Being

Mailman School of Public Health at Columbia University.

Beyond the corridors of medicine, she said, “we need society to build solutions” to issues raised in the index — the ability of seniors to work, volunteer, and engage with other people; the safety and accessibility of neighborhoods in which they live; ageism and discrimination against older adults; and more.

Meanwhile, a team of Chinese researchers recently published a comprehensive review of social frailty in adults age 60 and older, based on results from dozens of studies with about 83,900 participants in Japan, China, Korea, and Europe. They determined that 24% of these older adults, assessed both in hospitals and in the community, were socially frail — a higher portion than those deemed physically frail (12%) or cognitively frail (9%) in separate studies. Most vulnerable were people 75 and older.

What are the implications for health care? “If someone is socially vulnerable, perhaps they’ll need more help at home while they’re recovering from surgery. Or maybe they’ll need someone outside their family circle to be an advocate for them in the hospital,” said Dr. Kenneth Covinsky, a geriatrician at UCSF and co-author of the recent Proceedings of the National Academy of Sciences article.

“I can see a social frailty index being useful in identifying older adults who need extra assistance and directing them to community resources,” said Jennifer Ailshire, an associate professor of gerontology and sociology at the University of Southern California Leonard Davis School of Gerontology.

of good legislation got passed.

“Frankly, it’s impossible to know what will happen in the Republican-controlled House,” he said.

Stone noted Congress votes to fund many programs every year. That’s discretionary spending. Some things like Social Security, Medicare, and much of the Defense budget are paid for by dedicated taxes. Those programs are mandatory spending.

“I really don’t know how things are going to play out. We live in interesting times,” Stone said, adding support for Ukraine is not going to be a budget buster and China is the one place where both sides agree.

Defense spending & investments in families

Biden’s request on defense spending is $842 billion, $35 billion higher than last year. Defense officials are calling it the “largest, nominal-dollar peacetime budget ever.” If you add another $44 billion for the Department of Energy to upgrade nuclear weapons, it’s a total of $886 billion. That is still less than the $1.3 trillion spent on social welfare last year.

“The budget does propose to make some really important investments in children, families, seniors, workers, particularly those with low and moderate income, and it’s a particularly important moment, because a lot of the pandemic era programs are winding down,” says Elizabeth Lower-Basch, a social policy director at the Center for Law and Social Policy in Washington.

She said that costs for food, child care, and healthcare are continuing to rise. “So families are feeling the pinch. The President’s budget does propose to bring back the enhanced child tax credit which was rolled out in 2021 as part of the American rescue plan.”

Biden wants to bring it back permanently. And he wants to close the “Coverage Gap” for lowincome families and individuals who make too much to qualify for free insurance under the

Affordable Care Act (ACA).

Lower-Basch said Biden’s budget would require all states to expand Medicaid for postpartum women for 12 months. Right now, 11 states have not expanded Medicaid and the President’s proposal would require them to do so.

“The budget also calls to invest an additional $150 billion over 10 years for seniors and people with disabilities so that they can get care at home or in community settings rather than having to be cared for in a nursing home,” she said.

Investing in food security Biden’s budget puts a high priority on federal nutrition food security programs, including school meals. The WIC program provides new moms with baby formula and pregnant women with groceries. The Supplemental Nutrition Assistance Program (SNAP) helps poor families buy healthy food. A two-person family with a $1,526 monthly income qualifies.

“The Farm Bill is up for reauthorization this year. That’s usually a bipartisan bill, so the SNAP program is one area where there might be some opportunity for legislation to actually happen,” says Lower-Basch. Other things on the President’s wish list include 12 weeks of paid family and medical leave for all workers. Child Care and early childhood programs would get large increases — $600 billion over 10 years for childcare. Sixteen million children would get affordable childcare and four million 4-year-olds would go to preschool.

Lower-Basch says there’s going to be a lot of fighting and back and forth when Congress starts to debate Biden’s budget.

“These are proposals that didn’t quite make it to the finish line last year, even when Democrats did control both the House and the Senate, so they’ll definitely be more challenging to get through this year,” she said. (Peter White/Ethnic Media Services)