Helping Your Client Technically Qualify for SSDI and SSI

If you have a client with a disability or mental illness, he or she may want to apply for Social Security disability benefits. Before your client can be approved for disability benefits, the Social Security Administration (SSA) must verify your clients meets both the medical and technical eligibility requirements for disability benefits. Medical qualification is the same for both of the SSA’s disability programs, but technical eligibility rules differ.

Social Security Disability Insurance (SSDI)

SSDI is an “insurance” program that provides coverage for disabled workers. To qualify, your client must have:

  • paid into the Social Security system either through FICA or self-employment taxes
  • worked within the last 10 years
  • between 20 and 40 work credits available at the time of disability onset, although this will be even lower for younger applicants. The SSA does not expect a 21 year old to have worked as much as a 60 year-old applicant.

Work credits accumulate at a rate of about four per year for most workers. These credits build up as you pay employment taxes. Employment taxes may be either:

  • withheld automatically from a paycheck by an employer under the FICA tax code

OR

  • submitted to the IRS by self-employed persons as part of their self-employment taxes.

In either instance, employment taxes fund Social Security and Medicare. The taxes your client paid over your employment history make her a “covered person” under both of these insurance programs.

Supplemental Security Income (SSI)

SSI is a need-based program available to disabled persons of all ages and the elderly. There are no work credit requirements to qualify, but there are strict financial eligibility rules. To receive SSI, your client must meet the income and other financial resource limits.

When determining eligibility, the SSA specifically reviews your client’s:

  • earned and unearned income,
  • other benefits, like retirement or VA benefits,
  • money from other sources, like assistance from friends or family,
  • free food, housing, or other donated or gifted resources,

AND

  • any financial assets or other resources you have that could be converted to cash, like life insurance policies, savings bonds, and bank accounts, among others.

Although the SSA requires your client to disclose information about all of your finances, certain income sources and other financial resources are excluded from consideration. These include:

  • a percentage of earned income each month,
  • benefits you get through other need-based programs, like SNAP or TANF,

AND

  • one vehicle and your primary residence, if your clients owns his or her own house.

Financial resources from all countable sources cannot exceed the SSA’s established income and asset limit. This limit is reviewed and adjusted each year when cost-of-living increases go into effect. For 2016, the limit is $2,000 per month for an individual or $3,000 per month for a married couple in which both spouses receive SSI.

Applying for Benefits

If your client has worked enough to qualify for SSDI, or has income low enough for SSI, he or she can start the application process. Whether applying for SSDI, SSI, or both, your client can use the SSA’s online application portal, which allows applicants to fill out and submit all the required forms for an SSDI claim. The SSA can additionally use your client’s online application to start an SSI claim.

Some applicants choose instead to apply for SSDI at their local office. The SSA requires a personal interview to complete any SSI application, so your client may need to make a trip to the local office anyway.

When your client is applying for Social Security disability benefits, be sure to submit a letter outlining how your client’s illness keeps him or her from working. A social worker’s opinion and expertise can go a long way in helping your client win Social Security disability benefits.

The Need for Congress to Pass the ABLE Act

by Vilissa K. Thompson, LMSW

U.S. Capitol Building 1

The ABLE Act has the potential to improve the financial and employability statuses of people with disabilities in this country, if enacted.  The Achieve a Better Life Experience (ABLE) Act gained the attention of the disability community when it was first introduced into Congress on February 13, 2013.  The ABLE Act was not decided on last year due to the fact that the Congressional session ended before the bill could be considered; however, it has the support of over 400 co-sponsors in the House and Senate.  Having such a large amount of support gives many disability advocates, including yours truly, great hope that the Act will be considered and passed this year.

The purpose of the ABLE Act is to prevent disabled savers from losing their benefits by affording them the opportunity to open special tax advantaged saving accounts.  Under current policy, those who receive social security benefits such as Supplemental Security Income (SSI) and Medicaid cannot have saving assets of more than $2,000 in an account, and cannot earn income over $700 a month.  Those two financial restrictions unfairly places beneficiaries in the proverbial “a rock and a hard place.”  If beneficiaries have assets or income that exceed these financial thresholds, their benefits will be cut off.  If they decide not exceed these financial thresholds, then their employment and independence opportunities will be severely reduced.

I will give you a fictional example of the “rock and a hard place” choices people with disabilities like myself endure when it comes to wanting to be independent, but fear losing one’s benefits:

“Anita” was offered a part-time telecommuting position that would pay her the current minimum wage rate of $7.25 an hour.  Anita currently receives SSI and Medicaid benefits because she has a physical disability.  In order to keep her benefits, Anita could only work 24 hours a week, which would total $174 a week of earned income for her.  With this weekly schedule, Anita would earn $696 a month before taxes, which would put her under the $700 monthly financial threshold amount by $4.  

Anita would have to report her new income source to the Social Security Administration (SSA), which would take into consideration her total earnings, and not the amount Anita actually brings home after taxes.  The SSA has a special mathematical formula it utilizes to figure how much of Anita’s earned income should be counted against her benefits.  Anita’s monthly wage before taxes was $696; SSA would subtract 85 from this amount, and then divide that amount by 2 to figure how much her SSI benefits for that month should be reduced.  So, $696 – 85 would equal $611.  $611 divided by 2 would be $305.50.  Social Security would count $305.50 against Anita benefits, which would reduce her SSI benefits amount from $721 a month to $415.50 a month.  (The 2014 cost of living adjustment (COLA) for SSI beneficiaries is $721.)

This gross reduction of SSI does nothing to elevate Anita out of poverty.  Anita would have only $1,111.50 ($415.50 in reduced SSI, and the $696 (before taxes) she earned from working) to live off each month, which is not enough to cover the basic human needs of food, housing, and clothing.  This example is not hypothetical; it is fact.  This is the dreadful choice people with disabilities have to make:  do I work and put my benefits in jeopardy, or do I live off $721 a month that will keep me deep in poverty, and not allow me to be able to afford housing, transportation, entertainment, have an emergency fund, “nest egg” savings, and other “luxuries” that most take for granted?

This is why the passage of the ABLE Act is imperative – it would extinguish the current barrier of working and saving by ensuring that money saved through ABLE accounts would not be counted against the federal benefits an individual receives.  The ABLE Act would ease financial strains by allowing the tax-free saving accounts to cover qualified, essential expenses such as medical and dental care, community based supports, employment training, assistive technology, housing, education, and transportation.

The bill would assist in supplementing the benefits they already receive from private insurances, Medicaid, SSI, their employment, and other sources.  An ABLE account would provide people with disabilities the same types of flexible saving tools that other Americans have through college savings accounts, health savings accounts, and individual retirement accounts (IRAs).  Returning to our example, if the ABLE Act passed, Anita would be able to open an ABLE account where she could deposit her earned income and keep her SSI and Medicaid benefits intact.  This newfound freedom would allow people with disabilities to work without the fear of being penalized.

Like millions of Americans with disabilities, I am anxiously waiting for the passage of the ABLE Act.  From a personal standpoint, the ABLE Act would open a plethora of doors for me as an entrepreneur and a freelance writer.  Not having to worry about how much I earn or how much I have saved would be a joyous moment.  People with disabilities want the same things as everyone else – to work, have healthcare coverage, and be able to living independently and support themselves and those they love.  The ABLE Act would turn those hopes into reality.  Please urge your federal representatives to support and pass the ABLE Act this year because it is long overdue.

(Featured headlining image:  Courtesy of The Denver Channel.)

Long Term Disability: Understanding the Process

Seal of the United States Social Security Administration. It appears on Social Security cards. (Photo credit: Wikipedia)

Disability rulings are commonly issued by the Social Security Administration, although reaching a decision on what qualifies a person as disabled can be a long and frustrating experience.

According to socialsecurity.gov, “Disability is a subject you may…not think of as something that might actually happen to you. But your chances of becoming disabled are probably greater than you realize. Studies show that just over 1 in 4 of today’s youth will become disabled before reaching age 67.

What many applicants do not understand is that receipt of monthly disability payments is the second part of the application process. The first step in a Social Security case settlement is declaring the recipient legally disabled.

A disability ruling can do several things. As an example, it can render a disabled individual unemployable if the state only has one workers compensation insurance company, and the company refuses to qualify the claimant for workers comp coverage. It is a legal ruling in every sense of the term, which, if you are a New York resident, can be better understood via the services of an attorneys office such as the  The Perecman Firm which was voted as a “best lawyer” by U.S. News.

Supplemental Security Income

Some individuals are only eligible for Supplemental Security Income (SSI), which is awarded yearly based on personal financial assets and disability level. These recipients are usually not of age for standard Social Security Disability Insurance (SSDI). SSDI payments are based on the tax receipts from the claimant during their working career. SSI is awarded for serious medical conditions that will last for at least one year in which the recipient is receiving ongoing medical treatment. With “serious” being the operative word, SSI is often temporary, based on medical improvement. Older recipients are rarely re-evaluated, so this can amount to a permanent disability ruling for these individuals. Younger SSI recipients are encouraged to return to work through the Ticket to Work Program.

Social Security Disability Insurance

Social Security Disability Insurance differs greatly from Supplemental Security Income. SSDI claim approvals are permanent and total in nature, although disabled recipients can earn a nominal amount of money through part-time employment. Benefit amounts are determined by the tax receipts over the immediate previous ten-year employment span, with the applicant needing at least five complete years worked. This amounts to 20 credits of three-month employment deduction periods to qualify. Once the disability ruling is issued, the claimant will receive federal disability benefits for the remainder of their life.

Supplemental Security Income Funding

Supplemental Security Income is funded by Congress in the national operational budget that is normally issued every two years. The cost of the program has been the subject of much ridicule, but the program provides crucial medical benefits for disabled individuals who are in seriously declining health, many of which are in professional medical care facilities and hospitals. Both the monthly income benefit program and the medical funding for the program are included in the same action of funding.

Social Security Disability Funding

The Social Security Administration system was established with a trust fund that was used to pay recipients who have earned the benefit through tax deductions for program eligibility. However, individuals who become disabled before age 67 can petition the Social Security Administration for the disability ruling, which in turn makes the claimant eligible for monthly payments until death. In addition, disabled recipients dram an extra benefit allowance, so the disability ruling is worth more money.

Most beneficiaries attempt to win a disability ruling instead of waiting for standard Social Security retirement benefits. This situation clearly puts stress on the funding mechanism, which is determined by estimating the percentage of total tax receipts which are Social Security tax deductions and listed as an asset on the balance sheet. However, they are still a liability because the Social Security Trust Fund established in the 1940s was drained by Congress in 1987 and applied to the general fund.

This makes the Social Security program the largest reported expenditure of the government with no repayment of the transferred loans from the now-vacant trust fund, which is the primary reason Congress is highly concerned about the future viability of the program. This is also part and parcel to the absolute need for a Social Security Disability attorney like those at The Perecman Firm to represent these cases which often take years to settle because of funding problems.  When looking for an attorney in your area, us an accredited sites such as the U.S. News – Best Lawyers where “Best Law Firms” rankings are based on a rigorous evaluation process to find representation may be a wise choice.

Disability Claim Approved! Winning the Appeals Process for SSI

Social Security Administration
Social Security Administration

Most anyone who has gone through the Social Security or SSI disability system finds out how challenging it is, since most claims are denied the first time out. The chances of approval do go up substantially for those who appeal and have a disability lawyer to guide them through the process. Below is some information about the appeals and hearing process for disability claims.

Appeals Process

The appeals process for Social Security disability and SSI includes several levels. After the first round when the claim is denied, most states offer a chance at what is termed reconsideration. This must be requested formally within sixty days of the denial date. Because the process is complex, it is highly advisable to enlist the services of an experienced disability denial lawyer. Found online at www.disabilitydenials.com, a person can read more about what is needed for an experienced legal professional to help claimants prepare for and manage the appeals process.

Appeals Preparation

The most important thing to recognize with disability claims is that the decisions will be made based upon the information that has been provided. Therefore, claimants need to know what is in the file and have their own copies available. This is where having a lawyer on the case is very beneficial, since they know how the law works and what is necessary to establish and win the claim.

In order to respond to requests, claimants must understand their medical condition, what it entails and what doctors have reported. There is also a detailed work history and other data that Social Security and any disability claim will require. For instance, claimants must have this information at hand so that when it is requested it can be provided correctly. Otherwise, claims could drag out much longer than they need to or even continue to be denied.

Winning Disability Awards

1. Medical Records – One of the more important types of information that needs to be available are updated medical records. Hearings may take place a year or more after an initial claim is made and SSA may cease to gather medical evidence. Therefore, the file may not include the latest medical information. A disability lawyer representing the claim would be handling these tasks, which is another reason to enlist their services. In any case, claimants must gather all their medical updates and keep them handy to respond to SSA requests and be prepared for hearings.

2. Personal Records – The SSA will continue to request information about the disabling condition both in writing and at hearings. Therefore, claimants must keep good notes about how they feel and what they are able to do and not do. For instance, any activities that could be done prior and cannot since the condition should be noted. The precise reasons that a claimant is unable to perform their customary work-related responsibilities needs to be detailed so that when asked, the information is conveyed correctly to the administrative law judge (ALJ). Otherwise, decisions rendered without all of the pertinent information usually result in further claim denials.

Hearings

After the first appeal is denied, claimants may request a hearing before an ALJ. The best way to win any appeal is to understand the process so that it may be navigated more efficiently. The average time that Social Security Disability Insurance (SSDI) claimants wait for a hearing is around 400 days and as long as a year or more.

Statistically, the chances of winning any disability case are much higher when the claimant has engaged an attorney experienced in disability law. In these cases, attorneys usually do not charge fees until the claim is won, in accordance with the law. In fact, without an experienced disability lawyer, there is a very strong chance that the case will be denied repeatedly. As suggested online at www.disabilitydenials.com, anyone filing for Social Security Disability should seek counsel as soon as possible to greatly increase their chances of winning disability claims.

Global Analysis of Health and Social Determinants with Dr. Dennis Raphael

poor-family

If providing health care and a social safety net for citizens were an Olympic event, the United States would be in a dead heat for last among developed nations. Recently, I had the opportunity to interview Dr. Dennis Raphael a professor at York University in Toronto Canada. Dr. Raphael has done extensive study and research on social systems and health disparities on a global scale. I reached out to Dr. Raphael specifically for his international perspective and global research analysis because I was interested to see how the United States compared to other developed nations. It appears that my suspicions are worst than I had imagined.

Dr. Raphael goes in great detail and provides a host of resources for anyone who may be researching poverty and health care disparities. We have all heard the Liberal and Conservative view points for or against Obamacare, but what does the rest of the world see when viewing the normal course of business and politics in America?

As Americans, we are always ranking things in order to assign value, worth, and level of importance. One of the biggest revelations for me from this interview was seeing how the United States poverty rates compared to other countries. It’s astonishing! Here is what Dr. Raphael had to say:

SWH: Could you tell SWH readers about your background and your work on poverty and health care inequalities?

DennisRaphaelHead2DR: I am a professor of health policy and management at York University in Toronto Canada. I was originally trained in child development and educational psychology and have come to have an interest in health policy as it became apparent that the health and well-being of children and families was tightly related to the public policies that are implemented within a society. These public policies affect the health of citizens through what have come to be known as the social determinants of health. These public policies shape social determinants of health such as income and income distribution, employment and working conditions, food security, housing, and the availability of health and social services.

My work and those of others have also demonstrated that these social determinants of health have a much stronger impact on health than does the usual villains of physical inactivity, excess weight, excessive alcohol use, and even tobacco use. These effects are especially great for those living in poverty.

It is very convenient for governments and governmental authorities to blame individuals for their own health shortcomings by pointing to these so-called lifestyle factors rather than the public policies that have much importance in shaping health. My recent work has focused on differences among nations in these public policies and the social determinants of health such as the USA, Canada, and other wealthy developed countries that are members of the Organization for Economic Cooperation and Development.

SWH: How does the United States Model for Health Care and its social safety net compare to Canada and other developed nations?

DR: What has become apparent and is now well accepted in the literature is that the quality and distribution of the social determinants of health in nations such as United States and Canada lag well behind those seen in other wealthy developed countries. The United States is an especially great outlier as it is the only developed nation that does not provide citizens with healthcare as a matter of right. It also has the most unequal distribution of the social determinants of health and, not surprisingly, has the worst population health profile among all wealthy developed nations with the exception of Turkey and Mexico. US poverty rates are the highest outside of Mexico and Turkey.

I’ve also come to the conclusion that the reason for this has much to do with the dominant political ideologies of those who govern these nations. As unbelievable as it may seem for those of us who live in the United States and Canada, most developed nations are led by leaders who take an active interest in developing public policy that promotes the health and well-being of citizens. Most wealthy developed nations provide universal affordable childcare to all members of society, provide workers with legislative guarantees that provide some semblance of job security but also the availability of job training and if unemployment occurs, payments that allow them to live a life with dignity. For the last 20 years, the United States has been an exceptional outlier in providing people with virtually none of these social determinants of health, and the United States is the only nation that does not provide people with guaranteed vacation time, guaranteed supported maternity leave, and of course health care.

Unfortunately for us living in Canada, Canadian leaders have chosen to emulate the American model of public policy over the last two decades rather than the more sophisticated and helpful approaches adopted among European nations. The result is that Canada’s population health profile and the quality and distribution of the social determinants of health is increasingly beginning to look like that of the United States, with the accompanying expected declines in quality of life and overall health of the population. The primary factor that has become apparent is the nations that take seriously the provision of quality social determinants of health to its population are governed by political parties that are identified in the literature as being either Social Democratic or Conservative.

Despite what many people think, the so-called conservative parties of North America are not really conservative as much as “liberal”. This applies to both the Democratic and Republican parties in the USA. Despite the meaning of the word “liberal” in North America which many people think as meaning progressive, the term liberal in political science and political economy actually refers to a form of governance where governments take little if any interest in providing the population with the means of maintaining and promoting health. I’ve written extensively about the distinction between Social Democratic, Conservative, and Liberal welfare states, and I urge readers to take a look at some of these works. In essence, the approach governments have taken in the United States and Canada towards providing the means of their population to maintain health are incredibly undeveloped as compared to the nations of Europe.

SWH: Can you provide a snapshot of major social safety net programs put in place by the Canadian government to address income disparities and to assist vulnerable populations within your country?

DR: The most apparent difference between Canada and the United States in terms of social safety net programs is that in Canada every Canadian is entitled to the provision of healthcare as a matter of right. While this may seem exceptional to Americans, this is also the practice in every other wealthy developed nation that belongs to the Organization for Economic Cooperation and Development. For people like me and others who work in health, it is almost unbelievable that the United States does not provide health care to citizens as a matter of human rights. It should not be surprising that this lack of any kind of coordinated system in the United States leads to the United States having the most expensive and apparently least effective health care system among nations in the developed world. The US also has exceptionally high poverty rates which are particularly ironic considering its overall wealth.

Canada provides other aspects of the social safety net that are not available to Americans. In Canada the so-called RAND formula stipulates that once a union is certified in the workplace, all employees must belong to that union. In the United States the so-called “right to work laws” actually weaken unions and the economic and social security Americans obtain and as a result, Americans have some of the lowest wages among the Organization for Economic Cooperation and Development and the highest poverty rates among virtually all wealthy developed nations. Only 7% of Americans belong to unions and as a result their job security and working conditions, as well as their wages, are among the lowest of those working in wealthy developed nations.

In contrast, in the Scandinavian nations over 80% of people belong to unions and an even greater proportion of them work under collective agreements. Even in the conservative nations of Continental Europe, when unions themselves have lower membership than in Scandinavia, virtually all workers are covered by collective agreements. As a result, they experience greater job security, more employment and training opportunities, and generally greater security which translates into better health, and their poverty rates are the lowest among wealthy developed nations.

 In Canada, 31% of workers belong to a union and while this figure is low in comparison to other nations, it is of course rather high as compared the United States.

Other social safety net programs that Canadians have access to are guaranteed maternity leave that is supported through the employment insurance system. Women who have been employed are entitled to close to 60% of their average salary during the 12 months that constitutes maternity leave in Canada. In the United States there are no such provisions. Even then, provisions are stronger in many European countries where women are entitled to close to 100% of their average salary during their maternity leave. And even then there are nations in Europe when men are entitled to paid maternity leave.

SWH: Over the course of your work, have you done any comparisons of the Canadian and USA  social security systems to those of other industrialized nations, and what were your findings?

DR: I have written numerous articles that have compared the differing situations between the United States, Canada and other members of the Organization for Economic Cooperation and Development. Two of these articles recently appeared in the journal Health Promotion International and these titles are appended at the end of this interview. In addition, I recently published a book entitled Tackling Health Inequalities: Lessons from International Experiences. This book consists of a number of case studies of differing wealthy developed nations and includes a chapter on the United States in addition to ones on the United Kingdom, Canada, Australia, Finland, Norway, and Sweden. I urge readers to take a look at these documents and to consider the United States situation in relation to that seen in other wealthy developed nations.

To summarize the findings succinctly, United States is an incredible outlier in its approach to providing citizens with the conditions necessary for health. Canada does somewhat better and for many Canadians the comparison to United States gives cause for much satisfaction. However, when the Canadian situation is compared to the situation in other wealthy developed nations Canadians have much less to be happy about and there are many individuals, groups, and professional associations that are trying to move the public policy picture in Canada to that of these other wealthy developed nations and away from the United States model.

SWH: In your opinion, how has austerity measures implemented by various governments in developed nations contributed to or helped alleviate health inequalities of its citizens?

DR: In a nutshell, the austerity measures implemented by developed nations have served to contribute to the health inequalities that are apparent among the citizens. I direct your readers’ attention to three books in particular: To Live and Die in America, Class, Power, Health and Health Care by Robert Chernomas and Ian Hudson (2013), Social Murder and Other Shortcomings of Conservative Economics by Robert Chernomas and Ian Hudson (2007), and The Body Economic: Why Austerity Kills: Recessions, Budget Battles, and the Politics of Life and Death by David Stuckler and Sanjay Basu (2013).

SWH: Do you have any current projects and/or publications that you are working on or recently released, and how does someone find more of your research?

DR: In addition to my recent book Tackling Health Inequalities: Lessons from International Experiences that was published in 2012, I have written numerous articles that document how public policy is related to the health and quality of life of citizens in wealthy developed nations such as United States and Canada. More recently I’ve been examining how differing ways of thinking about health among public health departments lead to different directions in approaching their mandate. I’ve also written extensively about the mainstream media and how these media think about health and means of promoting public education that can lead citizens to think differently about health and become more involved in the public policy process in order to create the conditions necessary for health. People can see some of these recent articles by going to this link, and  I’ve also produced a primer that should be of interest to all readers entitled Social Determinants of Health: The Canadian Facts. This can be obtained online at http://thecanadianfacts.org.

Thank you for the opportunity to contribute to this ongoing discussion that is of such importance for those of us living in North America.

Relevant Readings:

Raphael, D. (2012). Tackling Health inequalities: Lessons from International Experiences. Toronto: Canadian Scholars’ Press.

Bryant. T., Raphael, D., and Rioux, M. (2010). Staying Alive: Critical Perspectives on Health, Illness and Health care, 2nd edition. Toronto: Canadian Scholars’ Press.

Raphael, D. (2013). The political economy of health promotion: Part 1, national commitments to provision of the prerequisites of health. Health Promotion International, 28, 95-111.

Raphael, D. (2013). The political economy of health promotion: Part 2, national provision of the prerequisites of health. Health Promotion International, 28, 112-132.

Raphael, D. (2011). Mainstream media and the social determinants of health in Canada: Is it time to call it a day? Health Promotion International, 26, (2), 220-229.

Photo Credit: Picture of Family Courtesy of  www.mlive.com

E-Verify: Could It Be Used to Track All Citizens

In the recently drafted immigration reform bill, it is 800 pages in length which incorporates several amendments, and it’s still in the early stages of debate and drafting. However, one of the most interesting components of this bill is the proposal of a “photo tool” to assist with e-verify. It may sound reasonable on the surface, but shouldn’t we also be looking past the immediate reason for the photo tool in the e-verify program in order to consider long-term implications and threats to our freedom?

The gang of eight, the immigration reform coalition, has added a plan that will create a national photo database, what is this and how does this play into the language of discrimination? Well, think of e-verify, but this could prove to be more intrusive. E-Verify of course is the system in which social security numbers are verified to determine citizenship status, and the new system of this “photo tool” will use individual photo identification to determine residency status for work purposes.

Rand Paul was quoted by Global Dispatch,

“Error rates reported by government and private audits of E-Verify are extraordinarily high. E-Verify mistakenly approves a majority of unlawful immigrant job applicants and, worse, misidentifies about one percent of American applicants as unlawful. That opens up another legal odyssey for many Americans who should not have to ask permission from the federal government to work.”

Being that e-verify is an electronic program that is a partnership between the Social Security Administration and the Department of Homeland Security, the original program was created to verify legal status. However, there is a growing fear that the amount of information collected in this database will be used for other purposes.

photo credit: SalFalko via photopin cc
photo credit: SalFalko via photopin cc

When social security numbers were created and passed as legislation, they were not used to verify “legal” status. Social security numbers were set up to track earnings and were later used as an identification number as it is unique to each person. The use of a Social Security number as an identification tool has been problematic as it only assigns a number to the person, or so it was thought. Since the adoption of the social security number, large government systems have tied the number to our taxes, loans, federal benefits programs, human service assistance programs, driver’s licenses, military and veteran services among others. In the age we live in, technology advances has made the unique identification number even more easily tracked using electronic measures. Living in this technologically rich world, adding a photo to the e-verify program would allow the government an unparalleled opportunity to track, or have a history of every American. Social security numbers hold the history of employment, educational systems, drivers licensing, IRS claims/ Taxes, and other social service involvement. Other concerns with this bill have been regarding the cost of the E-Verify program, The Society for Human Resource Management writes:

“The Congressional Budget Office estimated that a national E-Verify mandate would cost, on average, $1.2 billion annually, not including DHS personnel costs (the hiring of thousands of new enforcement agents would bump the price tag higher). A national E-Verify system would be costly for employers, too. Based on the estimates in the DHS’ Regulatory Impact Analysis for its 2008 E-Verify mandate for federal contractors, employers nationwide would spend”

In adding a photo to make sure “Carl” is not really “Carlos” is this now unconstitutional? Adding this photo and creating an expensive database full of information regarding every American citizen is concerning. In short, the argument remains, are we a nation “securing our borders” or are we putting the average citizen at risk of exploitation due to internet hacking and/or misuse of information?

Is Disability the New Welfare

by Vilissa K. Thompson, LMSW

It seems as if disability benefits has become a fiery political topic for many countries.  Across the pond in the United Kingdom, there has been an emotionally-charged debate and outrage about possible changes to the appeals process for disability benefits claimants.  Under the new appeals policy, those who object to the decision made about their sickness and disability benefits will be denied the opportunity to appeal until the governing body, the Department for Work and Pension (DWP), has reconsidered their case.

The main issue with the DWP overseeing the appeals process is that there is not a definite timeline of when DWP will review these cases; this leaves those who depend on their sickness and disability benefits to be at the mercy of the entity and be unable to sustain the quality of life those benefits allows them to have.  Until their case is reviewed and overturned by the DWP, those individuals will not have any income to rely on; most of the people receiving sickness and disability benefits are incapable of working and/or are severely disabled.

This new policy will affect those who have failed the Work Capability Assessment (WCA) since October.  The WCA has met its own level of controversy; opponents of the test remarks that the assessment does not adequately put into perspective the capacities of individuals who are not quite well enough to work, due to their health issues or disabilities.  Those who fail the assessment and are consequently denied Employment and Support Allowance (ESA) (which is the sickness benefits) will be automatically placed on the Job Seeker’s Allowance (JSA).  The Job Seekers’ Allowance program will require these persons to seek employment opportunities.  The potential for lack of consideration for such circumstances have many opponents of the changes, those who rely on these benefits and health care and legal allies, greatly disturbed.

Proponents of the changes believe that such actions will not negatively affect those who are currently enrolled in the benefits program, or those who are denied.  Those within the DWP stated that individuals who are placed on JSA will be assisted by employees within the work centers to find employment opportunities that are appropriate for their level of functioning and abilities.  Skeptics of this idea are concerned about the work center employees’ capabilities of accurately assessing the individuals’ abilities to work and pair them with appropriate employment agencies.

Reviewing the news about the proposed changes to disability benefits in the United Kingdom caused me to think about how such changes would be received here in  the United States.  The process of becoming a Supplemental Security Income (SSI) or Supplemental Security Disability Insurance (SSDI) beneficiary is an rigorous, time-consuming, and stressful process within itself; what would happen if we made similar changes to the appeals process  in this country?  Would all “heck break loose” by unintentionally disadvantaging persons who truly need the assistance of these benefits, or would we be able to finally pinpoint and remove those who are thought to be abusing the system  and wasting the taxpayers’ dollars?

The average U.S. citizen is bombarded with numerous legal firm commercials and advertisements competing to represent denied disability benefits claimants so that they will have the rights they are “entitled” to.  We also cannot forget about the whole debate surrounding “entitlement” programs themselves:  Are these programs truly serving the targeted populations that are considered to be in need of the resources and funding?  Are people taking advantage of the system, which is already deemed to be extremely broken?  Will the expanding number of beneficiaries placed on the entitlement rolls continue to add to the mounting national debt?  Will there be any money left for my generation, the Millennials and those who have yet to enter middle school, to seek assistance if we become disabled or have a child with special needs?  These questions, along with countless others, have caused the nation to ponder the existence of disability benefits and if they are truly beneficial at all.

Since its creation in 1935, the number of Americans on Social Security has increased exponentially.  In 1940, the number of Americans receiving Social Security benefits was 222, 488, less than 1% of the U.S. population.  That number seems quite small in comparison to today’s figure; a record-breaking 56 million Americans received Social Security benefits in 2011, which accounts for 18% of the total U.S. population.

With the number of beneficiaries continuously increasing, especially with Baby Boomers “aging into” the system, the Social Security Administration (SSA) had stated that they would not have enough money to pay out monthly benefits by 2036.  There have been steps enacted to keep the program alive.  Two well-known (and controversial) actions taken were the automatic Cost-Of-Living Adjustment (COLA) not being increased in 2010 and 2011, and requesting that Social Security beneficiaries sign up for direct deposit in order to receive their benefits electronically, which would save the U.S. Treasury $130 million each year.

These actions may address some of the issues involving the financial realities surrounding Social Security benefits, but these actions do not touch on questions pertaining to the “need” for such programs.  There is a strong belief that there is a great number of individuals intentionally taking advantage of the system; “bleeding the system dry” to be exact, as voiced by those with more conservative viewpoints who regard these programs as being fruitless and a waste of taxpayers’ money.  Those who are under this impression suggest that the main way to “extinguish” this “criminal, abusive” act is by doing a major overhaul on the system; privatizing Medicare and reducing the number of funds given to these programs.

Opponents of such drastic actions voice that there is a better way to address the shortfalls of the current system without disadvantaging those whose livelihood rely heavily on the existence of these programs.  These persons, those who are moderates, liberals, and those who utilize the programs, believe that changes are necessary to make the programs more effective, but cutting key programmatic facets and funding to disability benefits is not the “quick fix” answer.  Neither group, opponents or supporters, have come to a bipartisan agreement on what exactly should be done to save the programs and eradicate the problems that are detrimental to the programs’ longevity in our society.

It seems that everyone, on both sides of the pond, believe that they have the “magic” answer when it comes to sustaining the programs, and ameliorating or eliminating the issues within the disability benefits debate.  There is just one teeny problem – who is taking the time to ask those who receive these benefits what they think about the issue?  Is anyone inquiring about the issue those who receive disability benefits encounter, from applying for benefits to following the eligibility requirements to remain a beneficiary?  Who is truly listening to the voices of the American people?

Though there are programs in place (e.g., PASS) to help beneficiaries who are capable of working to become self-sufficient, is anyone researching the success rate of these particular programs?  By “success,” I am interested in knowing how many people actually remain off these programs for good?  How many of them had to reapply?

The proverbial “benefits moochers” seem to pervade the minds of those who believe that most of the people on these benefits are “unworthy,” feel “entitled,” or “undeserving” to be disability benefits recipients.  Do we know the exact figure of individuals found to have abused the system versus those who indeed meet the qualifications to become beneficiaries?

Also, is the average American aware of how much monies are given, on average, to benefits recipients?  From the way our politicians discuss these programs, you would be under the impression that beneficiaries are “living high off the hog” (as an old Southern saying goes) while receiving these benefits.  If more people were aware of the real dollar amounts distributed, would this change their minds about how much assistance are given?  Would people demand that more, or less, funding be issued?

These are just a few questions that run through my mind as a self-advocate for person with disabilities, and as someone who has had personal experience with these programs.

Tell me, do you believe that a major overhaul is needed for disability benefits to be more fiscally and resourcefully effective?  If an overhaul occurs, what are the potential positive and negative ramifications of such actions undertaken?  Who will come out as “winners?”  “Losers?”  

Finding the Consumer in the Midst of Medicare

The consumer is often caught in the middle when it comes to a provider presenting a reasonably priced product while striving to stay out of the red.  The American government is no different when it comes to Medicare and its beneficiaries.  The Medicare program provided assistance to over 49,000,000 people in 2012,1 and this number is expected to continue to increase as Baby Boomers become eligible for the federal program.  Our government is currently struggling with how to assess this growing demand with limited financial resources.  In all the budget and deficit debates, it can be easy to forget the most important part of the equation which is the medicare beneficiaries.

Medicare recipients currently pay different premiums for each of the four parts of Medicare.  Most individuals do not pay a monthly premium for Medicare Part A if they or their spouse have paid into the Medicare system via payroll taxes.  Individuals that do not meet this criteria can purchase Part A for $441 per month.

Many people pay the standard premium of $104.90 per month for Part B, but some individual’s will have to pay more if their income from the previous two years is above $85,000.2  Premiums for Parts C and D differ depending on the individual plan that a consumer decides to purchase.  The four parts are designed to offer beneficiaries the most comprehensive insurance program that they can afford.

What if you can’t afford Medicare premiums and deductibles?  Federal assistance, in the form of Medicaid, is available for low-income individuals.  Medicare also has an Extra Help program available to assist with prescription drugs.  Some states also help their Medicare beneficiaries by means of two state programs:  the Medicare Savings Programs pays Part A and Part B deductibles while the State Pharmacy Assistance Program provides financial assistance for prescription drugs.3

Both federal and state governments have options available for Medicare beneficiaries who are limited by their financial resources.  However, the state programs are not offered in every state and some lower-income seniors may still find themselves receiving few health care options while individuals with more money have the ability to pick and choose an insurance plan that best fits their medical needs.  The federal plan that was originally created to help all seniors and other eligible citizens does not help all recipients equally.

Regardless of any underlying inequalities, Medicare is still a more affordable and efficient health insurance provider than many private companies.  In fact, Medicare is viewed quite favorably among the general public.  While more than half of Americans agree that the federal deficit should be corrected with a combination of increased taxes and decreased spending, 58% oppose any spending cuts to Medicare or Social Security.  Three quarters said the deficit could be cut without any major reductions to Medicare.4

The overall general approval of this welfare policy ensures, to a certain degree, that the program will continue to assist the elderly and the disabled in the struggle to have affordable health care.  General opinion also encourages politicians and policy makers to take a more unique approach when considering how to make the program easier on the government’s wallet without directly cutting funds.

Many different ideas are being tossed around in Congress when it comes to making Medicare more affordable.  Some propose adjusting the age requirement from 65 to 67.  Others argue that Medicare should be a means-tested program with higher income individuals testing out.  Some also argue that spending cuts can be removed from the equation all together if the issue of Medicare fraud is thoroughly corrected.  Consumers should expect to hear more about major changes to the Medicare program within the next few months but should not expect to see a decrease in their premiums or deductibles.

Medicare is a complex federal program and this complexity sheds some light onto how challenging it can be for consumers to afford health care in America.  This leads to an interesting debate on how to more effectively serve American citizens.  Should the focus be on reducing Medicare costs or on reducing the cost of health care as a whole?

There is a growing opinion that health care is an overall wasteful, inefficient, and poor quality institution that is in need of reform.  Such a reform could have huge implications for eligible Medicare beneficiaries and other Americans.  Unfortunately, it is much easier for politicians and Congress to discuss how to change Medicare rather than how to improve the entire American health care system.  In the meantime, consumers continue to get caught in the crossfire between the debate over Medicare coverage and Medicare cost.

Photo Credit: Medicare Prospective Payment System

1The Henry J. Kaiser Family Foundation. (2013). Total number of Medicare beneficiaries, 2012. Retrieved from

2Social Security Administration. Social Security Administration, (2012). Medicare premiums: rules for higher-income beneficiaries (SSA Publication No.05-10536). Retrieved from Social Security Administration website:

3Medicare Resource Center. (n.d.). Frequently-asked medicare questions. Retrieved from

4Wessel, D. (2013, January 24). Whose budget fix is more popular?. The Wall Street Journal. Retrieved from

The Evolution and Implementation of Medicare

Since Medicare was created over 45 years ago, it has continuously evolved to meet the changing needs of society.  This has resulted in a system that strives to be more efficient, but in the process has become somewhat complicated if you are unfamiliar with the program.  The program is currently funded by a portion of payroll taxes, monthly premium deductions from Social Security checks, and Congress.  It is divided into four parts:

MedicarePart A: Hospital insurance – helps pay for inpatient care in a hospital or skilled nursing facility, some home health care and hospice care.

Part BMedical insurance – helps pay for doctors’ services and many other medical services and supplies that are not covered by hospital insurance

Part CMedicare Advantage – people with Parts A and B can choose to join a Medicare Advantage plan as offered by private companies and approved by Medicare.  You may have to pay a monthly premium for Medicare Advantage because of the extra benefits it offers.

Part DPrescription drug coverage – helps pay for medications doctors prescribe for treatment.1

The Medicare system that is in place today is not the same as it was in 1965.  As additional needs and concerns have become evident, the government has modified the social welfare policy to better fit the needs of the targeted population.  Originally, the program was only created to serve adults 65 and older with health insurance.  In 1972, the policy was expanded to include individuals younger than 65 with long-term disabilities and end-stage renal disease.

Medicare Part C was not implemented until 1997 under the Balanced Budget Act (BBA) and Part D was not legalized until 2003 under The Medicare Prescription Drug, Improvement, and Modernization Act.2  The program also originally paid for the entire costs of services as determined by the individual physician.  As Medicare costs began to grow, Congress decided to change the reimbursement system to provide fixed-rate paybacks for services.

Another prominent way in which Medicare has changed throughout the years is in regards to its cost to the consumer.  Medicare Part A and B have seen changes in the deductibles and premiums that individuals are responsible for paying.   Since Medicare’s creation, the deductible for Part A has increased from $40/year to $1,184/year in 2013.  The premium for Part B has increased from $3/month to $104.90/month for individuals with a yearly income of less than $85,000 in 2011.3 The rise in Medicare costs sheds some insight into how Medicare has had to evolve as medical costs increase and as the need for health insurance among the elderly and the disabled has increased.

As Medicare has changed over time, one thing remains constant. The program was established to help all eligible beneficiaries as a universal welfare policy.  An eligible individual can receive benefits regardless of which state they live in because Medicare is a federally operated program and the states are not involved in the program’s administration.4  However, there are some differences in how states approach Medigap services. Medigap, also known as Medicare supplemental insurance, refers to various private supplemental health insurance plans that are designed to assist Medicare beneficiaries with health care costs that are not covered by Medicare.

Insurance companies can only sell you standardized Medigap policies as they are regulated by federal and state laws.  In all but three states – Massachusetts, Minnesota, and Wisconsin – there are 10 standardized Medicare Supplement plans.  The three states that offer slightly different coverage had their own standardized Medigap plans prior to the enactment of the federal standardized regulations.5  For the most part, however, these three states offer Medigap plans that are very similar to those offered by other states.

Other social welfare policies, such as Medicaid, can differ dramatically from state to state because the federal government gives the states the freedom to distribute the money as they see fit.  As a federally operated program, Medicare exists to serve beneficiaries universally.  While the program has been expanded to cover more individuals, it has consistently covered individuals equally across state lines.

1US Social Security Administration. (2013, January 25).Medicare benefits. Retrieved from

2The Henry J. Kaiser Family Foundation. (2010). Medicare: a timeline of key developments. Retrieved from

3Centers for Medicare and Medicaid Services. Centers for Medicare and Medicaid Services, (2012). 2013 Medicare costs (Product No. 11579). Retrieved from Centers for Medicare and Medicaid Services website:

4Health Assistance Partnership. (2012). Overview of the medicare program. Retrieved from

5Rapaport, C. Congressional Research Service, (2012).Medigap: a primer (Report No. R42745). Retrieved from Congressional Research Service website:

Medicare: How It All Got Started

Medicare is a federally regulated social welfare policy that is funded from income taxes, monthly premiums deducted from Social Security, and Congress.  This policy specifically targets all individuals 65 and older, as well as persons with disabilities or permanent kidney failure.  It is estimated that there were roughly 50 million Medicare beneficiaries in the United States between 2010 and 2011, approximately 16% of the total US population.  Of those 50 million, 83% were eligible for Medicare because they were 65 or older.1   In fact, aging adults and their access to health care were the original motives behind creating Medicare.

francisperkinsConcerns for the aging and their health started to become a national and political concern during the Great Depression of the 1930s.  During this time, elderly adults and their families were presented with an interesting dilemma.  Historically, children were responsible for the care of their aging parents.  Given the financial despair of this time period, however, individuals had fewer and fewer financial resources with which to support themselves and their aging family members.  Medical costs were consistently the main issue for the elderly and a conversation began to form on how the United States government could provide assistance in the face of this growing concern.2

The economic changes that occurred during the Great Depression also led to a shift in how social welfare was viewed.  As more people struggled against the weight of financial depression, more people became open to the idea of government intervention.  The establishment of the Social Security Act of 1935 by President Franklin D. Roosevelt brought about the creation of many social welfare policies.  This major piece of legislation also brought a new group of professionals to the political table: social workers.  Frances Perkins, Harry Hopkins, and Whitney Young were some of the major players involved in the creation of the Social Security Act, and their knowledge and experiences as social workers enabled them to help the president properly address the concerns of American citizens in need.   In fact, the ideals of equality took the United States by storm in the 1950s and 1960s as issues of civil rights took storm.  The general opinion of the public during this time favored a more liberal perspective with Democrats becoming the majority party, and it was this more liberal ideal that helped support President Lyndon B. Johnson’s decision to make Medicare apart of America’s social welfare system in 1965.

Several conservatives during the 1960s felt that Medicare – and the other welfare policies bundled within the revamped Social Security Amendments of 1965 – was a shift toward socialism and that it was not the place of our government to interfere in personal matters, such as health care and medical insurance.  Ronald Reagan produced a record titled “Ronald Reagan Speaks Out Against Socialized Medicine” in which he warns that Medicare will encourage other federal programs that “will invade every area of freedom we have known in this country.”3  Reagan also encouraged listeners to write to Congress or else “we will wake to find that we have socialism.”3  Physicians were also among the people opposed to Medicare, and they argued that Medicare would inevitably lead to a deterioration of care.  This argument supported the idea that the government had no place telling educated professionals of medicine how to best provide and execute health care.4  Despite the opposition and accusations of socialism, Medicare became a policy in 1965 and more than 19 million individuals aged 65 and older were enrolled in the program just a year later.

It can be easy to dismiss the history of Medicare because it is a program that most people have heard mentioned all of their lives.  Given the general public popularity of the program today, it can also be difficult to comprehend a time when Medicare was fought against and defined as socialized medicine.  The history of the program is important to consider because it gives us a better idea of the general framework of the program, and it also helps us to better understand how the policy and opinions of the policy may have changed over time.

Reference

1The Henry J. Kaiser Family Foundation. (2012, September 7). United States: Medicare enrollment. Retrieved from http://www.statehealthfacts.org/profileind.jsp?sub=74&rgn=1&cat=6

2The Henry J. Kaiser Family Foundation. (Producer) (2012, December 17). The story of Medicare: A timeline. [Video ]. Retrieved from http://www.kff.org/medicare/medicare-timeline2.cfm

3Reagan, Ronald.  Ronald Reagan Speaks Out Against Socialized Medicine. Operation Coffee Cup Campaign.  American Medical Association, 1961, Phonograph Record. http://www.youtube.com/watch?v=fRdLpem-AAs

4Kristof, N. (2009, November 18). The wrong side of history. The New York Times. Retrieved from http://www.nytimes.com/2009/11/19/opinion/19kristof.html?_r=0

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