Hospitals & Asylums 








August 2017


By Anthony J. Sanders


Fiscal Year 2018 HA-14-7-17


This July 16th re-appraisement of Agency FY 18 budgets under Annualized Continuing Resolution for Fiscal Year 2017 (CR17) produces a budget surplus FY 18. The surplus cannot be attributed to any cruel and unusual budget cuts of civilian officials to levy war, unlikely to prevail in any Departments but Labor and Commerce, health insurance overestimates distorting totals are un-abolished, the FY 18 budget surplus is the product of accurate accounting of the supporting documentation of the agency outlay edger by HA. This FY 16 – FY 18 budget provides the most secure Treasury total outlay estimates for the year end production of undistributed offsetting receipts, to settle disputes regarding normal agency outlay growth, to produce a budget surplus FY 18 surplus, that can be sustained with or without taxing the rich to end poverty by 2020. Because of extra time it takes to codify the fiscal year budget that is due on July 16th, social security and other national welfare claim parts will be finished and book finally edited before the total eclipse of the arson on August 21, 2017. The Treasury may choose to retroactively abolish the refundable premium and cost sharing reduction subsidy to health insurance corporations, including those who fled, with profits more than 10% from FY 16, to turn the -$63 billion budget deficit into a + $16 billion surplus FY 17 under 26USC§6401. All Congress is requested to do is vote to tax the rich the 12.4% OASDI tax on all their income to end poverty by 2020 and end child poverty in 2018 by repealing the Adjustment of the contribution and benefit base under Section 230 of the Social Security Act 42USC§430 on October 1, 2017 the first day of FY 18.   There are five rows in the Outlay by Agency table that need to be deleted because they actually represent zero outlays because they are either not instrumental to calculating total on-budget outlays or they are accounted for by a Cabinet agency under 31USC§101 - (1) Allowances, (2) Other Defense - Civil Programs, (3) Other Independent Agencies on-budget and off-budget and (4) Small Business Administration (SBA). Deleting the first three rows result in an estimated $2 trillion - $1,950,164 million. Treasury Negotiations regarding interest payments on the federal debt might reduce the debt to 86.5% of its current value of $506 billion to $478 billion FY18. Then with a budget surplus pay only the 3.4% average interest rate on t-bonds $494 billion FY19. When the ledger is zeroed, agencies can reconcile their historical congressional budget justifications with WHOMB it may concern the historical tables regarding agency outlays, total outlays, surplus or deficit and gross national debt.  It is advised that Social Security on-budget row change its name to Human Services (HS) and adopt the total outlays of the Agency for Children and Families (ACF), Administration for Community Living (ACL) and Substance Abuse Mental Health Service Administration (SAMHSA) FY 18. Health and human services must be separated FY 18 to keep 3% federal public health spending growth from 2014 limited to less than $1 trillion for the time being. The United States must begin to redress 22-33% child poverty rate with 8% TANF growth FY 17, 4% every year thereafter. To end child poverty it is necessary to tax the rich the 12.4% Old Age Survivor Disability Insurance (OASDI) taxes on all their income to pay every poor child an SSI benefit 2018 and end poverty by 2020. To help federal health spending get under the $1 trillion limbo bar, it is advised that WHOMB make certain changes the outlay by agency ledger to recognize the graduation of HS. First, change the historical name of Social Security on-budget spending, the SSI program, to Human Services (HS). Second, make accurate notation of annual reports of total SSI outlays (benefits + administration) in the historical HS row or decide to use the existing numbers to postpone the duty to re-total historical outlays, surplus or deficit and debt. Third, graduate HS FY 18 so that it adds to or replaces Social Security on-budget FY 18 whereas SSI is going off-budget if the rich are taxed or HS is combined with SSI in the on-budget HS outlay row.


Government Outlays by Agency Ledger FY 16- FY 18



FY 16

FY 17

FY 18 untaxed

FY 18 taxed

Legislative Branch





Judicial Branch










Commerce and Small Business Administration





Defense – Military Programs















Health (& HS FY 16 & 17)





Department of Homeland Security





Housing and Urban Development





Human Services




















State and International Assistance















Veterans Affairs





Corps of Engineers – Civil Works





Environmental Protection Agency





Executive Office of the President





General Services Administration





National Aeronautics and Space Administration





National Science Foundation





Office of Personnel Management





Undistributed Offsetting Receipts





On-budget Outlays





On-budget receipts





On-budget Surplus or Deficit





Social Security Administration off-budget Outlays





Off-budget Receipts





Off-budget surplus or deficit





Total outlays





Total revenues





Total surplus or deficit





Gross Federal Debt





Gross Domestic Product





Debt as Percent of GDP






Source: OMB Table 1.1 and 4.1 Agency FY17; Agency Congressional Budget Requests FY 18; 2016 Annual Report of the Board of Trustees of the Federal OASI and DI Trust Funds June 22, 2016


To end poverty by 2020 HA-19-6-17


To tax the rich to end poverty by 2020 and end child poverty CY18 by repealing the Adjustment of the contribution and benefit base under Section 230 of the Social Security Act 42USC§430. To prioritize child poverty, before taxing the rich, with current revenues, Congress and Commissioner must immediately make insulin dependent diabetes mellitus (IDDM) and orphan as qualifying disabilities for full SSI benefits $777 (CY19). The poor, children first, shall be paid with SSI when the contribution base is expanded to include incomes over the maximum taxable limit. By 2020 all 50 million poor people will receive Supplemental Security Income (SSI). Eliminating tax havens is a sustainable development goal. In the case regarding the maximum taxable limit, failure to pay legal child support obligations under 18USC§228(b) may be treated as attempt to evade or defeat tax under 26USC§7201.  To sustain the Disability Insurance (DI) trust fund a 2.2% DI 10.2% OASDI tax rate is needed for CY19 now that all the Baby Boomers have retired. The OASDI tax rate must protect the smaller trust fund from being depleted. Since 2000 the Actuary has not demonstrated the ability to do the required calculus, enabling the DI trust fund to be depleted, except for the temporary and illegible DI tax rate of 2.37% CY16-18 under the Bipartisan Budget Act. The recidivism to a 1.8% DI tax rate is overruled to protect the smaller trust fund from further abuse.  The FY 17 Defense budget total growth is anemic and the FY 18 “pre-decisional” levy for war on steroids, the compromise is to stabilize Defense spending at 2.5% annual growth from $580 billion FY16 to $595 billion FY 17 to $609 billion FY 18 so end-strength might grow at 0.9% annually from 2,882,000 FY 16 to 2,907,938 FY 17 to 2,934,109 FY 18 and enjoy the 1.6% basic pay raise FY17 and thereafter in peace. Total FY 17 spending reported by the three military departments - Air Force $168.9 billion, Army $148 billion and the Navy and Marine Corp $164.9 billion = $477.4 billion military spending - $583.3 billion in federal revenues FY17 = $106 billion, of $150 billion total, on-budget undistributed offsetting receipts that OMB uses to recover unspent funds at year end, 70.7% from the Defense. Barack Obama won the Nobel Peace Prize, complied with the Nuclear-Non-Proliferation Treaty, reduced military spending FY2013-15 and most of all there were years of peacetime when there was not a single fatality in the 2.8 million volunteers.  For Congress to make law, without a split ticket, the only opportunity, besides the legal child support payments of the 'Labor Act', is for the informed voters of the United States to buy the FY 18 budget surplus and seventh Hospitals & Asylums (HA) stage of DR two party system political development, the White House OMB Director set afire, with a unanimous roll-call vote to tax the rich to end-poverty by 2020.   The ‘Labor Act’ provides (1) to begin to reverse the alarming increase in child poverty from 15.4% in 1996 to 22-33% in 2017 the federal minimum wage must automatically increase from $7.25 an hour 2009-2017 to '$7.50 in 2018 and 3% every year thereafter.' under 29USC§206(a)(1)(D). To replace Demonstration Projects with 'Maternity Protection' Section 305 of the Social Security Act 42USC§50 to provide 14 week paid maternity leave under Maternity Protection ILO Convention 183 (2000).  The primary finding is that to reduce the current fiscal year deficit and historical deficit and debt OMB must abolish the Allowances, Independent Agencies, Other Defense Civil Programs, Undistributed Offsetting Receipts off-budget rows because they are not agencies instrumental to calculating Outlays by Agency under 31USC§101. It is time for Human Services (HS) to graduate from the Public Health Department (PHD) to prevent true federal health spending from exceeding $1 trillions FY 18.  Total federal spending on Human Services programs is estimated to be $59 billion FY 16, $64 FY 17 and $69 billion FY 18 by CY 17.  HS costs are combined with SSI FY 17 and alone FY 18 in the Adjusted Agency columns to detail a $104 billion FY 18 on-budget surplus.


Preliminary SSI and OASDI Trust Fund Operation Tables HA-31-7-17


The Social Security Trust funds are established in Sec. 201 of the Social Security Act under 42USC§401. They are sustained by the Federal Insurance Contributions Act (FICA) to ensure that an appropriate amount of tax dollars are transferred from the General Fund to the Social Security Trust Funds under 26USC§3121. Aside from effectively treating the intellectually disabling effects of calculus upon the arteries, the most important substantive social security issue in the United States pertains to the law regarding the cost-of-living adjustment (COLA) under Sec. 215(i) of the Social Security Act under 42USC§415(i). COLA has been neglected since the hyperinflation of the early 1970s and religiously abused as an OASDI tax rate calculus substitute since 2009. COLA must be re-interpreted to guarantee lower-income by law social security and other welfare program beneficiaries a 3% COLA to stay ahead of average 2.7% consumer-price-index (CPI) annually adjusted rate of inflation since 1980, provided the combined OASDI trust fund has a trust fund ratio greater than 20%, to comply with the Iron Law of Wages for high rates of catch-up economic growth to escape the inflation of printing Engel's Law. Neither nation nor labor budget can afford to irregularly pay reparations for the resulting attrition of purchasing power. This attrition dangerously impoverishes and depletes the savings of lower income Americans. Lower-income social security and other welfare beneficiaries who do not have the patience to find rental expenses less than 30% of income, destitute at the end of the month. Lower-income workers, especially those with expensive children who need to legislate an automatic 3% annual increase in federal minimum wage under 29USC§206(a)(1)(D) and unemployment compensation contributions to ensure all 4 million women giving birth to United States citizens are equally paid maternity leave for 14 weeks maternity protection under ILO Convention 183 (2000) to reduce alarmingly high rates of legitimate demand by an industrialized nation for Supplemental Security Income (SSI) under Sullivan v. Zebley (1990) T with the payment of Temporary Assistance for Needy Families (TANF) under Sec. 404 of Title IV of the Social Security Act 42USC§604 and Supplemental Security Income (SSI) Program for the Aged, Blind and Disabled under Sec. 1611 of Title XVI of the Social Security Act 42USC§1382. There are three decisions that Social Security Administration (SSA) needs to make now, for fiscal and calendar year 2018. Hopefully in the first combined Annual Report on the OASDI and SSI Trust Funds. First, resolve to pay the high cost DI estimate to afford all social security beneficiaries their 3% COLA (or 2.7% 2018 and 3% every year thereafter to equal $777 SSI in 2019) and ensure working age contributing orphans and insulin dependent diabetes mellitus patients (IDDM) are qualified disabilities for a compassionate allowance. Second, compensate the DI Trust with 2.5% asset accumulation plus interest, for not being able to perform the OASDI tax rate calculation in a timely fashion 2009-2015, for an interest adjusted estimate of $240.4 billion transfer from OASI to DI in 2018. Third, create a Supplemental Security Income (SSI) trust fund to distribute the tax on the rich to end poverty by 2020 with a full SSI benefit, beginning with all 16-24 million children growing up in poverty in 2018.


Temporary Assistance for Needy Families FY 17 HA-17-8-17


TANF, the Temporary Assistance for Needy Families program, was created in the 1996 welfare reform law (P.L. 104-193). This $20 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 as codified 42USC§601 et seq. Like the federal minimum wage, TANF benefits have not grown 3% annually to stay ahead of consumer price index (CPI) inflation averaging 2.7%. Nor has TANF spending increased 4% to provide for 1% population growth and 3% annual benefit increase . Furthermore, more than 4 million certified births in Republican administrations and less during Democratic administrations is 1.2% of 330 million Social Security Area population 2016. It is necessary to produce a three year budget request for the TANF Program. TANF benefit spending has declined from 75% in 1994 to 25% of total “TANF” spending in 2017. The United States needs to end FY 17 approving TANF family and child benefits. In the final reckoning FY 17 needs to begin to account for “undistributed offsetting receipts” by sustaining a TANF budget that is somewhat less than the FY 17 Administration for Children and Families (ACF) TANF spending estimate of $20.1 billion FY 17 growing 4% to $20.9 billion FY 18 in this budget. Federal TANF spending should grow 4% annually from the prevailing FY 17 TANF budget request - 2.5% growth for administration, 3% growth for social work and child care, 3% growth for benefits, and >1.2% beneficiary population growth until the child poverty rate is normalized. TANF benefit spending shall sustain family benefits under the Convention on the Elimination of All Forms of Discrimination against Women of 18 December 1979 and child benefits under Art. 26 of the Convention on the Rights of the Child of 2 September 1990.  Trump Administration's planned FY 18 TANF budget cuts, renege on Obama Administration's FY 17 TANF budget of $20.1 billion, would provide for 0% growth from $17.4 billion FY 16 and FY 17, and reduce TANF spending to $15.1 billion FY 18, mostly by cutting federal spending for benefits. Family benefits are more expensive than the FY 15 fiscal report lets on. If the dead beat President's daughter cannot get her father to agree with his predecessor and this budget, the Secretary of Health and Human Services may also makes loans, repayable in 3 years, particularly in anti-welfare fraud cases under Sec. 406 of the Social Security Act under 42USC§606 et seq. $13.9 billion total federal spending estimated in FY 2015 Federal TANF & State MOE Financial Data seems low. After checking the subtotals for accuracy, total funds used was $15.4 billion FY 15 and the grand total with social service block grant and child care development fund was $17.9 billion not $16.4 billion FY15. The FY 16 TANF deficit of $1.1 billion is covered by the negligent method of accounting for $1.4 billion federal unliquidated obligations. Federal unliquidated obligations are not a generally accepted accounting practice (GAAP). Liability for the non-support of the FY 18 TANF budget request failure to distribute FY 17 child benefit obligations, to the burgeoning population of children growing up in poor families, is expressed as undistributed offsetting receipt from the FY 17 TANF budget request figures under 18USC§228 (b-d).


2.6% HI Tax Spending Limit FY 18 HA-28-8-17


It has been reported that the Treasury is going to discontinue refundable premium and cost-sharing reduction subsidies (for health insurance corporations with profit margins >10%) under the Affordable Care Act beginning FY 18. Un-redressed CMS accounting error is now the only reason the United States (US) is incapable of joining Hospitals & Asylums (HA) in declaring a federal budget surplus FY 18 under Art. 2 Sec. 2 of the US Constitution. To balance the federal budget, 6% annual growth in Part A tax revenues must run over into 3% health benefit growth in Parts A, B & D benefits from FY 14, effective FY 18. HI tax spending should be < 2.6% of the 2.9% + 0.9% of high income contributors to HI tax spending FY 18?  Administrative spending cuts, especially for research, and FY 17 Part B and D cuts are sustained into FY 18, except for ACF child and family benefits that grow 4% annually plus historical interest in undistributed offsetting receipts and anti-welfare fraud loans of Secretary Price under Sec. 406 of the Social Security Act under 42USCŠ§606 and 18USC§228. The FY 18 Administration for Families and Children (ACF) congressional budget request is overruled by the ACF FY 17 budget request. The dead-beat President is condemned to create an independent Cabinet-level Department of Human Services (HS) to sustain >4% family and child benefit spending growth FY 18 under 31USC§101.  Federal outlays for Medicare are estimated by Part A payroll tax revenues and Part B & D general revenues from the 2017 Annual Report of the Board of Trustees of the Federal Hospital Trust Fund and Supplemental Medical Insurance Trust Fund FY 14-17 after which time FY 14 becomes the baseline for sustainable 3% annual growth. Federal outlays are estimated for Medicaid from 2016 CMS Statistics with 3% benefit spending and 2.5% administrative spending growth from FY 14. The one budgetary success of the ACA was in reducing national health expenditures is in reducing state Medicaid payments to 11% of federal payments.   This must be sustained in hopes of reducing national health expenditure to less than 10% of GDP by 2020.  Health budget efforts must be careful not to allow any hyperinflation from occurring in response to other reasonable macroeconomic budget cuts that are not thought to get through the accounting fraud, to actually cause any deprivation of relief benefits.  The HI payroll tax is growing 6% annually and HI spending has stabilized at 2.1% growth. After experimentally reducing Part B & D outlays FY 17, federal outlays must go down in all three federally financed Medicare plans FY 18. Surplus FY 18 HI revenues must either run over into Medicaid price-controlled Part B & D payments or the $281.7 billion generated by the 2.9% HI tax rate must be somehow reduced to $255.9 billion, a tax rate of 2.6%, keep the 0.9% tax on the incomes of the rich - 15.0% Federal Income Contribution Act (FICA)? Does CMS have any undistributed offsetting receipts to report left over from the $917.1 billion federal outlays estimated to be administered FY 17 and $906.7 billion FY 18 from Oct. 1 under 31USC§1106?