The fiscal year (FY) 2023 budget recommendations submitted by President Biden to Congress on March 28, 2022, affirm his commitment to America’s seniors in major ways. It provides funding to improve customer service for Social Security beneficiaries as the Social Security Administration (SSA) emerges from service limitations imposed by the COVID pandemic. And the President continues to support legislation that cuts costs for prescription drugs and expands Medicaid home and community-based services (HCBS). With 10,000 baby boomers turning 65 every day – and the number of seniors projected to double by 2050 – it’s clear that this budget is mindful of the need to safeguard our older Americans now and into the future.
The President proposes $14.8 billion for SSA’s FY 2023 appropriation for administrative expenses. This is an increase of $1.8 billion — 12 percent – over the level enacted in the FY 2022 Continuing Resolution (CR) and is a badly needed increase to address years of underfunding. It represents a first step in stabilizing SSA’s continued customer service deterioration, which since FY 2010 saw Social Security’s core operating budget decline in inflation-adjusted terms by 13 percent while the number of beneficiaries grew by 22 percent. The effects of the COVID pandemic on SSA’s service delivery have magnified the effects of this long-standing disinvestment of Social Security’s core public services.
The National Committee applauds the Administration’s budget proposal as a solid first step toward rebuilding the agency’s ability to provide adequate services to the American people, though we feel compelled to point out the request is well below the $15.5 billion request submitted by Acting Commissioner Dr. Kilolo Kijakazi to the Office of Management and Budget. We firmly believe the agency itself is better positioned to anticipate the funding it will need to provide the level of service the American people deserve from SSA than budget bureaucrats at OMB, and we strongly urge Congress to provide the full requested level of $15.5 billion when formulating its own appropriations legislation for FY 2023.
Providing adequate funding is essential to begin the process of eliminating the backlogs that have developed during the pandemic in both the Disability Determination Services and the Offices of Hearings Operations and is clearly necessary to expedite the processing of the current backlog. The agency’s funding request is intended to address the significant pent-up demand for disability claims filing that developed during the COVID pandemic and is designed to provide ample overtime to enable agency employees to address workload imbalances before new backlogs develop. The agency’s request reflects the additional funding it expects will be needed to deal with these problems.
Regarding the adjudication of requests for hearings, we continue to be concerned about the effect of Trump-era regulations that authorizes the Commissioner of Social Security to use Administrative Appeals Judges (AAJ) to conduct hearings on appeals of denied disability claims. We are concerned that AAJs do not have the decisional independence of Administrative Law Judges, which could compromise the integrity of the appeals process. We urge appropriators to bar the expenditure of appropriated funds for the purpose of using AAJs in the hearing process.
We support the Administration’s proposal to provide additional funding to improve the level of service provided by SSA’s toll-free telephone service. Here too, misguided underfunding has led to a decline in service delivery. Perversely, since 2010 SSA’s national toll-free telephone service staff has declined substantially, even as call volume grew. The results, predictably, were more busy signals, more hang-ups, longer wait times and fewer calls handled. The President’s budget provides additional resources that should enable SSA to significantly improve its telephone service, and we thank the Administration for proposing to strengthen the adequacy of this vital service which, during the pandemic has served as the lifeline that remained available to those seeking SSA’s services.
President Biden’s budget proposal funds the production and mailing of only 15 million hard-copy Social Security statements. This proposal is part of SSA’s overall plan to limit the distribution of statements only to individuals who are 60 or older rather than sending them to all workers every year. The National Committee urges the Administration to develop plans to send these important financial planning documents to all workers 25 and older, as is required in section 1143 of the Social Security Act. We urge appropriators to include an earmark within SSA’s administrative budget requiring that section 1143 of the Social Security Act be fully funded.
While the President’s budget includes no proposals that directly affect Social Security cost-of-living adjustments (COLAs), we are concerned that the appearance of inflation in the national economy raises the specter that the inadequacies of the consumer price index (CPI) used to adjust Social Security benefits for inflation will continue to undercut the purchasing power of seniors’ benefits. All of America’s seniors deserve the full protection that COLAs provide against the ravages of inflation. That’s why the National Committee continues to advocate for the adoption of a CPI that more accurately gauges the effects of inflation on seniors’ purchasing patterns. We believe that the CPI for the Elderly, or the CPI-E, which more accurately measures the effects of inflation on seniors’ purchasing patterns, should be adopted as the official measure of inflation for Social Security and other income security programs.
Lastly, we note the absence of any Social Security legislative proposals in the President’s FY 2023 budget. To address this omission, we urge the Administration to support H.R. 5723 (S. 3071 in the Senate), legislation developed by Representative John Larson (D-CT) and Senator Richard Blumenthal (D-CT). This legislation makes important long overdue improvements to the Social Security program, as well as strengthening the program’s finances. We look forward to working with the Administration in moving this important legislation.
The National Committee supports Medicare legislative proposals in the President’s budget that would:
- Temporarily extend telehealth coverage under Medicare COVID-19 after the Public Health Emergency ends “to study its ability to promote proper use and access to care.”
- Provide $7.5 billion for the Mental Health System Transformation Fund to increase access to mental health services through workforce development and service expansion.
The National Committee continues to support Biden Administration proposals that would:
- Allow Medicare to negotiate for the price of prescription drugs, require drug manufacturers to rebate to the government the amount by which drugs used under Part B and Part D rise faster than inflation, and capping beneficiary out-of-pocket costs.
- Add hearing, dental and vision coverage to Medicare.
The COVID pandemic has highlighted the importance of allowing people to stay in their own homes instead of a nursing home, where they are much safer from infections and where most people prefer to be. The National Committee supports the Biden budget’s investment in home and community-based services (HCBS). The Biden Administration highlights that 107,000 individuals have been transitioned to the community from nursing homes because of the Money Follows the Person demonstration program. While the Administration can use the $450 million annual funding that was appropriated for the Money Follows the Person demonstration in the Consolidated Appropriations Act of 2022 (P.L. 117-103), that money will only last through 2023. The National Committee continues to push for at least a $150 billion increase in Medicaid HCBS funding as included in the House-passed Build Back Better Act (H.R. 5376).
While we support the Administration’ investments in Medicaid HCBS, we urge the President and Congress not to leave behind many middle-class seniors who will not directly benefit from them. Older Americans and people with disabilities should not have to impoverish themselves to become eligible for long-term services and supports as required by Medicaid. To that end, the National Committee urges the President and lawmakers to support broad-based reforms that will benefit more seniors including improvements to Medicare’s home health services.
The National Committee supports $81.7 billion for pandemic preparedness over five years for the Department of Health and Human Service’s Office of the Assistant Secretary for Preparedness and Response (ASPR), Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and Food and Drug Administration (FDA), including:
- $28 billion for the CDC to strengthen the public health infrastructure and early warning capabilities.
- $12.1 billion for the NIH to research and develop vaccines.
Discretionary Programs Affecting Older Americans
The Older Americans Act (OAA) supports a range of home and community-based services, such as home delivered meals and other nutrition programs, in-home services, transportation, legal services, elder abuse prevention and caregiver support. Up until recently, however, the Act’s broad and critical mission has been undermined by inadequate funding. Over the past 20 years, the OAA has lost ground due to federal funding that has not kept pace with either inflation or growth in the older population.
Annual OAA discretionary funding declined over the 10-year period from FY 2009 to FY 2019, and funding levels each year remained below the FY 2010 level when funding was at its highest level ($2.328 billion). However, for FY 2020, total OAA funding, including supplemental funding to respond to the needs of seniors during the COVID pandemic, reached its highest level ($3.220 billion) in the Act’s 55-year history. This trend continued into FY 2021 with an increase of $96 million, but slowed in FY 2022 with a nominal boost of $28 million.
The National Committee supports recommendations in the President’s budget to further increase funding – by 27.1 percent in FY 2023 – for Older Americans Act programs, including:
- $1.272 billion for nutrition programs, a $320 million or 33 percent increase over the FY 2022 enacted level.
- $500 million for support services, a $107 million or 27.2 percent increase over the FY 2022 enacted level.
- $249.9 million for the National Family Caregiver Support Program, a $61 million or 32 percent increase over the FY 2022 enacted level.
- $70.2 million for Native American nutrition and supportive services, a $35 million or 100 percent increase over the FY 2022 enacted level.
- $36.8 million for the Long-Term Care Ombudsman Program, an $18 million or 95 percent increase over the FY 2022 enacted level.
- $14.2 million for the Lifespan Respite Program, a $7 million or 100 percent increase over the FY 2022 enacted level.
- $55.2 million for the Medicare State Health Insurance Assistance Program (SHIP), a $3.1 million or 5.9 percent increase over the FY 2022 enacted level. SHIPs offer Medicare-eligible individuals, their families, and caregivers unbiased counseling to make informed health insurance decisions that optimize access to care and benefits.
Fast-track Budget Process Legislation
As Congress begins the process of designing a Budget Resolution for FY 2023, we take this opportunity to emphasize again our strong opposition to the inclusion of any provisions authorizing a fast-track legislative process for Social Security and Medicare in the guise of ‘fiscal responsibility”. Legislative proposals such as the TRUST Act create a back-door mechanism for cutting these essential programs that would not be possible through the normal legislative process because of their popularity and importance to the public. We urge Congress to consider legislation that would expand these essential programs, not create a fast-track process to facilitate benefit cuts that would be devastating to hard-working middle-class Americans who rely on their protections.