Hospitals & Asylums
Black Medicare
and Social Security Commissioner HA-17-6-13
|
Stanley
Friendship, Seattle Regional SSA Commissioner |
Carolyn
W. Colvin, Acting SSA Commissioner |
Barack
Obama, President of the USA |
By Anthony J. Sanders
A
BILL
To amend the DI tax rate to 2.61%, 1.305% for employees and 1.305% for
employers under Sec. 201(b)(1)(S) of the Social Security Act 42USC(7)II§401 and
the OASI tax rate to 9.79%, 4.895% for employee under 26USC(C)(21)(A)§3101 (a) and 4.895% for employers under 26USC(C)(21)(A)§3111 (a) without increasing the overall 12.4% OASDI or 15.3% OASDI and
Hospital Insurance (HI) tax-rate under 26USC(A)(2)§1401.
To require the Chief Actuary to
account for SSI in the 2014 Annual Report of the Board of Trustees of the
Federal Old-Age Survivors Insurance and Federal Disability Insurance Trust
Funds
To require the Chief Actuary to
account for Medicaid in the 2014 Annual Report of the Hospital Insurance and
Supplemental Medical Insurance Trust Funds
To commission an empirical survey
of Social Security beneficiaries by race at the request of the President, to investigate the
possibility of statistically significant discrimination against blacks in the
administration of social security benefits, aiming to redress this racial
disparity with SSI on the rational basis of poverty under Title VI of the Civil
Rights Act of 1964 42USC(21)V§2000d-1
To eliminate discrimination
(disclaimer) against naturalization papers in the administration of social
security cards, state ID and passports
To discuss paying for SSI with
OASDI without raising tax rates until 2020 to reduce the deficit
To purchase the rights to the balanced
federal budget for $1,000 and Hospitals & Asylums work in general from the
author for $1,000 a month DI
Be it enacted by the acting
Commissioner of Social Security Carolyn W. Colvin.
Review
of the Annual Reports of the Social Security Trustees
JACOB J. LEW,
Secretary of the
Treasury, and
Managing Trustee
of the Trust Funds.
SETH D. HARRIS,
Acting Secretary
of Labor,
and Trustee.
KATHLEEN SEBELIUS,
Secretary of
Health and Human Services,
and Trustee.
CAROLYN W. COLVIN,
Acting
Commissioner of Social Security,
and Trustee.
CHARLES P. BLAHOUS III,
Trustee.
ROBERT D. REISCHAUER,
Trustee.
DAVID A. WEAVER,
Associate
Commissioner,
Office of
Program Development and Research,
Social Security Administration,
and Acting
Secretary, Board of Trustees.
MARILYN B. TAVENNER,
Administrator,
Centers for Medicare & Medicaid Services,
and Secretary,
Boards of Trustees.
Table 1: SSI COLA, Rates,
Beneficiaries, Payments, Administrative Costs 1974-2011
Table 2: Changes to OASDI if
SSA paid for SSI 2013-2020
Table 3: Medicaid Population by State July 1, 1999
Table 4: Annual
Random Survey of 3.6 Million Beneficiaries by Age, Race and Sex 2009
Review
At the end of
2012, the OASDI program was providing benefit payments1 to about 57 million
people: 40 million retired workers and dependents of retired workers, 6 million
survivors of deceased workers, and 11 million disabled workers and dependents
of disabled workers. During the year, an estimated 161 million people had
earnings covered by Social Security and paid payroll taxes. Total expenditures
in 2012 were $786 billion. Total income was $840 billion, which consisted of
$731 billion in non-interest income and $109 billion in interest earnings.
Asset reserves held in special issue U.S. Treasury securities grew from $2,678
billion at the beginning of the year to $2,732 billion at the end of the year. The Trustees project that the combined
reserves of the OASI and DI Trust Funds will increase for the next several
years, growing from $2,732 billion at the beginning of 2013 to $2,922 billion
at the beginning of 2021. Beginning in 2021, annual cost exceeds total income,
and therefore reserves begin to decline, reaching $2,866 billion at the
beginning of 2023. The Trustees measure
financial adequacy by maintaining a trust fund ratio of 100 percent or more. Total DI disbursements, which started to
exceed non-interest income in 2005, continued to exceed such income in 2012. As
in 2011, DI disbursements exceeded total DI income (including interest). The
reserves in the DI Trust Fund at the end of calendar year 2012 totaled $122.7
billion, and consisted of $122.8 billion in U.S. Government obligations. At the
beginning of calendar year 2012, the reserves of the DI Trust Fund represented
110 percent of annual cost. During 2012, DI cost exceeded income, and the trust
fund ratio for the beginning of 2013 decreased to about 85 percent. The
projected cost in excess of income results in the estimated depletion of the DI
Trust Fund reserves by the end of 2016. Income and cost for the OASI Trust Fund
represent over 80 percent of the corresponding amounts for the combined OASI
and DI Trust Funds. Under current law, one trust fund cannot share financial
resources with another trust fund (Goss '13: 4, 9, 29, 43). The DI tax rate must be amended to 2.61% as requested by the Chief
Actuary in the 2012 Report, 1.305% for employees and 1.305% for employers under
Sec. 201(b)(1)(S) of the Social Security Act 42USC(7)II§401 and
the OASI tax rate to 9.79%, 4.895% for employee under 26USC(C)(21)(A)§3101 (a) and 4.895% for employers under 26USC(C)(21)(A)§3111 (a) without increasing the overall 12.4% OASDI or 15.3% OASDI and
Hospital Insurance (HI) tax-rate under 26USC(A)(2)§1401 (Sanders '12).
Total
Medicare expenditures were $574 billion in 2012. The Board projects that, under
current law, expenditures will increase in future years at a somewhat faster pace
than either aggregate workers’ earnings or the economy overall and that, as a
percentage of GDP, they will increase from 3.6 percent in 2012 to 6.5 percent
by 2087 (based on the Trustees’ intermediate set of assumptions). If lawmakers
continue to override the statutory decreases in physician fees, and if the
reduced price increases for other health services under Medicare are not
sustained and do not take full effect in the long range, then Medicare spending
would instead represent roughly. 9.8 percent of GDP in 2087. Growth of this
magnitude, if realized, would substantially increase the strain on the nation’s
workers, the economy, Medicare beneficiaries, and the Federal budget. HI
services are inpatient hospital, skilled nursing facility, home health, and
hospice. The primary Part B services affected are outpatient hospital, home
health, and dialysis. The Trustees set the per beneficiary growth rate for
these services equal to the sum of the statutory price update and the assumed
growth in the volume and intensity of services per person. The first factor
equals the market basket price increase (3.6 percent) minus the productivity
adjustment (1.1 percent), for a statutory price update of 2.5 percent per year.
The second factor equals the year-by-year increase in the volume and intensity
assumption from the “factors contributing to growth” model less the ACA growth
impact of 0.1 percent. Under the Trustees’ intermediate economic assumptions,
the resulting year-by-year increases for these provider
services start at 4.5 percent in 2037, or “GDP plus 0.4 percent,”
declining gradually to 3.6 percent in 2087, or “GDP minus 0.5 percent.” On
average, the resulting ultimate cost growth rate for these provider services is
4.3 percent, or “GDP plus 0.2 percent" (Spitalnic
'13: 8, 9, 16, 17). The proceeds of the
tax provisions of the ACA, which extends Medicare taxation to income, without
limit, are not evident because they were stolen by the General Fund, but there
is no cause for concern for the solvency of Medicare in the immediate future
only interference with health care matters by the federal government. The names of the CMS administrator Ms. Tavenner and acting Chief Actuary Mr. Spitalnic
warn against dependency upon health care providers who can no longer be relied
upon for moral support, as of the annual report dated May 31, 2013 (nerds
beware)!!!
The Social Security
Administration makes special payments to uninsured persons who meet certain
requirements. The General Fund of the Treasury largely reimburses costs
associated with providing such payments. Although there was no reimbursement in
2012, a reimbursement of about $1 thousand is scheduled for 2013, reflecting
costs incurred in fiscal year 2011. The DI Trust Fund pays for benefits to
disabled workers who: (1) satisfy the disability insured requirements; (2) are
unable to engage in any substantial gainful activity due to a medically
determinable physical or mental impairment severe enough to satisfy the
requirements of the program; and (3) have not yet attained normal retirement
age. Spouses and children of such disabled workers may also receive DI benefits
provided they satisfy certain criteria, primarily age and earnings
requirements. Beneficiaries stop receiving disability benefits when they die,
recover from their medically-determinable disabling condition, or return to
work. Eligibility for worker benefits under the OASDI program requires some
threshold level of work in covered employment. A worker satisfies this
requirement by his or her accumulation of quarters of coverage (QCs). Prior to
1978, a worker earned one QC for each calendar quarter in which he or she
earned at least $50. In 1978, when annual earnings reporting replaced quarterly
reporting, the amount required to earn a QC (up to a maximum of four per year)
was set at $250. As specified in the law, the Social Security Administration
has adjusted this amount each year since then according to changes in the AWI.
Its value in 2013 is $1,160. There are
three types of insured status that a worker can acquire under the OASDI
program. The number and recency of QCs earned
determine each status. A worker acquires fully insured status when his or her
total number of QCs is greater than or equal to the number of years elapsed
after the year of attainment of age 21 (but not less than six). Once a worker
has accumulated 40 QCs, he or she remains permanently fully insured. A worker
acquires disability insured status if he or she is: (1) a fully insured worker
who has accumulated 20 QCs during the 40-quarter period ending with the current
quarter; (2) a fully insured worker aged 24-30 who has accumulated QCs during
one half of the quarters elapsed after the quarter of attainment of age 21 and
up to and including the current quarter; or (3) a fully insured worker under
age 24 who has accumulated six QCs during the 12-quarter period ending with the
current quarter. A worker acquires currently insured status when he or she has
accumulated six QCs during the 13-quarter period ending with the current
quarter. Periods of disability reduce the number of quarters required for
insured status, but not below the minimum of six QCs (Goss '13: 26, 126,127,
129, 118, 119).
The
SSI program is a nationwide Federal assistance program administered by SSA that
guarantees a minimum level of income for needy aged, blind, or disabled
individuals. It acts as a safety net for individuals who have limited resources
and little or no Social Security or other income. Under the SSI program, the monthly Federal
cash payment in 2011 for an eligible person living in his or her own household
and having no other countable income is $674 ($1,011 for a couple if both
members are eligible). During 2010, 8.6 million aged, blind, or disabled
individuals received at least 1 month’s Federal SSI benefit. In January 2011,
8.0 million individuals received Federally-administered monthly SSI benefits
averaging $500. Of these, 7.7 million
received monthly Federal SSI payments averaging $478, up from 7.5 million
recipients with an average payment of $476 in January 2010 and 2.4 million
received monthly State supplementation payments averaging $125. This group was composed of 1.1 million aged
recipients, 6.4 million disabled recipients, and 65 thousand blind recipients.
Of the 6.5 million blind or disabled recipients, 1.2 million were under age 18,
and 0.8 million were aged 65 or older.
As a percentage of the total U.S. population, the number of Federal SSI
recipients increased slightly from 2.37 percent in 2009 to 2.42 percent in
2010. In 2010 applicant success ran at
about 45.8%. During calendar year 2010,
2.4 million individuals applied for SSI benefits based on blindness or
disability, an increase of 3 percent over 2009. Additionally, 148 thousand
applied for SSI benefits based on age, an increase of less than 1 percent over
2009. In 2010, 1.1 million applicants were awarded SSI benefits, an increase of
5 percent as compared to the 1.0 million awarded benefits in 2009. Each month
on average during calendar year 2010, 7.6 million individuals received Federal
SSI benefits. Federal SSI expenditures
expressed as a percentage of the Gross Domestic Product (GDP) were 0.293 in
2008 and increased to 0.325 percent of GDP in 2009 due to the economic
recession. After increasing slightly to 0.326 percent of GDP in 2010, SSA
projects that expenditures as a percentage of GDP will
decrease slightly to 0.324 percent of GDP in 2011, and continue to decline
thereafter to 0.244 percent of GDP by 2035.
Federal expenditures for cash payments under the SSI program during
calendar year 2010 increased 4.1 percent to $47.8 billion, while the funds made
available to administer the SSI program in fiscal year 2010 increased 9.2
percent to $3.7 billion. In 2009 the corresponding program and administrative
expenditures were $45.9 billion and $3.4 billion, respectively. Administration increased more than twice as
fast as beneficiaries. Administrative costs rose from 7.4% to 7.7% in
2010. SSI administrative costs are too
high. SSI must be deregulated to reduce
paperwork and not interfere with cottage industry (Sanders '11: 22-24)..
SSI COLA, Rates, Beneficiaries, Payments, Administrative Costs
1974-2011
|
Year |
COLA |
Benefit Rate |
Total Beneficiary (thousand) |
Federal Payments (millions) |
Admin. Costs (millions) |
|
1974 |
4.3% |
$146.00 |
3,996 |
16,741 |
|
|
1980 |
14.3% |
$238.00 |
4,142 |
15,470 |
668 |
|
1990 |
4.7% |
$386.00 |
4,817 |
21,724 |
1,075 |
|
2000 |
2.5% |
$513.00 |
6,602 |
36,906 |
2,321 |
|
2001 |
3.5% |
$531.00 |
6,688 |
38,112 |
2,397 |
|
2002 |
2.6% |
$545.00 |
6,788 |
38,935 |
2,522 |
|
2003 |
1.4% |
$552.00 |
6,902 |
39,680 |
2,656 |
|
2004 |
2.1% |
$564.00 |
6,988 |
40,155 |
2,806 |
|
2005 |
2.7% |
$579.00 |
7,114 |
40,824 |
2,795 |
|
2006 |
4.1% |
$603.00 |
7,236 |
41,502 |
2,916 |
|
2007 |
3.3% |
$623.00 |
7,360 |
42,208 |
2,857 |
|
2008 |
2.3% |
$637.00 |
7,521 |
43,143 |
2,820 |
|
2009 |
5.8% |
$674.00 |
7,677 |
47,429 |
3,316 |
|
2010 |
0.0% |
$674.00 |
7,912 |
48,357 |
3,629 |
|
2011 |
0.0% |
$674.00 |
7,866 |
49,038 |
3,931 |
|
2012 |
3.6% |
$698.00 |
8,057 |
52,010 |
3,766 |
Source: Annual Report of the SSI Program 2011 Table
IV. A2. pp. 28; Table IV.B9 pp. 44; Table IV. C3. pp. 48; Table IV.E1. pp. 52
Notices
were sent out in March 2011 to terminate 44,096 SSI beneficiaries in March, social
work month, and retro-active payments, dating to December 2010 when a 0.55%
total decline in enrollment was led by a 4.5% decline in beneficiaries
receiving only federal SSI payments. In
his April newsletter Senator Bernie Sanders (S-Vt)
expressed the public outrage of hundreds of protesting beneficiaries. This is not the first time the number of SSI
beneficiaries has declined. In October
2009 the total number of SSI beneficiaries declined by 9,264 (0.12% of
population) for savings of $69,709,000 (1.7% of monthly spending). In December 2009 total beneficiaries declined
by 45,223 (0.5%) saving $50,456,000 (1.2%).
In July 2010 total beneficiaries declined 6,354 (0.07%) saving
$79,520,000 (1.86%). In December 2010
total beneficiaries declined by 44,096 (0.55%) netting only $22,874,000 (0.53%). December 2010 stands out as a particularly
criminal violation of civil rights statute pertaining to the deprivation of
relief benefits under 18USC(13)§246 which applies
equitably to the horrible economic scourge of $666 ($674) SSI for three years
without COLA. The only operation made available this political capital at the end of
the year when Congress came to ask what they had done with their windfall was
the termination of benefits to reduce the occurrence of improper payments. One of the most common forms of
standardization is price indexing, which uses some measure of change in the
prices of consumer goods. The Bureau of Labor Statistics, Department of Labor,
publishes one such price index, the Consumer Price Index for Urban Wage Earners
and Clerical Workers (CPIW, hereafter referred to as CPI). The Social Security
Administration (SSA) uses this index to determine the annual cost-of-living
increases for OASDI monthly benefits. The Trustees assume the ultimate annual
rate of increase in the CPI will be 1.8, 2.8, and 3.8 percent for the low-cost,
intermediate, and high-cost sets of assumptions, respectively. Table VI.F7
provides CPI indexed dollar values (those adjusted using the CPI in table
VI.F6), which indicate the relative purchasing power of the values over time.
Wage indexing is another type of standardization. It combines the effects of
price inflation and real-wage growth. The wage index presented here is the
national average wage index, as defined in section 215(i)(1)(G) of the Social Security Act. SSA uses this index to
annually adjust the contribution and benefit base and other earnings-related
program amounts. The Trustees assume that the average wage will grow by an
average rate of 3.5, 3.9, and 4.3 percent under the low-cost, intermediate, and
high-cost assumptions, respectively, between 2022 and 2087. Wage-indexed values
indicate the level of a series relative to the standard of living of workers
over time (Goss '13: 203). Having ended
the SSI $666 ($674) for three years without COLA SSA must (stop chaining
benefits to GDP growth, guarantee 3% COLA) ensure that beneficiaries of Title I
and II of the Social Security Act who were singled out for cruel and unusual
sentences of years at reduced benefits in the $600-$699 range are brought to
safety above the $700 line, restored to their previous benefit amount and
issued a special check for the underpayment, redetermined
to $1,000 a month for their service, or a reliable $1,000 reimbursement.
OMB
has never accurately accounted for on-budget and off-budget SSA spending and
must pay closer attention to the Annual Report of the Trustees to Congress that
comes out in April of each year, that needs to expanded itself to include study
of SSI spending, in consideration of paying for SSI with the combined Old Age
Survivor Disability Insurance (OASDI) trust funds, without raising overall
OASDI taxation until after 2020, and we have satisfactorily made a withdrawal
from what has become over the past decade the largest savings account in the
world. In 2012 the annual report of the
OASDI trust funds indicates that off-budget receipts amounted to an estimated $733.9 billion FY 2012, taking into consideration $112.1
billion reimbursed by the General Fund for the unwise and insignificant 2%
OASDI tax relief, and $788.7 billion in expenditures, $777.7 billion for
benefits. In FY 2013 reimbursements are
scheduled to go down to $2.7 billion for total off-budget revenues of $870.7
billion and $832.3 billion in expenditures.
For OMB SSA off-budget column, it is probably best to account for total
revenues, but normally it makes no difference to the federal budget. What then do the on-budget statistics mean
for the federal budget? The on-budget
statistics include the reasonable cost of administration plus SSI, until SSA is
given responsibility for paying for SSI by Act of Congress, and the cost of
reimbursing the unwise 2% OASI tax relief.
The figures provided by OMB are however $6.8 billion over in FY 2008 to
$22.2 billion over in FY 2009, going down to $8.8 billion over in FY 2010 and
$3 billion over in FY 2011 before becoming statistically significant at $24.6
billion in FY 2012 and $47.8 billion in FY 2013. OMB needs to revise on-budget statistics to
reflect actual spending reported in the Annual Reports. The then
Commissioner is principally responsible for the +/-$666 ($674) for three years
without Cost-of-Living Adjustment (COLA) December 2008-2012 that caused the
99.9% of the Great Recession by racketeering Hospitals & Asylums (HA),
producer of the highly infringed only balanced budget since 2005 using a
strategy of military spending reduction and OASI surplus return to the General
Fund, now obsolete in favor of total management of all federal agency budgets,
if not committing and covering up mass genocide upon 50 million beneficiaries,
7 million or so marked with the number of the beast 2008-2011 and 1 million
wise afterwards due >$700 a month and settlement of their written claim, to
the degradation of constitutional governance (and national life expectancy in
2008 now covered up). The question is
when will Congress wise up and require SSA pay for SSI saving the General Fund
$52 billion (base year FY 2012) plus 7% annual growth. It was wrong under antitrust principles for
Congress to reimburse SSA for a 2% OASDI tax reduction and needs to stop at the
soonest possible time October 1, 2012, the first day of FY 2013 is the
time. This harmful error must cease and
must not be remembered by historians and propagandists as anything but a
harmful error that caused massive layoffs and stifled economic growth from
America’s usual 3% 2011-2012 to an anemic 1.4% mid-year 2012. Reason being, we all know, if we haven’t been
brainwashed by trust fund propaganda, we have to make a significant withdrawal
from the largest savings account in the world – the OASDI Trust Fund – and
doctor the deficit, by making OASDI pay for SSI, without increasing the overall
12.4% OASDI tax rate, until after 2020.
The people should be informed of the true cost of disability with a
legislated 3.6% DI+SSI and 8.8% OASI tax split 50/50 between employers and
employees. The SSA Chief Actuary must be
immediately required to include SSI in the Annual Report to Congress, for the
agency to be prepared to withdraw OASDI assets to a $2.4 trillion limit
(Sanders '12: 3b)..
Changes to OASDI if SSA paid for SSI 2013-2020
|
|
2011 |
2012 |
2013 |
2014 |
2015 |
|
OASDI
Net Increase at end of year |
69,000 |
57,300 |
41,100 |
42,400 |
43,100 |
|
SSI 7% annual growth from 2012 |
49,038 |
52,010 |
55,650 |
59,546 |
63,714 |
|
Revised
Net Increase |
n/a |
n/a |
-14,550 |
-17,146 |
-20,614 |
|
Revised
OASDI Balance |
|
|
2,720,
650 |
2,703,504 |
2,682,890 |
|
Current
OASDI Balance |
2,677,900 |
2,735,200 |
2,776,300 |
2,818,800 |
2,861,900 |
|
|
2016 |
2017 |
2018 |
2019 |
2020 |
|
OASDI
Net Increase at end of year |
46,200 |
49,700 |
48,900 |
36,900 |
17,300 |
|
SSI 7% annual growth from 2012 |
68,175 |
72,947 |
78,053 |
83,517 |
89,363 |
|
Revised
Net Increase |
-21,975 |
-23,247 |
-29,153 |
-46,617 |
-72,063 |
|
Revised
OASDI Balance |
2,660,915 |
2,637,668 |
2,608,515 |
2,561,898 |
2,489,835 |
|
Current
OASDI Balance |
2,908,100 |
2,957,800 |
3,006,800 |
3,043,700 |
3,061,000 |
Sources:
2012 Annual Report of the Board of
Trustees of the Federal Old-Age and Survivors Insurance and Disability
Insurance Trust Funds, Table IV.A.3 Operations of the Combined OASI and DI Trust
Funds 2007-21; 2012 Annual Report of the SSI Program, Annual Report of the
Advisory Council 2012 and Table C.1 SSI Federal Payment in Current Dollars
1974-2012; The Revised OASDI Balance may not take into account adjusted
interest earnings.
Medicare is a nationwide, federally administered
health insurance program authorized in 1965 under Title XVIII of the Social
Security Act to cover the cost of hospitalization, medical care, and some
related services for most people age 65 and over. In 1972, lawmakers extended
coverage to people receiving Social Security Disability Insurance payments for
2 years and people with End-Stage Renal Disease. (For beneficiaries whose
primary or secondary diagnosis is Amyotrophic Lateral Sclerosis, the 2-year
waiting period is waived.) In 2010, people exposed to environmental health
hazards within areas under a corresponding emergency declaration became
Medicare-eligible. In 2006, prescription
drug coverage was added as well. Medicare consists of two separate but
coordinated trust funds—Hospital Insurance (HI, Part A) and Supplementary
Medical Insurance (SMI). The SMI trust fund is composed of two separate
accounts—the Part B account and the Part D account. Almost all persons who are
aged 65 and over or disabled and who are entitled to HI are eligible to enroll
in Part B and Part D on a voluntary basis by paying monthly premiums (Goss '13:
224, 225). In 2012, Medicare covered 50.7 million people: 42.1 million aged 65
and older, and 8.5 million disabled. About 27 percent of these beneficiaries
have chosen to enroll in Part C private health plans that contract with
Medicare to provide Part A and Part B health services. Total expenditures in
2012 were $574.2 billion. Total income was $536.9 billion, which consisted of
$523.5 billion in non-interest income and $13.4 billion in interest earnings.
Assets held in special issue U.S. Treasury securities decreased by $37.3
billion to $287.6 billion. Under current law, payments would be reduced to
levels that could be covered by incoming tax and premium revenues when the HI
trust fund was depleted. The Patient
Protection and Affordable Care Act, as amended by the Health Care and Education
Reconciliation Act of 2010, introduced even larger policy changes and
projection uncertainty. This legislation, referred to collectively as the
“Affordable Care Act” or ACA, contains roughly 165 provisions affecting the
Medicare program by reducing costs, increasing revenues, improving benefits,
combating fraud and abuse, and initiating a major program of research and
development to identify alternative provider payment mechanisms, health care
delivery systems, and other changes intended to improve the quality of health
care and reduce costs. To date, lawmakers have never allowed the assets of the
Medicare HI trust fund to become depleted. Under the ACA, Medicare’s annual
payment rate updates for most categories of providers would be reduced below
the increase in providers’ input prices by the growth in economy-wide
multifactor productivity (1.1 percent over the long range). In addition, the
IPAB would be charged with recommending cost savings as are necessary to hold
overall per capita Medicare growth to the average of the CPI and CPI-medical
increases in 2015-2019 and to the rate of per capita GDP growth plus 1
percentage point thereafter (subject to certain limits). The ACA specifies that individuals with
incomes greater than $200,000 per year and couples above $250,000 pay an
additional “Medicare contribution” of 3.8 percent on some or all of their non-work
income (such as investment earnings). However, the revenues from this tax are
not allocated to the Medicare trust funds (Spitalnic
'1: 6, 2, 24).
To
establish a suitable base from which to project future HI costs, the incurred
payments for services provided must be constructed for the most recent period
for which a reliable determination can be made. Accordingly, payments to
providers must be attributed to dates of service, rather than to payment dates;
in addition, the nonrecurring effects of any changes in regulations,
legislation, or administration, and of any items affecting only the timing and
flow of payments to providers, must be eliminated. For those services still reimbursed on a
reasonable-cost basis, the costs for covered services are determined on the
basis of provider cost reports. Reimbursement for these services occurs in two
stages. First, bills are submitted by providers to the intermediaries, and
interim payments are made on the basis of these bills. The second stage takes
place at the close of a provider’s accounting period, when a cost report is
submitted and lump-sum payments or recoveries are made to correct for the
difference between interim payments and final settlement amounts for providing
covered services (net of coinsurance and deductible amounts). Tabulations of
the bills are prepared by date of service, and the lump-sum settlements, which
are reported only on a cash basis, are adjusted (using approximations) to
allocate them to the time of service.
In
late 2008, CMS suspended payments to a number of home health agencies and
increased program integrity efforts for this category of services. From 2010
onward, outlier payments to agencies have been capped as a percentage of total
payments. Assumed growth rates for home health expenditures reflect this
initiative, along with the ongoing effects of growth in the number of
beneficiaries, payment rates, utilization of services, and legislated changes
affecting future payments. Medicare payment rates for inpatient hospital
services are about 67 percent of those paid by private health insurance.
The
average complexity of hospital admissions (case mix) is expected to increase by
0.5 percent annually in fiscal years 2013 through 2037 as a result of an
assumed continuation of the current trend toward treating less complicated
cases in outpatient setting. Medicare payments for physician services
are based on a fee schedule, which reflects the relative level of resources
required for each service. The fee schedule amount is equal to the product of
the procedure’s relative value, a conversion factor, and a geographic
adjustment factor (Spitalnic '13: 107, 110, 119.136, 137, 144, 145, 208, 126). Together Medicare and Medicaid serve more than 87 million
people. Medicaid pays approximately 1 in
5 health care dollars and 1 in 2 nursing home dollars. The Medicaid Program provides medical
benefits to groups of low-income people, some who may have no medical insurance
or inadequate medical insurance. Although the Federal government establishes general
guidelines for the program, the Medicaid program requirements are actually
established by each State. Whether or not a person is eligible for Medicaid
depends upon the State where he or she lives (Sanders '11: 461, 462 §96). Universal health insurance is achieved
through Medicaid expansion (Sanders '08).
Medicaid
Population by State July 1, 1999
State of
|
|
272,691 |
38,319 |
14.1 |
188,456,539,000 |
|
|
4,370 |
678 |
15.5 |
2,426,546,629 |
|
Alaska |
620 |
40 |
6.5 |
407,574,922 |
|
|
4,778 |
661 |
13.8 |
1,977,585,436 |
|
|
2,551 |
431 |
16.9 |
1,472,148,586 |
|
|
33,145 |
3,861 |
11.6 |
18,322,124,498 |
|
|
4,056 |
462 |
11.4 |
1,840,149,345 |
|
|
3,282 |
515 |
15.7 |
3,106,833,711 |
|
|
754 |
112 |
14.9 |
464,675,516 |
|
|
519 |
76 |
14.6 |
812,307,451 |
|
|
15,111 |
2,793 |
18.5 |
5,842,382,222 |
|
|
7,755 |
910 |
11.7 |
3,762,757,168 |
|
|
1,185 |
164 |
13.8 |
605,014,726 |
|
|
1,252 |
161 |
13.0 |
517,507,218 |
|
|
12,128 |
1,622 |
13.4 |
6,755,100,123 |
|
|
5,943 |
838 |
14.1 |
2,977,949,366 |
|
|
2,869 |
457 |
16.6 |
1,461,173,214 |
|
|
2,654 |
385 |
14.5 |
1,106,965,283 |
|
|
3,961 |
612 |
15.5 |
2,770,613,802 |
|
|
4,372 |
595 |
13.6 |
3,384,670,228 |
|
|
1,253 |
214 |
17.1 |
1,178,880.711 |
|
|
5,172 |
635 |
12.3 |
3,014,952,844 |
|
|
6,175 |
972 |
15.4 |
5,446,127,975 |
|
|
9,664 |
1,385 |
14.0 |
6,158,362,777 |
|
|
4,776 |
647 |
13.5 |
3,119,764,555 |
|
|
2,769 |
414 |
15.0 |
1,843,880,902 |
|
|
5,468 |
852 |
15.6 |
3,639,967,302 |
|
|
883 |
135 |
15.3 |
424,328,043 |
|
|
1,666 |
253 |
15.2 |
984,253,204 |
|
|
1,809 |
235 |
13.0 |
559,503,198 |
|
|
1,201 |
165 |
13.7 |
787,062,321 |
|
|
8,143 |
1,201 |
14.7 |
5,772,631,914 |
|
|
1,740 |
230 |
13.2 |
1,103,690,454 |
|
|
18,197 |
2,674 |
14.7 |
28,673,589,131 |
|
|
7,651 |
1,112 |
14.5 |
4,967,172,053 |
|
|
634 |
102 |
16.1 |
346,720,664 |
|
|
11,257 |
1,697 |
15.1 |
5,908,994,760 |
|
|
3,358 |
503 |
15.0 |
1,496,145,904 |
|
|
3,316 |
490 |
14.6 |
1,962,544,049 |
|
|
11,994 |
2,082 |
17.4 |
9,556,752,320 |
|
|
981 |
168 |
17.0 |
1,063,037,589 |
|
|
3,886 |
556 |
14.3 |
2,472,958,395 |
|
|
733 |
118 |
16.1 |
377,830,154 |
|
|
5,484 |
815 |
14.9 |
4,159,707,338 |
|
|
20,044 |
2,226 |
11.1 |
10,350,823,295 |
|
|
2,130 |
204 |
9.6 |
756,590,971 |
|
|
514 |
88 |
14.6 |
473,137,876 |
|
|
6,173 |
878 |
12.8 |
2,487,100,612 |
|
|
5,250 |
724 |
12.6 |
3,564,389,167 |
|
|
1,807 |
336 |
18.6 |
1,355,044,060 |
|
|
5,250 |
770 |
14.7 |
2,738,075,303 |
|
|
480 |
64 |
13.3 |
204,334,030 |
Source: Sanders '11: 461, 462; §96; Fig. 3.36
A civil right is an enforceable right or privilege for an
individual, which if interfered with by another gives rise to an action for
injury. Examples of civil rights are freedom of speech, press, assembly, the
right to vote, freedom from slavery and involuntary servitude, and the right to
equality in public places. Discrimination occurs when the civil rights of an individual
are denied or interfered with because of their membership in a particular group
or class. Statutes have been enacted to
prevent discrimination based on a person’s race, gender, religion, age, previous condition of servitude, disability, national
origin and in some instances sexual preference.
The Social Security Act contains no provisions regarding
discrimination. Severer punishments for
crimes were imposed on the slave than on free persons guilty of the same
offenses and continue to be imposed on racial minorities committing the same
crime as whites. Congress, by the civil rights bill of 1866, passed in view of
the thirteenth amendment, before the fourteenth was adopted, undertook to wipe
out these burdens and disabilities, incidental to slavery, and to secure to all
citizens of every race and color, and without regard to previous servitude,
those fundamental rights which are the essence of civil freedom, namely, the
same right to make and enforce contracts, to sue, be parties, give evidence,
and to inherit, purchase, lease, sell, and convey property, as is enjoyed by
white citizens. In
1868 the 14th Amendment was passed to counter the "black codes" and
ensure that no state "shall make or enforce any law which shall abridge
the privileges or immunities of the citizens of the United States or deprive
any person of life, liberty, or property without due process of law, or deny to
any person within its jurisdiction the equal protection of the laws”. Racial and sexual disparities are
particularly evident in state and federal prison. In 2007 7% of all inmates
were women. In the 25-29 age group, 8.1% of black men
- about one in 13 – were behind bars, compared with 2.6% of Hispanic men and
1.1% of white men. SSA may be equally discriminatory although their local
offices are heavily staffed with women and minorities. State welfare program have exhibited much
higher rates of sanctions for non-compliance with program rules amongst racial minorities, especially African
Americans who have been previously sanctioned.
The Social Security Administration
(SSA) needs to produce an authentic Annual Statistical Supplement, of all their
beneficiaries by race, sex and national origin.
SSA numbers should suffice to determine national origin and the
paperwork takes into consideration age, race, sex and disability. New questions can survey religion. The President needs to approve statistical
surveys of the number of beneficiaries and benefit amount to ensure
non-discrimination against beneficiaries of Federal Assistance Programs on the
basis of race, sex, disability, religion or national origin under Title VI of
the Civil Rights Act of 1964 42USC(21)V§2000d-1.
Annual Random Survey of 3.6 Million
Beneficiaries by Age, Race and Sex 2009
|
|
All |
Male |
Female |
All Races |
White |
Black |
Other |
|
Average Benefit of
Retired Workers |
1,182 |
1,366 |
974 |
1,182 |
1,229 |
1,073 |
964 |
|
Average Benefit of
Disabled Workers |
1,120 |
1,255 |
963 |
1,120 |
1,180 |
1,014 |
963 |
|
Number of Retired
Workers |
2,739,966 |
1,452,329 |
1,287,637 |
2,739,966 |
2,147,458 |
246,045 |
346,463 |
|
Number of Disabled
Workers |
970,696 |
521,424 |
449,272 |
970,696 |
655,392 |
173,181 |
136,536 |
|
Actual Number of
Retired Workers |
37
million |
Actual Number of Disabled Workers |
10
million |
Actual Number of Survivors |
6
million |
FICA Taxpayers |
157
million |
Source: Annual Statistical
Supplement, 2010. February 2011 is a purely academic survey
of race, gender or average price, using a random sample that is clearly not
representative. Actual Statistics come from the 2011 Annual Report of the
Trustees
Because SSA actively conspires to deny naturalized U.S. citizens
their identification cards (Social Security Cards) it is necessary identify
this issue of identification theft left untreated by the Inspector General
although local SSA officials neither accept naturalization papers nor do they
conduct an investigation to procure proof of citizenship to issue social
security cards to known beneficiaries. Discrimination against
naturalization in the issuance of identification documents must be eliminated.
This is a new development by Obama's adversarial birther
movement employing countless lawyers in meaningless cruise ship like
immigration jobs. Naturalized U.S. Citizens have a right be issued
identification documents - social security cards, driver's license, state
identification, and passports - at no extra cost, and are due costs from the
U.S for delinquency incurred by this major fraud, in civil rights, more of a
conspiracy against rights than deprivation of rights under color of law. USCIS
conceals the validity of naturalization papers, with a disclaimer, while the Authentification Office in the State Department collects
bribes demanding the "original" naturalization paper they stole two
administrations ago. The bribery conviction in the statute seems to have been
concealed, before the passage of legislation, in violation of 18USC(27)§551.
The real long-term issue driving sado-masochists to
express themselves criminally is officers aiding importation of obscene or
treasonous book or article under 18USC(27)§552,
forcibly resisting changing the name of Title 22 Foreign Relations and
Intercourse (a-FRaI-d) to Foreign Relations (FR-ee), Court of International Trade of the United States
(COITUS) to Customs Court (CC) and Department of Homeland Security (DHS) to
U.S. Customs as directed by Customs House Act, St. Elizabeth (CHASTE).
Bibliography
Goss, Stephen C. The 2013 Annual Report of the Board of Trustees of the Federal
Old-Age Survivors Insurance and Federal Disability Insurance Trust Funds.
Chief Actuary, Social Security Administration. May 31, 2013
Sanders,
Tony J. Defense of Social Security Caucus. Hospitals & Asylums HA-1-7-11
--
Customs House Act St. Elizabeth
(CHASTE) HA-26-2-11/HA-5-9-11
--
Disability Insurance Replenishment Tax (DIRT). Hospitals & Asylums HA-16-6-12
-- Federal Budget Balanced to Prevent Debt from Exceeding 100% of GDP FY 2012.
Hospitals & Asylums HA-13-7-12
-- Health and Welfare.
Book 3. 8th Ed. Hospitals & Asylums HA-14-7-12
--
National Health Insurance: Compromise to Immediately Achieve Single Payer Universal
Coverage and Progressively Realize National Health Insurance that is Free for
All. Hospitals & Asylums HA-28-4-08
Spitalnic, Paul. 2013 Annual Report of the Board of Trustees of the Federal Hospital
Insurance and Supplemental Medical Insurance Trust Funds. Acting Chief Actuary. Centers for Medicare
& Medicaid Services. May 31, 2013