customers. So they were demoralized, they were battered, they were embarrassed that they weren't serving the public like they were able to in the not-so-distant past. That was the agency that President Biden asked me to go pick up off the mat.”

O’Malley immediately prioritized improving the work environment, from asking Congress to beef up staffing to challenging the risk-averse work culture that had developed there. He did this because there can be terrible consequences for ordinary people when a bureaucracy is not able to run efficiently. Speaking to Salon in September, Bert A. Rockman, professor emeritus of political science at Purdue University, explained that bureaucracies can be extremely useful because "the most proficient means of organizing is with a professional class of operatives with expertise in the relevant subject matter." It is true in government just as it is true in business — and any organization's success therefore depends on the quality of the people who work there.

"A great deal of the anti-bureaucracy sentiment is associated with right-wing populism, which often sputters between anarchism and fascism (turning all agencies into the playthings of a right-wing dictator)," Rockman said. For right-wing governments to achieve that result, they need to spread misinformation about the programs they aim to weaken or destroy. O’Malley combatted this firsthand while trying to turn things around for Social Security.

“Whenever I would go to a field office, instead of coming in the locked back door, I would always go into the reception area and I'd introduce myself, point to the official photos on the wall and tell people I’m the other guy in the blue tie,” O’Malley recalled. “And I'd asked them what they were doing there, and what they were hoping to get done in the field office.” He would explain to people that assume Social Security is a “Ponzi scheme,” pointing out that “these are real dollars that get paid in every year and real dollars that get paid out. It is more akin to an insurance company where premiums are collected and benefits are paid out.”

O’Malley debunked false claims made by Trump that undocumented people receive Social Security benefits, noting that “there were a couple of big lies that were being told in this election season. One of them was that illegal immigrants are bankrupting social security when in fact illegal immigrants — people working here out of legal status — are prohibited from receiving any benefits from Social Security nor can they earn any credits for retirement. But they do pay in $22 billion [in taxes] a year for the rest of us, and they'll never see a dime of that money.”

O’Malley also said that the system is not going bankrupt.

“Social Security cannot go bankrupt because it is structured to be a pay-as-you-go program,” O’Malley said. “In other words, last year we paid out $1.35 trillion in benefits, and most of the dollars for paying those benefits came from people working last year in the economy.”

Finally, O’Malley clarified how the system is financed and how that could collapse in the future: “If we're not going to ask millionaires to pay into FICA again and we're not going to have people pay in through their paychecks, then there won't be benefits to pay out,” O’Malley said. “It's a simple mathematical equation.”

Karoline Leavitt, the Trump-Vance transition spokeswoman who was recently named the youngest ever White House press secretary, told Salon that "President Trump delivered on his promise to protect Social Security and Medicare in his first term, and President Trump will continue to strongly protect Social Security and Medicare in his second term." They did not respond to any specific questions about their Social Security policies, a fact that will likely provide little reassurance to recipients like 72-year-old Sheila Sorvari in Texas, who said she is outright “scared” of another Trump presidency.

“I worry about my daughter,” Sorvari said. She is 40-years-old and has the most deadly form of brain cancer: glioblastoma.” After surviving for three years following an operation where she had a 14-month prognosis, she relies on both SSDI and Medicare since many of America’s top cancer centers would not accept insurance through the Affordable Care Act.

“Months after her diagnosis, my husband and I sold our home and moved to a tiny condo so we would have cash for her care,” Sorvari said. “I am terrified for my daughter. I am terrified for everyone who doesn’t have savings and health insurance. Just thinking about this makes me cry.”