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Public Health Department (PHD)

 

To supplement Chapter 9 Hospitalization of Mentally Ill Nationals Returned from Foreign Countries §321-329. To graduate the Department of Health and Human Services (HHS) into two separate agencies, the Public Health Department (PHD) and the Department of Human Services (HS), with separate congressional budget justifications under 31USC§101, as should have been done by the Department of Education Reorganization Act on May 4, 1980, under 20USC§3508. To redress hyperinflation in medical bills, that cause an estimated 67% of bankruptcies today, up from 8% in 1980, it is necessary to nullify and repeal 'Medical records and payments' from the Fair Credit Reporting Act under 15USC§1681a(x)(1). To create a Medicaid Trust Fund to account for both Medicare and Medicaid spending, so advance appropriations equal trust fund balance at year end, in the expanded Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund, Federal Supplemental Medical Insurance Trust Fund and Federal Medicaid Trust Fund. To immediately amend the 1.8% DI tax rate starting January 1, 2019 in Sec. 201(b)(1)(T) of the Social Security Act under 42USC§401(b)(1)(T) to either; (1-a) 2.1% DI tax, or (1-a) 2.0% DI tax if OASI pays $240 billion to replicate to the extent possible revenue if the OASDI tax had been properly adjusted by Public Law 112-96. To create a SSI Trust Fund to redress child poverty rates by 2020 and all poverty by 2030 by taxing the rich the full 12.4% OASDI tax on all their income in the Annual Report of the Board of Trustees of the Federal Old Age Survivor Insurance Trust Fund, Federal Disability Insurance Trust Fund and Federal Supplemental Security Insurance Trust Fund. To update CPR to differentiate between rescue breathing one breath per five seconds or 100-120 chest compression per minute, using 30 compression for adults and 15 compressions for children per 2 breaths, if respiratory arrest due to more common cardiac arrest. To treat atherosclerosis with vegan diet, fresh fabric, exercise, statins to reduce cholesterol and antibiotics to treat endocarditis. To prescribe: Naloxone (Narcan) rescue injection and naltrexone oral to reverse respiratory depression in opiate overdoses. Amantadine (Symmetrel) to cure in one dose human influenza and the extra-pyramidal side effects of anti-psychotic drugs and treat Parkinson's. Ampicillin (Principen) treats pneumonia, meningitis and sinusitis. Metronidazole (Flagyl ER) (1960) treats resistant joint, lower lung, heart, pancreatic, kidney, liver and gastrointestinal infections caused by Helicobacter pylori, Entamoeba histolytica, Bacteroides fragilis, Salmonella, Giardia, E. coli and antibiotic associated colitis caused by Clostridium difficile. Doxycycline (1967), the once a day antibiotic, heals wounds infected with hospital acquired Methicillin Resistant Staphylococcus Aureus (MRSA), bubonic plague, Lyme disease and syphilis. Clindamycin (Cleocin) treats Staph in children under age 8 and pregnant women. Staph heart attacks are 50% fatal on hospital admissions. Toxic shock syndrome is caused by hospital acquired Staphylococcus aureus sensitivity to Streptococcus spp. and is best treated with doxycycline or clindamycin. One cup of bleach per 5 gallons hospital cleanser. Brush teeth within 10 minutes of eating sweets. Hydrocortisone creme treats aspergillosis and allergies. Clotrimazole (athlete's foot creme) treats the foot and shin. Stonebreaker (Chanca piedra) cures urinary and gallstones overnight.

 

Be it enacted in the House and Senate assembled

 

1st Draft 2 Aug. 2005, 2nd 7 April 2006, 3rd 7 April 2007, 4th 9 Aug. 2007, 5th 26 September 2009, 6th 28 August 2011, 7th 4 June 2018, 8th 30 July 2018

 

1. This work supplements Title 24 US Code Chapter 9 §321- §329 Hospitalization of Mentally Ill Nations Returned from Foreign Countries, National Health Expenditure (NHE) Accounts: Methodology Paper, 2016 Definitions, Sources, and Methods, Centers for Medicare and Medicaid Services (CMS) Justification of Appropriations FY 19, 2017 Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund and Federal Supplemental Medical Insurance Trust and Department of Health and Human Services (HHS) FY 19 Budget-in-brief. It is time for the Department of Health and Human Services (DHHS) to graduate into two separate agencies, the Public Health Department (PHD) and the Department of Human Services (DHS), with two separate congressional budget justifications under 31USC§101, as should have been done by the Department of Education Reorganization Act on May 4, 1980, under 20USC§3508. The dual purpose is for the Health Department to keep spending under the <$1 trillion limbo bar until FY 20 with the goal for 2030 of NHE <10% of GDP and for Human Services to redress the loss of 10 million Aid for Families with Dependent Children (AFDC) benefits 1996-2000 with healthy child welfare program growth, in their polar opposite congressional budget justifications of estimates for appropriations committees. To redress hyper-inflation in health care, that causes an estimated 67% of bankruptcies today, up from 8% in 1980, it is necessary to nullify and repeal 'Medical records and payments' from the Fair Credit Reporting Act under 15USC§1681a(x)(1). To redress the loss of 10 million Aid for Families with Dependent Children (AFDC) benefits 1996-2000 and 22-33% of children growing up in poverty today, it is necessary to sustain growth in programs for low income families. To eliminate child poverty by 2020 and all poverty by 2030 it is necessary to tax the rich the full 12.4% Old Age Survivor Disability Insurance (OASDI) tax on all their income, and create a Supplemental Security Income (SSI) Trust Fund, for the Actuary to estimate the optimal OASDI and SSI tax distribution, every-year. in the expanded Annual Report of the Board of Trustees of the Federal Old Age Survivor Insurance Trust Fund, Federal Disability Insurance Trust Fund and Federal Supplemental Security Insurance Trust Fund. CMS estimates must be redone, taking into account that Medicaid advance appropriations do not contribute to $885 billion (FY19) federal outlays, although they, and off-budget trust fund revenues, do contribute to $1,249 billion (FY 19) congressional budget authority.  The FDA is directed to terminate the Center for Tobacco Products under the Nuremberg Code and use the revenues tobacco fees to reduce federal outlays.  HRSA reinvests in clinical and hospital services, National Poison Control Centers need to held responsible for the prescription opiate and heroin overdose epidemic statistics, in their annual report.  IHS is growing steadily and may appropriate national forest headquarters for the Interior Department. Outlays for CDC are going down, budget authority derived from vaccine fund.  NIH has taken responsibility for Occupational Health and Healthcare Quality and needs to terminate the proposed National Institute for Disability, Independent Living and Rehabilitation Research under the Nuremberg Code.  ACF outlays sustain the LIEAP and TANF program budgets, despite a second year of proposed cuts.  ACL grows 2.5%.  SAMHSA increases budget authority from the one time opiate allocation FY 19 while reducing federal outlays for mental health and substance abuse.. The fine print of the HHS budget-in-brief reveals the terms outlays and budget authority are reversed from generally accepted accounting principles (GAAP), outlays means congressional budget authority and budget authority means federal outlays for internal budgeting purposes, and this must become consistent with the Historical Tables of the White House Office of Management and Budget.

 

Health and Human Services, Budget FY 17 – FY 20

(millions)

 

Health and Human Services Department Operations

FY 17

FY 18

FY 19

FY 20

Gross Outlays

1,055,020

1,111,713

1,142,765

1,182,049

Undistributed Offsetting Receipts

-115,583

-125,220

-134,848

-138,893

Net Outlays

939,437

986,493

1,007,917

1,043,156

Congressional Budget Authority

1,261,531

1,372,251

1,424,707

1,509,932

Health Department

Centers for Medicare & Medicaid Services, outlays

938,165

994,261

1,019,455

1,057,940

BA

1,089,778

1,195,791

1,248,974

1,333,426

Food and Drug Administration

2,800

2,781

3,254

1,729

BA

4,449

4,342

5,136

4,754

Health Resources and Services Administration

6,208

6,164

9,990

9,738

BA

11,254

11,362

10,951

10,661

Indian Health Service

5,039

5,011

5,109

5,241

BA

6,388

6,363

6,311

6,473

Centers for Disease Control and Prevention

6,354

6,290

5,587

5,847

BA

12,100

11,973

10,921

11,198

National Institutes of Health

33,265

33,099

33,846

34,389

BA

34,229

34,067

34,767

35,109

Departmental Management outlays subtotal

3,430

3,051

3,128

3,207

BA subtotal

3,574

6,699

3,474

3,554

Offsetting Collections

-975

-1,373

-1,243

-1,274

Other Collections

-125

-125

-125

-125

Health Department, Subtotal Outlays

994,161

1,049,159

1,079,001

1,116,692

Undistributed Offsetting Receipts

-115,583

-125,220

-134,848

-138,893

Health Department, Net Outlays

878,578

923,939

944,153

977,799

Health Department, Subtotal BA

1,161,772

1,270,597

1,320,543

1,405,175

Human Services Department

Administration for Children and Families

54,852

56,510

58,336

60,099

BA

93,752

95,610

97,536

99,499

Administration for Community Living

1,896

1,953

2,002

2,052

Substance Abuse and Mental Health Services Administration

4,111

4,091

3,426

3,206

Human Services, Outlays

60,859

62,554

63,764

65,357

BA

99,906

101,800

104,326

104,921

Total Federal Outlays, Department of Health and Human Services

1,055,020

1,111,713

1,142,765

1,182,049

Undistributed Offsetting Receipts

-115,583

-125,220

-134,848

-138,893

Net Outlays

939,437

986,493

1,007,917

1,043,156

Total Congressional Budget Authority

1,261,531

1,372,251

1,423,498

1,509,932

Source: HHS Budget-in-brief FY 19; Agency Justifications of Estimates for Appropriations Committees FY 19

 

2. Since 1964, the health department has published an annual series of data presenting total national health expenditures (NHE). These estimates are compiled with the goal of measuring the total annual dollar amount of health care consumption in the U.S., as well as the dollar amount invested in medical sector structures and equipment and non-commercial research to procure health services in the future. After four decades of high inflation averaging 8.9% annually for Medicare and 9.8% annually for private health insurance between 1970, when inflation was over 20% and 2005, when it was about 6.6%, the inflation in health care prices was nearly been brought under control- defined as less than 3% annual inflation since 2012. There has been a relapse into hyperinflation of government health insurance premiums since 2016. NHE as a percent of gross domestic product (GDP) is estimated to have increased from 5.6% in 1965, to 7.1% in 1970, to 8.9% in 1980, to 12.6% in 1990 to more than 16% in 2000 to as high as 17.8% in 2013 when the 17.3% of GDP deflator of 2009-2013 was broken. Health, United States, estimates for Private Health Insurance spending need to be downwardly revised in accordance with Net Earned Premiums reported in the National Association of Insurance Commissioners (NAIC) and Center for Insurance Policy Research (CIRP) 2014 Analysis of the Health Insurance Industry. Using NAIC private health insurance and NHE totals are much lower. Due diligence of overestimations, will continue to reduce future and historical estimations of NHE as % of GDP, through accounting revelations in support of cost-reducing laws, to a point, where actual benefits are stabilized at Medicaid prices. For NHE $70 billion state and local public health needs to be added to $56 billion FY 16 federal outlays reported by the HHS budget-in brief for the Public Health Service (PHS), for total public health expenditures of $126 billion FY 16, administrative expenses growing 2.5% annually to $135.5 billion FY 19.  The lesson is that advance appropriations are non-add to federal outlays. Advance appropriations are one of several off-budget contributions to congressional budget authority. States spending on Medicaid can be calculated because the matching formula, state outlays and budget authority means the federal and state governments use the same ratio of advance appropriations, that are non-add to national health expenditures, 31% advance appropriations FY 17 & FY 18 and 33% FY19 and FY 20. The federal government agreed to pay 100% of Medicaid payments for new enrollees under 2014-2016, 95% in 2017, 94% in 2018, 93% in 2019; and 90% in 2020 and each year thereafter, under Sec. 1905 of the Social Security Act under 42USC§1396d (b, y) by comparison, federal contributions toward the care of beneficiaries eligible pre-ACA range from 50% to 83%, and averaged 57% between 2005 and 2008. 2014-2020 state Medicaid spending is estimated to be 37%-39% and federal spending 63%-61%. The ACA is estimated to have only increased federal spending and decreased state spending by 4%. The Kaiser Family Foundation estimates that overall state spending on Medicaid increased by only about 1% in FY 2014, and expansion states had a median growth rate that was almost one-third that of non-expansion states. Among expansion states, aggregate state spending decreased by 1.8%, and the median change in state spending was an increase of 1.6%. In review, NHE is not, and never reached 18% of GDP; in fact, NHE probably never exceeded 14% of GDP in 2014, and is going down to 13% by 2020.  It is re-estimated that, NHE as % of GDP peaked at nearly 14% in 2013 and has subsequently gone down, as the result of the 10% state Medicaid share, state and local public health department estimates and the trillion-dollar limbo bar CMS must process before either the HHS budget-in-brief or NHE Account in Health, United States can be done. $2.6 trillion NHE in 2016 NHE, 14.2% of the $18.3 billion GDP, is compared with $3.3 billion, 18% of GDP, in the Methodology Paper of 2016. It is provisionally estimated that NHE will be about $2.6 trillion, 13.0 % of a $20 trillion GDP in 2019. Although NHE peaked at 14.2% in 2014 it has slowly been going down to 13.9% in 2017 and continues to go down at a slightly faster rate under 3% health and 2.5% administrative growth rule of law. The sustainable development goal for 2030 for Health, United States, is NHE <10% of GDP.

 

National Health Expenditure Account 2013-2020

(billions)

 

2013

2014

2015

2016

2017

2018

2019

2020

Private Health Insurance

451

525

541

557

573

591

609

627

Medicare

551

564

578

593

608

623

638

654

Federal

500

513

526

539

553

566

581

595

Medicaid

407

413

423

434

419

443

433

445

Federal

235

242

248

254

261

267

274

281

State

172

171

175

180

157

159

157

161

CHIP

11.3

11.6

11.9

12.2

12.5

12.8

13.1

13.4

Federal

7.8

8.0

8.2

8.4

8.6

8.8

9.0

9.3

State and local

3.5

3.6

3.7

3.8

3.9

4.0

4.1

4.2

Other health insurance programs

89

92

94

96

99

101

104

106

All Health Insurance Payments

1,509

1,606

1,648

1,692

1,712

1,771

1,797

1,845

Other third-party payers and programs

221

227

232

238

244

250

257

263

Out-of-pocket payments

339

348

357

366

375

384

394

404

Investment

152.5

153.9

156

157

159

160

162

164

Public Health

117

120

123

126

127

130

134

137

National Health Expenditure

2,339

2,455

2,516

2,579

2,617

2,695

2,744

2,813

Gross Domestic Product

16,768

17,271

17,789

18,323

18,873

19,439

20,022

20,623

NHE as % of GDP

13.9

14.2

14.1

14.1

13.9

13.9

13.7

13.6

Source: Daveline, Dan; Koenigsman, Jane; Rivers, Bill, 2014 Health Insurance Industry Analysis Report National Association of Insurance Commissioners and Center for Insurance Policy and Research, 2015. OMB FY 17 Table 10.1. Tables 102 & 104; Health, United States, 2014 & 15.

 

3. CMS employed 4,754 FY 17 and 4,752 FY 18 and although it is proposed to reduce the workforce by 266 to 4,486 FY 19, it would be better to plan on 0.9% growth to 4,526 full-time federal employees, who administrate Medicaid FY 19. Instead of going down to $3,544 million FY 19, federal outlays for CMS Program Management should increase 2.5% from $3,948 million FY 18 to $4,047 million FY 19. Over 140 million Americans are expected to be enrolled in Medicare, Medicaid, CHIP and the Exchanges. Medicaid enrollment is estimated at 77.7 million, 81 million including CHIP FY 19. In 2019 Medicare will insure a total of 62.2 million OASDI beneficiaries, 95% of 65.3 million OASDI beneficiaries. Medicare Part A insures an estimated 61.9 million, Part B insures 56.6 million, Part D 47.7 million and Part C 21.3 million. The Medicare program provides hospital and supplemental medical insurance to Americans age and older and to disabled persons, including those with End Stage Renal Disease (ESRD). The program was expanded in with the introduction of a voluntary prescription drug benefit, Part D. Medicare enrollment has increased from 19 million in 1966 to 62 million beneficiaries expected in FY 19.  CMS admits that they met their FY 17 target of maintaining an unmodified opinion on four out of the six principal financial statements. During FY 17, the auditors could not express an opinion on the CMS Statement of Social Insurance (SOSI) as of January 1, 2016 or the CMS Statement of Changes in Social Insurance Amounts (SCSIA). A hold-harmless provision in the law restricted Part B premium increases for most beneficiaries in 2017 to an average increase of about $4.00 per month. However, for the 30 percent of beneficiaries to whom the provision does not apply, the 2017 Part B monthly premium rate increased substantially from $121.80 to $134.00 where it remains until it goes up $5 to $139.00 in 2020. CMS was substantially compliant with the Federal Financial Management Improvement Act (FFMIA) since FY 10, but relapse into hyperinflation in excess of 3% annually in 2016, must be constantly checked by a trillion-dollar limbo bar to redress overestimations of federal outlays. CMS considers its financial systems to be integrated in accordance with OMB Circular A-127, Financial Management Systems and OMB Circular A-123 review. As a committed steward of public funds, CMS is dedicated to moving toward a health care system that will drive down costs, give Americans more choices, and put patients and doctors in control of their health care. Auditing CMS is difficult. To accurately calculate federal outlays and congressional budget authority, two new ledgers are needed, to compare and add the spending estimates from the Justification of Estimates for Appropriations Committees, and on-budget HI tax revenues from the Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund and Federal Supplemental Medical Insurance Trust Fund, and state Medicaid payments must be calculated and added. CMS must be crunched before balancing the HHS budget-in-brief and OMB Historical Tables. The numbers in the FY 19 Justification of Estimates cannot be copied with a cursor. The FY 19 Justification of Estimates is compromised by two accounting errors. First, indefinite annual appropriations, defined as taxation of social security benefits, are generally accounted for as an off-budget revenue, they contribute to congressional budget authority, but not federal outlays. To lawfully get publicly reported federal health outlays of CMS and HHS under the trillion-dollar limbo bar, although OMB has not produced an annual update of the Historical Tables since FY17, it seems best to express the federal spending reduction using the generally accepted accounting principles of federal outlays and congressional budget authority to explain advanced appropriation.  

 

Centers for Medicare and Medicaid Services, Federal Outlays FY 17 – FY 20

(millions)

 

Accounts

FY 17

FY 18

FY 19

FY 20

Program Management

3,966

3,948

3,544

4,047

HCFAC - Discretionary

725

725

770

761

Annual Appropriations for Grants to States for Medicaid

262,004

284,798

276,236

284,523

Payments to Health Care Trust Funds

482,810

503,759

526,212

549,542

Supplemental Medical Insurance

215,463

221,927

228,585

235,442

Hospital Insurance Payroll Tax

267,200

281,700

297,500

314,000

Hospital Insurance for Uninsured Federal Annuitants

147

132

127

100

Program Management Administrative Expenses

878

1,104

898

920

Part D

71,900

74,400

76,632

78,931

Reimbursement for HCFAC

299

307

315

323

Federal Outlays

822,582

869,041

884,607

919,047

Source: Seema, Verma. Centers for Medicare & Medicaid Services (CMS). Justification of Estimates for Appropriations Committees. Department of Health and Human Services (DHHS). Fiscal Year 2019. Spitalnic, Paul; Kouzoukas, Demetrios L. 2017 Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund and Federal Supplemental Medical Insurance Program. July 13, 2017; Part A pg. 53; B pg. 93 + 3% annual growth, D pg. 105 2017 + 3% annual growth.

 

4. To accurately calculate federal outlays and congressional budget authority, two new ledgers are needed, to compare and add the spending estimates from the Justification of Estimates for Appropriations Committees, and on-budget HI tax revenues from the Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund and Federal Supplemental Medical Insurance Trust Fund, and state Medicaid payments must be calculated. CMS must be crunched before the HHS budget-in-brief and OMB Historical Tables can be completed. To complicate matters the numbers in the FY 19 Justification of Estimates cannot be copied with a cursor. The FY 19 Justification of Estimates holds two accounting errors. First, indefinite annual appropriations, defined as taxation of social security benefits, are generally accounted for as an off-budget revenue, they contribute to congressional budget authority, but not federal outlays. Second, advance appropriations mean funds at year end, undistributed offsetting receipts or rescission, depending on the accounting method used. Advance appropriations do not count for either federal outlays or national health expenditures. To get publicly reported federal health outlays of CMS and HHS under the trillion-dollar limbo bar, although OMB has not produced an annual update of the Historical Tables since FY17, it seems best to express the federal spending reduction using the generally accepted accounting principles (GAAP) of federal outlays and congressional budget authority to explain advanced appropriation. For the most part, lower estimates are adopted from the Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund and Federal Supplemental Medical Insurance Trust Fund. To consolidate federal accounting for CMS in their highest quality report, Congress may require the Actuary to account for the Medicaid program in the Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund, Federal Supplemental Medical Insurance Trust Fund and Federal Medicaid Trust Fund, by passing a law to create in the Treasury a Federal Medicaid Trust Fund.  The SMI trust fund is expected to be adequately financed over the next 10 years and beyond because premium income and general revenue income for Parts B and D are reset each year to cover expected costs and ensure a reserve for Part B contingencies. Part B and Part D costs are overestimated to have average annual growth of 5.4% and 8.3%, respectively, over the last 5 years, as compared to growth of 3.7% for GDP and 2.7% for consumer inflation. A hold-harmless provision in the law restricted Part B premium increases for most beneficiaries in 2017 to an average increase of about $4.00 per month. In 2016, HI income exceeded expenditures by $5.4 billion. The Trustees project modest surpluses to continue in 2017 through 2022, with a return to deficits thereafter until the trust fund becomes depleted in 2029. The assets were $199.1 billion at the beginning of 2017, representing about 67% of expenditures during the year, which is below the Trustees’ minimum recommended level of 100% but above the 20% threshold of concern to Constitution. Growth in HI expenditures has averaged 2.1% annually over the last 5 years, compared with non-interest income growth of 5.9%. This surplus must be sustained and distributed to Medicare Parts B & D and Medicaid. A finding of excess general revenue Medicare funding (defined as a determination that occurs when the difference between Medicare’s total outlays and its dedicated financing sources exceeds 45% of outlays) is projected for fiscal year 2023. Therefore, the Trustees are issuing a determination of projected excess general revenue Medicare funding, 2017-2022. Such determinations were previously made in each of the 2006 through 2013 reports.

 

CMS, Congressional Budget Authority FY 17 – FY 20

(millions)

 

Program

FY 17

FY 18

FY 19

FY 20

Program Management

4,691

4,673

4,790

4,910

Grants to States for Medicaid

377,587

410,018

411,084

423,416

Advanced Appropriation

(115,583)

(125,220)

(134,848)

(138,893)

Annual Appropriations for Grants to States for Medicaid

(262,004)

(284,798)

(276,236)

(284,523)

Total Trust Fund Revenues

(707,500)

(781,100)

(833,100)

(905,100)

Part A

306,000

324,000

343,600

364,200

Part B

302,800

353,700

372,900

413,800

Part D

98,700

103,400

116,600

127,100

Grand Total

1,089,778

1,195,791

1,248,974

1,333,426

Source: Seema, Verma. Centers for Medicare & Medicaid Services (CMS). Justification of Estimates for Appropriations Committees. Department of Health and Human Services (DHHS). Fiscal Year 2019. Spitalnic, Paul; Kouzoukas, Demetrios L. 2017 Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund and Federal Supplemental Medical Insurance Program. July 13, 2017. Parts A pg. 53; B pg. 90, D pg. 105

 

5. CPI + 2.5% growth Ultimate Assumptions in Table II C1 of the Annual Report of the Board of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Insurance Trust Fund is an overestimation of 3% health, education and social service inflation compared with 2.5% administrative spending growth and 2.7% average annual consumer price index (CPI) inflation, that could be written - 3% health inflation > 2.5% administrative spending or 2.7% average annual CPI inflation <4% cash welfare growth. As a rule, government and administration expect 2.5% annual growth, to afford a 1.6% annual pay raise and 0.9% increase in workforce. Education, health and social service agencies expect a 3% increase in spending to afford normal 2.7% inflation in consumer products for their population. Cash welfare must grow 4% annually, to afford the poor the 3% cost-of-living adjustment to compete with 2.7% CPI inflation and 1% enrollment growth.  These rules of inflation have been in effect since inflation stabilized between 2.5-3% in 1980. Sustainable economic growth can only be achieved by prioritizing income for the poor and marginalizing government in relation to 2.7% average annual consumer price index inflation, so that a conscious effort is made to increase the number of cash welfare benefits for the poor, to provide effective consumer economic subsidy, and increase the amount of benefits more than inflation to improve purchasing power, and improve administrative efficiency of government spending that grows slightly less than inflation. The Iron Law of Wages states, that if wages rise above subsistence level, they produce inflation, which in turn forces wages down to subsistence level again. States and employers from time to make estimates as to the minimum living wage so as to keep the standard of living of the population above the poverty line.  Care must be taken in collective bargaining to ensure that growth in income does not lead to inflation.  Given wide currency by British economist David Ricardo, of French origin. Engel’s Law anticipates that with rising incomes, the share of expenditures for food and other products declines.  Based on surveys of families' budgets and expenditure patterns, that the income elasticity of demand for food was relatively low.  The resulting shift in expenditures affects demand patterns and employment structures. Engel's Law does not suggest that the consumption of food products remains unchanged as income increases! It suggests that consumers increase their expenditures for food products, in % terms.  Ernst Engel was a 19th century German statistician. To promote prudent prices, administrative and payroll growth is usually limited to only around 2.5% - 1.6% raise and 0.9% new employment, management and professional income increases by promotion. With consumer price-inflation more or less stabilized at 2.7%, to maximize federal socio-economic efficiency, it is necessary to guarantee minimum wage workers and social security beneficiaries a 3% annual raise. 3% annually would annually improve the purchasing power of minimum wage workers and should be affordable to reasonable employers.  The poor will spend proportionally more money than richer people would, on the consumer economy pursuant to Engel’s law, and the growth in their subsistence will sustain economic growth under the Iron Law of Wages.

 

Human Services Department, Budget Summary FY 17 – FY 20

(millions)

 

FY 17

FY 18

FY 19

FY 19

FY 20

Administration for Children and Families

51,990

54,539

48,971

54,700

56,431

Administration for Community Living

1,896

1,953

1,966

2,002

2,015

Substance Abuse and Mental Health Services Administration

4,111

4,091

3,426

3,426

3,206

Human Services Federal Outlays Subtotal

57,997

60,583

54,363

60,128

61,652

Child Support Collections (non-add)

28,900

29,100

29,200

29,200

29,400

State TANF MOE (non-add)

10,000

10,000

10,000

10,000

10,000

SAMHSA Additional Opiate Allocation (non-add)

0

0

1,200

1,200

0

Human Services Department, Congressional Budget Authority

99,907

99,749

94,763

99,470

99,859

Supplemental Security Income

58,536

59,978

58,866

62,313

64,739

Grand Total, Federal Outlays

116,533

120,561

113,229

122,441

126,391

Grand Total, Congressional Budget Authority

155,433

159,661

153,629

162,841

165,791

Sources: Wagner, Steven. Acting Assistant Secretary for Children and Families. Administration for Children and Families. Justification of Estimates for Appropriations Committees. FY 19. Berger, Dan. Acting Administrator and Acting Assistant Secretary for Aging. Administration for Community Living. Justification of Estimates for Appropriations Committees. 2018. McCance-Katz, Elinore F. M.D., Ph.D. Assistant Secretary for Mental Health and Substance Use. Substance Abuse Mental Health Services Administration. Justification of Estimates for Appropriations Committees Fiscal Year 2019. Berryhill, Nancy. Acting Commissioner of Social Security. 2017 Annual Report of the Supplemental Security Income Program. September 1, 2017

 

6. Human Services (HS) Department is created as a federal accounting instrument to produce a self-determinate congressional budget request that patronizes the poor, children, elderly, addicted and mentally ill, with reliable federal outlay growth. The extra work of creating HS is justified by the need to pay legal child support obligations by 2020. HS would consolidate on-budget federal human services, and pre-tax SSI outlays for the Historical Tables of the White House Office of Management and Budget (WHOMB), often known as OMB, last updated by the previous administration FY 17 under 31USC§101, despite the hyperinflation in health and college tuition prices un-redressed by the Department of Education Reorganization Act of 1980 under 20USC§3508. The rule of law is that 4% annual growth in cash welfare programs is needed to afford a 3% COLA and 1% population growth, 3% growth in total spending for health, education, social and children's services programs and 2.5% growth in government, administrative and most payroll spending to afford +/- 0.9% employment growth and 1.6% raise, are needed to conform with Engel's law and Iron Law of Wages, since inflation stabilized at an average annual rate of 2.7% in 1980.  The primary mission of HS is to redress the deprivation of 10 million Aid For Families with Dependent Children (AFDC) benefits 1996-2000 whereas child poverty how runs at 22%-33%, working age poverty 10%, elderly poverty 9%, and the average poverty rate remains virtually unchanged at +/-15%. HS is a generally accepted accounting practice (GAAP) in many states and counties. HS seems to be more common than the combined HHS instrument. HS would redress the stunting of federal outlays for Administration for Children and Families (ACF) child welfare programs, non-growth of Administration of Community Living (ACL) programs for the elderly and focus budget cuts on the anti-terrorist practices of deinstitutionalization, and debunking psychiatric drug abuse and other forms of biological, chemical and cyber torture and slavery, within the jurisdiction of the Substance Abuse Mental Health Service Administration (SAMHSA), suing for on-budget Supplemental Security Income (SSI).  The one time “no opes” additional inter-agency opiate allocation of $1.2 billion FY 19, for total SAMHSA congressional budget authority of $4.5 billion FY 19 will result in -8.6% lower federal outlays from $3.5 billion FY 17, down from $3.2 billion FY 20, for SAMHSA programs administrated by 1% annual increase to 645 FTEs FY 20.  It would take years of study after the authorization of the Secretary to “make ($3.4 billion FY 18) grants” was amended to “provide tax relief to energy corporations” under 42USC§8621(a) and the expectations repealed or described, to hypothetically terminate all federal outlays for Low-income-energy assistance program (LIEAP).  Due to extraordinarily high 22%-33% rates of child poverty in the United States, it would take a commensurate increase, in more administratively efficient, child SSI benefits to justify -$2.3 billion cuts to federal outlays from $17.4 billion FY 18 to $15.1 billion and outlays of $17.9 billion FY is predicted for Temporary Assistance for Needy Families (TANF).

 

TANF, Federal Budget Summary FY 15- FY 20

(millions)

 

Category

FY 17

FY 18

FY 19

FY 20

Basic Assistance

4,497

4,677

4,862

5,054

Assistance Authorized Solely under Prior Law

729

747

766

788

Non-Assistance Authorized Solely Under Prior Law

666

683

711

728

Work, Education and Training Activities

2,071

2,123

2,187

2,253

Early Care and Education

1,369

1,403

1,460

1,504

Relief

1,798

1,843

1,890

1,936

Support

1,454

1,498

1,543

1,590

Child Welfare Services

1,073

1,105

1,137

1,173

Program Management

2,686

2,754

2,824

2,894

Total Expenditures Federal Outlays

16,343

16,833

17,380

17,920

Total Transfers

2,630

2,709

2,790

2,874

Total Funds Used

18,973

19,542

20,170

20,794

State Match +

10,000

10,000

10,000

10,000

Congressional Budget Authority

28,973

29,542

30,170

30,794

Source: FY 2015 Federal TANF & State MOE Financial Data

 

7. The Temporary Assistance for Needy Families (TANF) program, was created in the 1996 welfare reform law (P.L. 104-193). TANF is $16.5 billion a year block grant to States replaced Aid to Families with Dependent Children (AFDC) and other related welfare programs in Sec. 401 of Title IV-A of the Social Security Act under 42USC§601 et seq. TANF provides assistance to needy families so that children may be cared for in their own homes or in the homes of relatives, end the dependence on government benefits by promoting job preparation, work, and marriage; prevent and reduce the incidence of out-of-wedlock pregnancies and encourage the formation and maintenance of two-parent families. TANF funds can be used in any manner a state can reasonably calculate helps it achieve the goals of (1) providing assistance to needy families so that children may be cared for in their own homes or in the homes of relatives; (2) ending the dependence of needy parents on government benefits through work, job preparation, and marriage; (3) preventing and reducing the incidence of out-of-wedlock births; and (4) encouraging the formation and maintenance of two-parent families. Under TANF, the federal government gives states a fixed block grant totaling $16.5 billion each year and requires them to maintain a certain level of state spending (totaling $10 billion-11 billion a year), based on a state’s level of spending for AFDC and related programs prior to its conversion to TANF in 1996. This state funding requirement is known as the “maintenance of effort” requirement, or MOE.  TANF’s performance is measured on state welfare-to-work efforts, with states assessed based on numerical work participation standards, although welfare programs are usually judged on the basis of administrative efficiency and payment accuracy. Consequentially, TANF benefit spending has declined from 75% in 1994 to 25% of total “TANF” spending in 2017. Basic assistance—what many call “cash welfare”— accounted for only 27.6% of all TANF funding in FY2013. Administrative costs of social security program are normally less than 1% of expenditures. The TANF caseload is much smaller—1.7 million families in FY2013 versus 5.0 million families in FY1994. The number of TANF children declined from 14 million in 1995 to 4 million in 2018. TANF provides a safety net to significantly fewer poor children and families than in the past: In 2014, just 23 families received TANF benefits for every 100 poor families with children, down from 68 families receiving TANF for every 100 poor families in 1996. Even more troubling, 12 states’ TANF programs reach only ten families or fewer for every 100 poor families. TANF is often these families’ only source of support; without it they would have no cash income to meet basic needs.  The President's budget proposes to cut the TANF block grant by 10 percent, from $16.2 FY 18 billion to $14.7 billion FY 19, and eliminate the $608 million Contingency Fund — bringing the total proposed 2019 cut to about $2.2 billion. The FY 18 budget cut attempt failed, and the FY 19 is also likely to fail to pay legal child support obligations of the United States for 22-33% of children growing up in families living below the poverty line under 18USC§228(b).

 

Poverty Guidelines for the 48 Continuous States and District of Columbia, 2017 & 18

 

Persons in Family / Household

2017 Poverty Guideline

2018 Poverty Guideline

1

$12,060

$12,140

2

$16,240

$16,460

3

$20,420

$20,780

4

$24,600

$25,100

5

$28,780

$29,420

6

$32,960

$33,740

7

$37,140

$38,060

8

$41,320

$42,380

For families/households with more than 8 persons

$4,180 for each additional person

$4,320 for each additional person

Source: HHS Assistant Secretary for Planning and Evaluation; Alaska and Hawaii have higher poverty thresholds.

 

8. The President has provided tax relief for the rich and acknowledges that he must support welfare to sustain economic growth.  His treasonous scheme to rob welfare to levy war, must be rejected as one of the stupidest ideas of all times – first degree murder.  The rule of law, as it relates to the current 2.7% average annual consumer inflation, prioritizes federal outlay growth for cash welfare to the poor 4%, health, education and social services 3%, government and administration 2.5%.   To reverse skyrocketing rates of 22-33% of children growing up in poverty, up from 15% in 1996, the United States must furthermore, prioritize the elimination of child poverty.  The United States has the highest birth rate (12.5 per 1,000 population), infant mortality rate (6.1 infant deaths per 1,000 live births and 8 under age 5 deaths per 1,000) and maternal mortality rate (32 deaths per 100,000) of any industrialized nation. The reason for abysmal statistics is that child poverty has increased from 15% to 22% - 33% today.  Children are depressing. Americans with children are 12 percent less happy than non-parents, the largest “happiness gap” of 22 rich countries surveyed. The main source postpartum depression seems to be the failure of the US Labor Secretary to pay mothers for 14 weeks of maternity leave with unemployment compensation, SSI and TANF benefits under Maternity Protection ILO Convention 183 (2000). Children are expensive and minimum wage has not been increased since 2009. Working 40 hours a week in 2016 at the $7.25 an hour federal minimum wage earns a pre-tax income of only $290 a week, $1,160 a month, $13,920 a year, not enough for a $16,020 spouse or $21,160 first child and $4,160 each additional child. Two parents working for 60 hours a week for the minimum wage could earn $435 a week, $1,740 a month, $20,888 a year, not quite enough for child, Working 80 hours a week a couple insured for maternity leave and child care could earn $580 a week, $2,320 a month, $27,840 a year, enough for two children. Annually the poverty line for one is $11,880, for two $16,020, for three, $20,160, for four $24,300 and $4,160 for each additional child. In summary each child costs about $80 a week, $347 a month, $4,160 a year. Poverty thresholds are produced by the Census Bureau and poverty guidelines by the Department of Health and Human Services (DHHS). The federal hourly minimum wage statute needs to be amended so that it automatically increases 3% every year from $7.25 since 2009 under 29USC§206 (a)(1)(D).  The Convention on the Elimination of All Forms of Discrimination against Women of 18 December 1979 bears in mind the great contribution of women to the welfare of the family and to the development of society. Article 11(1)(e) The right to social security, particularly in cases of unemployment, sickness, invalidity and old and other incapacity to work, as well as the right to paid leave; (2)(b) to introduce maternity leave with pay or with comparable social benefits without loss of former employment, seniority of social allowances. The 12 weeks of unpaid Family and Maternity Leave Act needs to be repealed to insure women for 14 weeks of maternity leave paid by unemployment compensation for contributing women holding their job for more than a year, TANF for women with temporary maternity leave related income shortfalls and SSI for chronically poor families with children under Maternity Protection ( ILO Convention 183) of 2000 and 3 weeks annual paid sick days under the Holidays with Pay Convention (Convention 132) of 1970 and Workers with Family Responsibilities (Convention 156) of 1981. Article 13 State parties shall take all appropriate measure to eliminate discrimination against women in other areas of economic and social life in order to ensure on a basis of equality of men and women, the same rights, in particular (a) to family benefits. Convention on the Rights of the Child of 2 September 1990 Article 26 (1) States Parties shall recognize for every child the right to benefit from social security, including social insurance, and shall take the necessary measures to achieve the full realization of this right in accordance with their national law. (2) The benefits should, where appropriate, be granted, taking into account the resources and the circumstances of the child and persons having responsibility for the maintenance of the child, as well as any other consideration relevant to an application for benefits made by or on behalf of the child.

 

OASDI Tax Rate Settlement 2009-2015

(billions)

 

Year

Total Revenues

Tax Revenues

GF Reimbursement

Tax on Benefits

Net interest

Total

Scheduled Benefits

Administrative Costs

R&R Interchange

Net increase end of year

Assets at end of Yer

Trust fund Ratio

2008

805.3

672.1

0

16.9

116.3

625.1

615.3

5.7

4.0

180.2

2,419

358

1.8

109.8

97.6

0

1.3

11.0

109.0

106.0

2.5

0.4

0.9

215.8

197

10.6

695.5

574.6

0

15.6

105.3

516.2

509.3

3.2

3.6

179.3

2,203

392

2009

807.6

667.3

0

21.9

118.4

685.8

675.5

6.2

4.1

121.8

2,541

353

1.8

109.4

96.9

0

2.0

10.5

121.5

118.3

2.7

0.4

-12.1

203.6

178

10.6

698.2

570.4

0

19.9

107.9

564.3

557.2

3.4

3.7

133.9

2,337

390

2009

807.6

667.3

0

21.9

118.4

685.7

675.5

6.1

4.1

121.9

2,541

353

2.03

121.8

109.3

0

2.0

10.5

121.5

118.3

2.7

0.4

0.0

215.8

168

10.37

685.8

558.0

0

19.9

107.9

564.3

557.2

3.4

3.7

121.5

2,325

390

2009

807.6

667.3

0

21.9

118.4

685.7

675.5

6.1

4.1

121.9

2,541

353

2.13

127.1

114.6

0

2.0

10.5

121.5

118.3

2.7

0.4

5.4

221.2

168

2010

781.2

637.3

2.4

24.0

117.5

712.5

701.6

6.5

4.4

68.6

2,610

357

1.8

104.0

92.5

0.4

1.9

9.3

127.7

124.2

3.0

0.5

-23.6

180.0

159

10.6

677.1

544.8

2.0

22.1

108.2

584.9

577.4

3.5

3.9

92.2

2,429

400

2010

781.1

637.3

2.4

24.0

117.4

712.5

701.6

6.5

4.4

68.6

2,610

357

2.25

127.9

115.6

0.4

1.9

10.0

127.7

124.2

3.0

0.5

0.2

216.0

169

10.15

653.2

521.7

2.0

22.1

107.4

584.9

577.4

3.5

3.9

68.3

2,393

398

2010

781.1

637.3

2.4

24.0

117.4

712.5

701.6

6.5

4.4

68.6

2,610

357

2.35

133.4

120.9

0.4

1.9

10.2

127.7

124.2

3.0

0.5

5.5

226.7

173

10.05

647.8

516.5

2.0

22.1

107.2

584.9

577.4

3.5

3.9

62.9

2,383

397

12.4 Tax

Total Revenues

Tax Revenues

GF Reimbursement

Tax on Benefits

Net interest (3.0)

Total

Scheduled Benefits

Administrative Costs

R&R Interchange

Net increase end of year

Assets at end of Yer

Trust fund Ratio

2011

805.1

564.2

102.7

23.8

114.4

736.1

725.1

6.4

4.6

69.0

2,678

354

1.8

106.3

81.9

14.9

1.6

7.9

132.3

128.9

2.9

0.5

-26.1

153.9

136

10.6

698.8

482.4

87.8

22.2

106.5

603.8

596.2

3.5

4.1

95.0

2,524

402

2011

805.1

666.9

0

23.8

114.4

736.1

725.1

6.4

4.6

69.0

2,679

354

2.25

132.1

121.0

0

1.6

9.5

132.3

128.9

2.9

0.5

-0.2

215.8

163

10.15

673.0

545.9

0

22.2

104.9

603.8

596.2

3.5

4.1

69.2

2,462

396

2011

805.1

666.9

0

23.8

114.4

736.1

725.1

6.4

4.6

69.0

2,678

354

2.36

138.0

126.7

0

1.6

9.7

132.3

128.9

2.9

0.5

5.7

232.4

167

10.04

666.8

540.1

0

22.2

104.5

603.8

596.2

3.5

4.1

63.0

2,446

395

12.4 Tax

Total Revenues

Tax Revenues

GF Reimbursement

Tax on Benefits

Net interest (3.0)

Total

Scheduled Benefits

Administrative Costs

R&R Interchange

Net increase end of year

Assets at end of Yer

Trust fund Ratio

2012

840.2

589.5

114.3

27.3

109.1

785.8

774.8

6.3

4.7

54.4

2,732

341

1.8

109.1

85.6

16.5

0.6

6.4

140.3

136.9

2.9

0.5

-31.2

122.7

110

10.6

731.1

503.9

97.7

26.7

102.8

645.5

637.9

3.4

4.1

85.6

2,610

391

2012

840.2

703.8

0

27.3

109.1

785.8

774.8

6.3

4.6

54.4

2,732

341

2.31

140.5

131.1

0

0.6

8.8

140.3

136.9

2.9

0.5

0.2

216.0

154

10.09

699.7

572.7

0

26.7

100.3

645.5

637.9

3.4

4.1

54.2

2,516

381

2012

840.2

703.8

0

27.3

109.1

785.8

774.8

6.3

4.6

54.5

2,733

341

2.39

145.8

135.7

0

0.6

9.5

140.3

136.9

2.9

0.5

5.5

237.9

166

10.01

694.4

568.1

0

26.7

99.6

645.5

637.9

3.4

4.1

48.9

2,495

379

12.4 Tax

Total Revenues

Tax Revenues

GF Reimbursement

Tax on Benefits

Net interest (3.0)

Total

Scheduled Benefits

Administrative Costs

R&R Interchange

Net increase end of year

Assets at end of Yer

Trust fund Ratio

2013

855.0

726.2

4.9

21.1

102.8

822.9

812.3

6.2

4.5

32.1

2,765

332

1.8

111.2

105.4

0.7

0.4

4.7

143.4

140.1

2.8

0.6

-32.2

90.4

86

10.6

743.8

620.8

4.2

20.7

98.1

679.5

672.1

3.4

3.9

64.3

2,674

384

2013

855.0

726.2

4.9

21.1

102.8

822.9

812.3

6.2

4.5

32.1

2,766

332

2.30

143.9

134.7

0.7

0.4

8.1

143.4

140.1

2.8

0.6

0.5

216.5

151

10.1

711.1

591.5

4.2

20.7

94.7

679.5

672.1

3.4

3.9

31.6

2,548

370

2013

855.0

726.2

4.9

21.1

102.8

822.9

812.3

6.2

4.5

32.1

2,765

332

2.45

149.4

143.6

0.7

0.4

8.9

143.4

140.1

2.8

0.6

6.0

243.9

166

9.95

705.6

582.6

4.2

20.7

93.9

679.5

672.1

3.4

3.9

26.1

2,521

367

12.4 Tax

Total Revenues

Tax Revenues

GF Reimbursement

Tax on Benefits

Net interest (3.0)

Total

Scheduled Benefits

Administrative Costs

R&R Interchange

Net increase end of year

Assets at end of Yer

Trust fund Ratio

2014

884.3

756.0

0.5

29.6

98.2

859.2

848.5

6.1

4.7

25.0

2,790

322

1.8

114.9

109.7

0.1

1.7

3.4

145.1

141.7

2.9

0.4

-30.2

60.2

62

10.6

769.4

646.2

0.4

28.0

94.8

714.2

706.8

3.1

4.3

55.2

2,729

374

2014

884.4

756.0

0.5

29.6

98.2

859.2

848.5

6.1

4.7

25.2

2,790

322

2.23

145.5

136.0

0.1

1.7

7.7

145.1

141.7

2.9

0.4

0.4

216.9

149

10.17

738.9

620.0

0.4

28.0

90.5

714.2

706.8

3.1

4.3

24.7

2,573

357

2014

884.4

756.0

0.5

29.6

98.2

859.2

848.5

6.1

4.7

25.2

2,790

322

2.31

151.3

140.8

0.1

1.7

8.7

145.1

141.7

2.9

0.4

6.2

250.2

168

10.09

733.1

615.2

0.4

28.0