The fiscal year (FY) 2025 budget recommendations submitted by President Biden to Congress on March 11, 2024 affirm his commitment to America’s seniors in major ways.  The budget provides funding to improve customer service for Social Security beneficiaries as the Social Security Administration (SSA) continues to grapple with service delivery challenges.  And the President continues to support legislation that cuts costs for prescription drugs and expands Medicaid home and community-based services (HCBS).   With thousands of baby boomers turning 65 every day – and the number of seniors overall projected to reach 74 million people, or 21 percent of the total U.S. population by 2030 – this budget is laser-focused on the need to safeguard foundational programs supporting older Americans both today and as the U.S. transitions to an older society.

Social Security

Social Security represents the foundation of income security for the American people.  Without a solid foundation, other programs designed to protect workers and their families from the ravages of death, disability and old age simply will not be able to adequately fulfill their missions.  And the activities of the Social Security Administration (SSA) are at the heart of the administration of the Social Security program.  Adequate funding for SSA is vitally important to millions of Americans across the country who either are receiving Social Security or expect to do so in the future, both to ensure that they receive the benefits they have earned and to maintain the public’s support for this essential program.

Unlike most other agencies, the Social Security Administration’s operations are not funded by general tax revenues but through Social Security’s Trust Funds.  As a result, although the money used to fund the Agency is technically “on budget” for budget scoring purposes, SSA’s operations are actually paid for by American families when they make their payroll tax contributions.  Rather than appropriating funds from the general Treasury, Congress limits the amount the Agency can spend annually from the Trust Funds through the appropriations process.  The long history of Agency underfunding is therefore especially frustrating when one considers that contributions from American workers have built up an almost $2.8 trillion surplus in the Trust Fund accounts, in addition to over $1 trillion received in Federal Insurance Contributions Act (FICA) contributions each year.

In 2025, SSA anticipates delivering about $1.6 trillion in direct payments to beneficiaries, at a remarkably low administrative cost of about 1 percent.  The President proposes $15.402 billion for SSA’s FY 2025 appropriation for administrative expenses.  This is an increase of $1.2 billion — or 8.5 percent – over the level of $14.2 billion enacted for the 2024 Fiscal Year.  

Congress did not enact a permanent appropriations bill for SSA for FY 2024 until March 23, 2024, or almost one-half of the way through the fiscal year.  Since October 1, 2023, SSA was operating on essentially flat funding, and the FY 2024 appropriations bill only provided an additional $100 million for the remainder of the fiscal year.  This level of funding will have a detrimental effect on service, effectively halting the progress SSA made to begin improving service in FY 2023.  Level funding does not cover the over $500 million increase in the agency’s annual fixed costs such as salaries and rent on more than 1,500 field and hearings offices across the country.  SSA had to freeze hiring during the extended continuing resolution, which has caused the agency’s staffing levels to fall back to where they were in April 2023.  SSA also significantly reduced overtime levels in FY 2024 compared to FY 2023, limiting one of the agency’s most important tools for increasing processing capacity and supporting offices.  The level of funding provided for FY 2024 will allow the agency to restart hiring on a very limited basis, but otherwise most of the limitations on activities will remain in place.  This situation only increases the need to ensure adequate funding is provided in FY 2025. 

SSA has approximately 500 million interactions with the public each year through field office visits, call centers, and other engagements. While they have exceptional employees dedicated to serving millions of people, SSA is serving 50 percent more customers with less staff than they had in 1995.  Since FY 2010, Social Security’s customer service budget has declined in inflation-adjusted terms by 17 percent and its staffing by 16 percent, while at the same time the number of SSA’s beneficiaries has grown by 22 percent.

This long history of disinvestment in the Agency’s core public services must be reversed if the American public is to receive the services they have already paid for through their monthly payroll contributions.  If the President’s budget request is approved by Congress, SSA intends to continue ongoing efforts to re-build its workforce, thus allowing SSA to process increasing numbers of disability claims, reduce wait times on the national toll-free number and begin to address the pending backlogs.  This funding request represents a solid first step toward what will need to be a multi-year effort to rebuild the agency’s ability to provide the customer service America’s workers and retirees deserve and expect.

While the National Committee applauds the Administration’s budget proposal, we feel compelled to point out the request is well below the $16.45 billion request submitted by SSA to the Office of Management and Budget.  It is also well below the 1.2 percent of outlays that was historically provided to the agency prior to 2018.  We firmly believe the agency itself is best positioned to anticipate the funding it will need to provide the level of service the American people deserve from SSA.  The agency’s new Commissioner, former Maryland Governor Martin O’Malley, has estimated restoring SSAs administrative funding to a level of 1.2 percent of the benefits it pays each year is required for the agency to provide these services.  We urge Congress to provide the full requested level of $16.45 billion originally requested by SSA when formulating its own appropriations legislation for FY 2025, with a goal to restoring future funding to 1.2 percent of outlays.  Providing adequate funding in FY 2025 is especially important considering the seriously insufficient funding the agency received for FY 2024.  

Providing adequate funding is essential to begin the process of eliminating the backlogs that have developed in both the Disability Determination Services and the Offices of Hearings Operations and is clearly necessary to expedite the processing of the current backlog. Relative to level staffing, a hiring freeze and the anticipated loss of about 4,500 staff in 2024 would add an estimated 20 more days and 175,000 more cases in the disability backlog. The President’s FY 2025 Budget request is projected to reduce initial disability claims wait times to an average of 215 days and reduce the claims backlog by 15 percent. 

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, over the years 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, with a projected reduction in wait times on SSA’s 800 Number by over 20 minutes to 12 minutes.  We thank the Administration for proposing to strengthen the adequacy of this vital service which must be available as a critical lifeline for those who have difficulty visiting a field office in person due to age or disability.

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 who do not have an online account 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 continuation 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 applaud the President’s commitment to improve and strengthen Social Security, and his support for requiring individuals to pay payroll taxes on income at or above $400,000 annually.  The President has made clear his commitment to ensuring the wealthy pay their fair share throughout his FY 2025 budget and we hope Congress will support his efforts.  However, we note the absence of any specific Social Security legislative proposals in the President’s FY 2025 budget.  To address this omission, we urge the Administration to support the Social Security 2100 act, introduced as H.R. 4583 in the House by Representative John Larson (D-CT) and in the Senate as S. 2280 by Senator Richard Blumenthal (D-CT), and the Social Security Expansion Act, S. 393 (H.R. 1046 in the House), legislation developed by Senator Bernie Sanders (I-VT) and Representative Jan Schakowsky (D-IL). These bills make 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 enacting this important legislation.


As America’s “age wave” takes hold, Medicare has never been more important: In 2025, the Centers for Medicare and Medicaid Services (CMS) projects that Medicare will cover 68.7 million beneficiaries, and gross spending will total $1.1 trillion. Hospital benefits, covered under the Part A program and financed through the HI payroll tax, carry a beneficiary deductible of $1,632 per hospitalization. For care in a skilled nursing facility, beneficiaries pay a $204 daily coinsurance for days 21–100. For outpatient physician services covered through Part B (financed through general revenues), the standard monthly Part B premium is $174.70.

Over half of Medicare-eligible beneficiaries are now enrolled in a managed care private insurance plan that is part of the Medicare Advantage (MA) program. In 2023, MA enrollment grew to about 32 million beneficiaries, or 53 percent of all eligible Medicare beneficiaries.  Over the last decade, private plan enrollment has increased by 18.5 million enrollees, or 106 percent, compared to 22 percent growth in the overall Medicare population.  This growth comes at a rising cost to taxpayers, with the Medicare Payment Advisory Commission warning that payments to plans are higher than they would be to provide Part A and B benefits in traditional Medicare. In 2023, alone, Medicare Advantage had an improper payment rate of 6 percent and overpayments exceeded $16 billion. This pattern negatively affects the solvency of the HI Trust Fund — and also increases Part B premiums.

Medicare Part D prescription drug coverage is changing too – but the direction of change is positive for beneficiaries. Medicare Part D offers a standard prescription drug benefit with a deductible of $545 in 2024, and a base beneficiary premium of $34.70 per month. Starting this year, the Inflation Reduction Act (IRA) eliminates the 5 percent beneficiary coinsurance requirement for those whose drug costs exceed $8,000.

There is also good news for low-income beneficiaries who enroll in Medicare’s Low-Income Subsidy (LIS) program. LIS program enrollees have very low copayments, ranging from $0 to $11.20.  Also starting this year, LIS program eligibility is being expanded to beneficiaries with incomes up to 150 percent of the federal poverty line (up from 135 percent). And in 2025, annual out-of-pocket drug costs for all Part D beneficiaries will be capped at $2,000.

The National Committee strongly supports a variety of Medicare legislative proposals in the President’s budget that would extend Medicare solvency indefinitely by directing revenues from tax code reforms and an amount equivalent to the Medicare drug reform savings into the Part A trust fund.

Specifically, we endorse:

  • The President’s proposals to permanently close the projected financial shortfall in Medicare’s Hospital Insurance (HI) trust fund.
  • Closing a tax loophole that allows some business income to escape both the HI payroll tax and the net investment income tax (NIIT).  Currently, business owners that receive income through an S corporation, a limited liability company, or a limited partnership, and are considered an active participant in the business, can evade paying the Medicare NIIT.
  • Raising the HI payroll tax, HI self-employment tax, and NIIT rates from 3.8 percent to 5.0 percent on incomes over $400,000 and dedicating the proceeds of the NIIT to the HI trust fund.
  • Further lowering Medicare prescription drug prices and crediting these savings to the HI trust fund. For example, the budget would expand provisions in the Inflation Reduction Act (IRA) that enable Medicare to negotiate fair drug prices for more drugs — saving the program $200 billion over 10 years.
  • Limiting cost sharing in Medicare’s prescription drug program for certain generic drugs to $2 per month.
  • Extending the IRA’s drug inflation rebates to private insurance, 35 cost sharing for insulin, and $2,000 annual limit on out-of-pocket drug costs.

In addition, the Biden Administration FY 2025 budget calls for a range of helpful legislative proposals. Among these are:

  • Expansion of Medicare coverage of select, evidence-based supportive services delivered   by a community health worker for prevention, care navigation for chronic or behavioral health conditions, screening for social determinants of health, and linkage to social supports.
  • Creation of a permanent Medicare Part B diabetes prevention benefit.
  • For individuals who donate a non-renal organ for transplant into a Medicare beneficiary, coverage under Medicare Part A and B for care associated with the donation.
  • A significant increase in the budget for nursing home health and safety inspections conducted by State Survey and Certification Programs through shifting the program from a discretionary appropriation to a mandatory appropriation, and increasing the funding to achieve a 100 percent survey frequency, adjusted annually for inflation. The increase in mandatory funding would be partially offset by reductions in discretionary spending equal to the projected 2026 need inflated into the 10-year window. The overall goal is to provides stable resources to the program, which will guard against negligent care and ensure that Americans receive high quality, safe services within nursing facilities and many other types of providers.
  • Making permanent the Home Health Value-Based Purchasing Model, launched by the CMS Innovation Center in 2016.
  • A new requirement for MA plans to meet a minimum medical loss ratio of 85 percent specifically for supplemental benefits (beyond basic Part A and B benefits), to align with the existing 85 percent medical loss ratio across all other types of benefits.
  • A new requirement for MA plans to submit data that confirms diagnoses with beneficiary medical records that are submitted for payment. This approach would focus prepayment review on plans, diagnosis, and on beneficiaries at elevated risk of improper payments.
  • Addition of a new category of standardized patient assessment data on social “drivers of health,” e.g., transportation, housing, social isolation, and food insecurity, for post-acute care providers (i.e., inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies) to report.
  • Strengthening nursing home oversight, transparency, and enforcement of penalties, when appropriate. The provisions protect older adults and younger people with disabilities (those younger than age 65) living in nursing homes by identifying and penalizing nursing homes that commit fraud, endanger patient safety, or prescribe unnecessary drugs.
  • A new requirement for skilled nursing facilities with private equity or real estate investment trust ownership to disclose detailed profit/loss statements and expense reports that go beyond the basic annual cost report filing required of most Medicare-certified providers. 


The National Committee continues to support Biden Administration proposals that would invest $150 billion over 10 years to improve and expand Medicaid home and community-based services (HCBS), which would provide states and HCBS providers with the financial resources they need to expand and improve the quality of careers focusing on direct care and other key infrastructure – such as accessible adapted transportation systems for those who do not drive; additional sources of support for family caregivers to obtain respite care; a more diverse array of employment opportunities for individuals living with disabilities; and innovative health care technology. There has been substantial growth amongst the younger population under 65 with disabilities living in nursing homes. The percentage of individuals younger than 65 living in residential nursing facilities grew from 10.6 in 2000 to 16.2 in 2017.

In other provisions, the FY 2025 budget proposes to improve the quality of jobs for home care workers, and to extend Medicaid-like coverage to low-income individuals living in states that have not expanded Medicaid under the Affordable Care Act, paired with financial incentives to ensure states maintain their existing expansions. And the Administration is proposing to ensure that Medicaid and the Children’s Health Insurance Program (CHIP) are prudent purchasers of prescription drugs, including a proposal that would authorize HHS to negotiate supplemental drug rebates on behalf of interested States in order to pool purchasing power.

NCPSSM also encourages the Administration to embrace the HCBS Access Act (S. 100), introduced by Senator Bob Casey (D-PA). This thoughtful policy would take practical steps to ensure that older Americans and individuals living with disabilities have a real choice of getting HCBS with practical, actionable steps, including improving the stability, availability, and quality of direct care providers to help address the decades-long workforce shortage crisis through providing states with greater resources, and providing better training and support for family caregivers.

Emergency Preparedness and Response

In response to COVID-19 – and in anticipation of other public health threats, the President’s budget includes over $28.9 billion in total resources across HHS to support and bolster biodefense and public health preparedness and response capabilities. For example, it proposes to bolster the medical supply chain by investing $95 million in the Administration for Strategic Preparedness and Response (ASPR) to accelerate development and domestic production of medical countermeasures, as well as onshore production of active pharmaceutical ingredients and essential medicines. The budget includes $12 million to enhance the Food and Drug Administration’s (FDA) capabilities in preparing for and responding to both supply chain and demand-driven medical and food shortages, and proposes $10 million for a new supply chain coordination office within HHS.

Older Americans and those living with disabilities are particularly vulnerable during emergencies. Lack of accessible transportation and emergency shelters and other barriers often mean they are unable to evacuate their homes safely.  They also face higher rates of death and injury during emergencies and disasters.  The FY 2025 budget therefore includes $5 million to improve emergency planning and create surge capacity to respond to crisis needs among vulnerable and older adults. Specifically, ACL will establish a national center to provide training, technical assistance, and partnership development support to the Department of Health and Human Service/Administration for Community Living’s (ACL) networks, emergency management authorities, and public health systems. In addition, ACL will fund demonstration grants to develop inclusive disaster planning models and increase capacity for meeting needs during emergencies.

Discretionary Programs Affecting Older Americans

The Older Americans Act (OAA) – which is administer by the Department of Health and Human Services’ Administration for Community Living (ACL) – 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 OAA appropriation jumped to $139.1 million in FY 2023, but back down to $61.4 million in FY 2024.

The President’s budget further increases funding – by $90.7 million or 3.7 percent in FY 2025 – for Older Americans Act programs, including:

  • $621.6 million for congregate meals, a $56.3 million or 10 percent increase over the FY 2023 enacted level.
  • $447.7 million for home delivered meals, a $66.3 million or 17.3 percent increase over the FY 2023 enacted level.

However, the rest of the OAA programs were flat funded in the President FY 2025 budget.  The National Committee urges Congress to increase funding for all OAA programs, including the Family Caregivers Support, Seniors Community Service Employment Program, the Ombudsman/Elder Rights program and Direct Care Workforce Demonstration.

While not part of the Older Americans Act, but administer by the ACL, Congress should more adequately fund the State Health Insurance Assistance Program (SHIP) since it provides one-on-one unbiased counseling to individuals who are eligible for Medicare, including those who also are eligible for Medicaid, to help make informed decisions about health insurance and to enroll in the plans that best meet their needs.

Finally, the President’s budget request includes a $3 million provision for a White House Conference on Aging in 2025, noting that the decennial conferences are designed to provide “a dedicated forum for the President, Congress, states and tribes, federal agencies, the aging services networks, and other stakeholders to convene to plan the nation’s aging policy”.

Fast-track Budget Process Legislation

As Congress begins the process of designing a Budget Resolution for FY 2025, 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 Fiscal Commission 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.