social security, medicare and medicaid work for tennessee 2012

7/31/2019 Social Security, Medicare and Medicaid Work For Tennessee 2012

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www.StrengthenSocia Sec rit .org


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Social Security, Medicare and Medicaid Work for tenneSSee

ACKNOWLEDGMENTSLike our Social Security, Medicare and Medicaid, this report is the product of the foresight and hard work of many people. Social SecurityWorks partnered closely with the Alliance for Retired Americans who are coordinating the release of this report in Tennessee.

We are grateful to the following people for writing, designing and producing this report: Daniel Marans, Policy Director of Social SecurityWorks (SSW), is the principal author and lead researcher, whose commitment to excellence, along with that of Alex Lawson, SSWsExecutive Director, drove the project to its successful conclusion. Michael Phelan, SSWs Deputy Director managed the actual productionof the report. We would like to thank Don Owens and Lacy Crawford, respectively, SSWs Communications Director and Communications

Associate for assembling, sometimes writing and editing the personal stories included in all 50 state reports. Dana Bell and MollyChecksfield, SSWs Legislative and Policy Associates, played a crucial role in the reports completion, performing a significant amount ofthe initial research, drafting the appendices, and editing and verifying the data in the report. Tom Arnold-Forster, National Academy of SocialInsurance Summer Policy Fellow, proofread the data.

Very importantly, we want to acknowledge our appreciation to Sarah Slayton for generously sharing her story and views about theimportance of Social Security in her life. The Center for Economic Policy and Research provided the invaluable analysis and graphshowing the causes of the recent run-up in federal deficits. We would also like to acknowledge the staff of the Kaiser Family Foundationfor their assistance in finding and understanding the Medicare and Medicaid data in the report, especially Research Associates LindsayDonaldson and Jessica Stephens. Graphic design was provided by Deepika Mehta.

This report also benefited from the work and commitment of several persons who assisted with a previous series of reports. Arloc Sherman,Senior Researcher, and Paul N. Van de Water, Senior Fellow, at the Center on Budget and Policy Priorities generously provided advice andaccess to poverty data analyzed by the Center. Alice Wade, Deputy Chief Actuary of the Social Security Administration, with the help ofVirginia Reno, Vice President for Income Security at the National Academy of Social Insurance, graciously provided data on the value ofSocial Securitys survivors and disability insurance.

The data presented in this report speaks volumes about the importance of Social Security to families, communities and state and localeconomies. We hope the report is useful to you as you work to strengthen Social Security in this 77th anniversary year. Please contact theSocial Security Works Communications Director, Don Owens, if you have questions about this report: dowens @socialsecurity-works.org.

Nancy Altman and Eric KingsonFounding Co-directors, Social Security WorksCo-chairs, Strengthen Social Security Coalition

The Alliance for Retired Americans is a grassroots organization representing more than 4 million retirees and seniorsnationwide. Headquartered in Washington, DC, the Alliances mission is to advance public policy that protects thehealth and economic security of older Americans by teaching seniors how to make a difference through activism.Learn more about The Alliance and its work at www.retiredamericans.org

The mission of Social Security Works is to protect and improve the economic status of all Americas, especiallydisadvantaged and at-risk populations, and, in so doing, to promote social justice for current and future generationsof children as well as young, middle-aged and older adults. www.socialsecurity-works.org

The Strengthen Social Security Coalition is made up of more than 320 national organizations and many stateorganizations, representing more than 50 million Americans. The Coalition is united around core principles, whichinclude that Social Security benefits should not be cut and, instead, should be increased for those who are mostdisadvantaged, and the belief that our nations Social Security, Medicare and Medicaid systems are fundamental tothe well-being of Americas families and to the type of nation we are. www.strengthensocialsecurity.org

OurSocial Security, Medicare and Medicaid Work for America series of 50 state reports includes much information that public officials, membersof the press, and advocates will find useful. In addition to providing information about the programs history, character and vitality, as well ascompelling, real-life stories, each report includes statistics about the number of people who receive benefits, the types of benefits they receiveand the total amount of funds flowing from these programs into every state, its congressional districts and counties.

Please note that a one-page fact sheet summarizing the data in this report can be found at the end of the report, directly following the endnotes.

For congressional district-level Social Security data, please see Appendix 1: Social Security Works for Tennessees Congressional Districts, toward

the back of the report, just before the end notes.For county-level Social Security, Medicare, Medicaid and demographic data, please see Appendix 2: Social Security, Medicare, and MedicaidData for Tennessees Counties, toward the back of the report, just before the end notes.
http://socialsecurity-works.org/http://www.retiredamericans.org/http://www.socialsecurity-works.org/http://www.strengthensocialsecurity.org/http://www.strengthensocialsecurity.org/http://www.socialsecurity-works.org/http://www.retiredamericans.org/http://socialsecurity-works.org/


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Social Security, Medicare and Medicaid Work for tenneSSee 1

In 1935, when President Franklin D. Rooseveltsigned the Social Security Act into law he called

it a cornerstone, the foundation of a structure tobe maintained and built upon by and for futuregenerations. Social Security could not protect all

Americans against every risk, but, as the Presidentsaid, it could lessen the consequences of lostearnings in old age for workers and their families.

Since then, we have built our Social Securitystructure carefully and deliberately. In 1939, weadded Survivors Insurance benefits for widowsand dependent children, eventually extending itto widowers as well. Disability Insurance benefitswere added in 1956, followed by Medicare andMedicaid in 1965. The automatic cost-of-livingadjustment (COLA) was added in 1972, designedto maintain the purchasing power of benefitsno matter how long someone lives. We built,

maintained and strengthened these institutions fora reason: to enable working men and women to

protect themselves and their families. We built thembecause we, as a nation, value hard work, personalresponsibility, and human dignity; we care for ourparents, our children, our spouses, our neighborsand ourselves.

This report reveals the success of these institutionsfor Tennessee and the nation. The numbers tellpart of the story: how many people receive benefitsin Tennessee, in its congressional districts andits counties; how many dollars flow into these

jurisdictions in a year; the types of benefits and thetypes of people who receive benefits. Perhaps moreimportantly, the report presents the stories of hard-working Tennesseans and their families whose livesare immeasurably better because of the protectionsthey have earned.

du d SuMM y

FIG RE 1 1

Socia Sec rit , Me icare an Me icai s mpact on the conom an Pop ation o ennessee

PROGRAM BENEFICIARIES INTENNESSEEPERCENT OF RESIDENTS

RECEIVING BENEFITS AVERAGE BENEFIT TOTAL ANN AL BENEFITS2

Social Security 1,251,947 19.7 percent $12,711 $15.9 billion

Medicare 1,020,977 16.2 percent $10,125 $10.3 billion

Medicaid 1,502,364 23.9 percent $4,853 $7.3 billion

Sources: Social Security Administration, 2011; .S. Census Bureau; Kaiser Family Foundation, 2011; Economic Policy Institute, 2011.

We can never insure one-hundred percent of the population against one-hundred percent of the hazards

and vicissitudes of life. But we have tried to frame a law which will give some measure of protection to theaverage citizen and to his family against the loss of a job and against poverty-ridden old age. This law, too,represents a cornerstone in a structure which is being built but is by no means complete. It is a structureintended to lessen the force of possible future depressions. It will act as a protection to future Administrationsagainst the necessity of going deeply into debt to furnish relief to the needy. The law will flatten out the peaksand valleys of deflation and of inflation. It is, in short, a law that will take care of human needs and at thesame time provide for the nited States an economic structure of vastly greater soundness.

Franklin D. Roosevelt, August 14, 1935


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As you read through this report, think of the peopleyou know. Family members who live in dignity in oldage because they can count on a monthly SocialSecurity check that they or another family memberhave earned. Think of that older person who hasMedicare, and with it the peace of mind that he orshe can receive medical care without becomingbankrupt. Think of a family you know who is ableto care for a functionally disabled child at homebecause Medicaid is there. Think of a grandparent, aparent, an older aunt, uncle, cousin or family friend,whose life savings may have been lost paying fornursing home care, but who is still able to receivethat care because of Medicaid.

Think, too, of how these institutions, like the nationshighway system, are part of a rich legacy by those

who came before, a legacy that keeps workingin good times and bad. Throughout the past fewdifficult years, Social Security, Medicare, andMedicaid have been even more vital than before forTennessee residents, and the lifeblood of many smallbusinesses, hospitals and nursing homes and homecaregivers. Virtually all of the jobs our Social Security,Medicare, and Medicaid systems support stay in

America.

As important as these programs protections aretoday, the need for Social Security, Medicare andMedicaid programs will only increase in coming

years. The population of persons aged 65 andover is growing. Income growth is slow for most oftodays workers. Jobs are less secure, and manyworkers have sustained substantial losses of homeequity and other savings. Furthermore, employers,who historically have offered supplements to SocialSecurity, are increasingly terminating traditionalpension plans and either not replacing them, orreplacing them with far more risky and inadequate401(k) savings accounts.

Cutting these programs would threaten our familieseconomic security and health and deepen our jobscrisis. Indeed, the nation should be thinking aboutexpanding, not cutting, these programs and theprotections they provide. They, like our highways,are so fundamental to our family and community life,

and, in an increasingly uncertain environment, evermore important to middle-aged and young workersand those who will follow. We are much wealthier asa nation than we were in 1935, 1939, 1956, 1965,or 1972, when these structures were begun andimproved. Now it is our turn to maintain and buildupon that structure, as those who came before havedone. It is our turn to preserve and improve thesevaluable systems for ourselves and for those whofollow. It is our turn to build a legacy for our nationschildren and grandchildren so when they becomeworkers, they will have the economic security thatSocial Security, Medicare, and Medicaid provide.


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We built our Social Security system because it isthe most efficient, secure, universal and fair way for

Americans to replace wages in the event of death,disability, or old age. For over 75 years, even as ournation has endured wars, political crises and severeeconomic recessions, Social Security has nevermissed a payment; it has paid every dollar of earnedbenefits, on time and in full.

In the wake of the greatest financial crisis since theGreat Depression, the risks of investing money onWall Street or in real estate have never been clearer.

Since 2008, millions of Americans have seen theirsavings wiped out, as the value of 401(k)s and homeequity have plummeted. Meanwhile, Social Securitycontinues to prove reliable.

That is why our Social Security system is now moreimportant than ever. In a world of risky investmentschemes and unpredictable markets, Social Securityis a fortress of security and reliability. In this uncertainworld, where no one is invulnerable to the tragedyof premature death or serious and permanentdisability, Social Security is there to cushion theeconomic blow of such tragedies. Today, 56 million

Americans receive benefits each monthretired anddisabled workers, their families, and surviving familymembers. 3 Its benefits to Tennessee residents, andall Americans, are very modest, but vital; the averagenational benefit was $12,982 a year in 2010. 4 Thesebenefits are the building block of the retirementincome security for middle class Americans. In 2010,two out of three households aged 65 and over relied

on Social Security for half or more of their income,and over 1 out of 3 relied on Social Security for90 percent or more of their income. 5 The programlifted 20 million Americans out of poverty in 2008,including one million children.6

Social Security can pay all benefits in full and ontime for the next twenty years. After that, if Congresswere not to act, it could still pay more than 75 cents

on every dollar of earned benefits. 7 The shortfall isequivalent to 1 percent of Gross Domestic Product(GDP), which is roughly the amount of revenues thatwould be lost to the federal budget from extendingthe George W. Bush-era tax cuts benefitting therichest 2 percent of American householdsthosewith taxable income above $250,000 a year. 8

All we need to maintain our Social Security systemis a simple adjustment: have everyone, includingmillionaires and billionaires, pay the same rateas ordinary Americans. While the vast majority of

Americans must make payroll tax contributions onall of their wages, millionaires and billionaires only doso on the first $110,100 of their earnings this year.

Asking all Americans to pay the same rate wouldcome very close to closing Social Securitys entireprojected 75-year funding gap.

While the federal budget has run a deficit in everyyear but five over the last half century, SocialSecurity is not allowed to pay benefits unless it hasthe funds to cover every penny of the cost, and isnot allowed to borrow any shortfall. 9 That means thatSocial Security does not, and, by law, cannot add apenny to the federal deficit or debt (which is simplythe accumulation of annual deficits). 10 Maintainingour Social Security system has nothing to do withreducing the federal budget deficit, and thereforeshould be off the table in deficit talks. It should notbe part of any deficit reduction legislation consideredby our nations leaders.

Social Security Works for TennesseesResidents and Economy Social Security provided benefits to 1,251,947

people in 2010, 1 out of 5 residents (19.7 percent). 11 Tennessee residents received Social Security

benefits totaling $15.9 billion in 2010, an amountequivalent to 6.2 percent of the states annualGDP (the total value of all goods and servicesproduced). 12

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The average Social Security benefit in 2010 was$12,711. 13

Social Security lifted 502,000 Tennessee residents

out of poverty in 2008.14

Social Security Works for TennesseesSeniors 15 Social Security provided benefits to 756,708

retired workers in 2010, 6 out of 10 (60.4 percent)of beneficiaries. 16 [Figure 3]

The typical benefit received by a retired worker inTennessee was $13,790 in 2010. 17

Social Security provided benefits to 104,318widow(er)s in 2010, 1 out of 12 (8.3 percent) of allbeneficiaries. 18 [Figure 3]

Social Security lifted out of poverty 315,000Tennessee residents aged 65 and older in 2008. 19

Without Social Security, the elderly poverty ratein Tennessee would have increased from 1 outof 9 (11.6 percent) to nearly half (49.3 percent). 20 [Figure 2]

Social Security Works for TennesseesWomen Social Security provided benefits to 642,006

Tennessee women in 2010, 1 out of 5 women(19.7 percent).21

Social Security provided benefits to 49,737spouses in 2010, 1 out of 25 (4 percent) of allbeneficiaries. 22 [Figure 3]

Social Security lifted out of poverty 193,000Tennessee women aged 65 and older in 2008. 23

Without Social Security, the poverty rate of elderlywomen would have increased from 1 out of 6(15 percent) to more than half (54.3 percent). 24 [Figure 2]

Social Security Works for TennesseesWorkers with Disabilities 25 Social Security provided disability benefits for

230,168 workers in 2010, 1 out of 5 (18.4 percent)of all beneficiaries.26 [Figure 3]

The typical benefit received by a disabled workerbeneficiary in Tennessee was $11,393 in 2010. 27

FIG RE 2

Povert ate or Bene iciaries65 an er With an Witho tSocia Sec rit , 20062008

Source: Center on Budget & Policy Priorities

65+ Women 65+

n Poverty rate without Social Securityn Poverty rate with Social Security

49.3%54.3%

11.6%15%

FIG RE 3

ennessees Socia Sec ritBene iciaries, 2010

Source: Social Security Administration, 2012

60.4%Retired Workers

8.9%Children

18.4%DisabledWorkers

8.3%Widow(er)s

4% Spouses


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Social Security Works for TennesseesChildren 28 Social Security is the major life and disability

insurance protection for more than 95 percent ofTennessees 1,496,001 children. 29

Social Security provided benefits to 111,016

children in 2010,30

and it is the most importantsource of income for the 177,701 children living inTennessees grandfamilies, which are householdsheaded by a grandparent or other relative. 31

Social Security Works for Tennessees African Americans In Tennessee, Social Security provided benefits

to 150,257 African Americans in 2009, 1 out of 7(14.1 percent) of all African American residents.32

Nationwide, Social Security provided nearly

three-quarters (73.7 percent) of the income of African American elderly couples and unmarriedindividuals receiving benefits, on average, in 2010.Social Security was 90 percent of the total incomefor half (49.4 percent) of these African Americanelderly households. 33

Nationwide, 3 out of 10 (32.1 percent) of all African American beneficiaries received disabilitybenefits in 2009; for white beneficiaries it wasabout half of that number (15.9 percent). 34

Social Security Works for TennesseesLatinos In Tennessee, Social Security provided benefits

to 1 out of 13 (7.8 percent) Latino households in2010, 5,562 households. 35

Nationwide, Social Security provided more thanthree-quarters (77 percent) of the total income ofLatino elderly couples and unmarried individualsreceiving benefits, on average, in 2010. SocialSecurity was 90 percent of the income for more

than half (55.1 percent) of these Latino elderlyhouseholds. 36

The Social Security Administration estimates thatLatinos receive a higher rate of return on theirSocial Security contributions than the overallpopulationthe highest of any group. Thatsbecause they tend to have lower lifetime income,longer life expectancies, higher incidence ofdisability and larger families.37

Social Security Works for Tennessees American Indians and Alaska Natives In Tennessee, Social Security provided benefits to

3 out of 10 (31 percent) American Indian and AlaskaNative households in 2010, 7,007 households. 38

Nationwide, Social Security provided 90 percent

of the income for 15 percent of elderly AmericanIndian and Alaska Native married couples, and 57percent of elderly unmarried persons in 2010. 39

Since Social Security has a higher incomereplacement rate for workers with lower earnings,Social Security replaces more of AmericanIndians and Alaska Natives pre-retirementearnings than the overall population. The medianearnings of workingage American Indians and

Alaska Natives are about $34,000, comparedto $41,500 for all working-age people. Social

Security provides average benefits of about$13,206 and $11,265 annually for American Indianand Alaska Native men and women aged 65 andolder, respectively. 40

Social Security Works for Tennessees Asian Americans In Tennessee, Social Security provided benefits

to 1 out of 9 (10.6 percent) Asian Americanhouseholds in 2010, 3,246 households. 41

Nationwide, Social Security provided twothirds(68.9 percent) of the total income for Asian

American households with beneficiaries aged 65and older, on average, in 2010. Social Securitywas 90 percent of the income for 4 out of 10(41.7 percent) of these Asian American elderlyhouseholds. 42


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Nationwide, Asian Americans and PacificIslanders receive a high rate of return from SocialSecurity because of their long life expectancies.

An Asian American or Pacific Islander managed 65 in 2010, can expect to live until age85, compared to age 82 for all men. An Asian

American or Pacific Islander woman of the sameage can expect to live until age 88, compared toage 85 for all women. 43

Social Security Works for TennesseesRural Communities 44 Social Security is more important to rural

Tennesseans than to other Tennesseans. One outof 4 (24.9 percent) rural Tennesseans receivedSocial Security compared with 1 out of 6 (17.8percent) non-rural Tennesseans in 2010. 45

Social Security is more important to the localeconomies of Tennessees rural counties than toits non-rural counties. Total personal income inTennessees 57 rural counties was $47.4 billionin 2010 of which $5.1 billion, or 10.8 percent,was from Social Security. By comparison, totalpersonal income in the states 38 non-ruralcounties was $174.6 billion, of which $10.8 billion,or 6.2 percent, was from Social Security. 46

Social Security Works for TennesseesWorking Families Through their hard work and payroll tax contributions,

nearly all Tennessee workers earn SocialSecuritys retirement, disability and survivorshipprotections for themselves and their families.

Social Security is the most valuable disabilityand life insurance protection for most Tennesseeworkers. Nationwide, an estimated 3 out of 10workingaged men and 1 out of 4 workingagedwomen will become severely disabled beforereaching retirement age. An estimated 1 out of 11workingaged men and 1 out of 20 workingagedwomen will die before reaching retirement age. 47

A 30-year-old worker who earns about $30,000and who has a spouse and two young children,receives Social Security insurance protection

equivalent to private disability and life insurancepolicies worth $465,000 and $476,000, respectively. 48

Social Security is a commitment made to all Americans that has withstood the test of time. Itrepresents the best of American valuesrewardinghard work, honoring our parents, caring for ourneighbors, and taking responsibility for ourselvesand our families. Social Security is based on apromise that if you pay in, then you earn the right toguaranteed benefits.


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Army Specialist E-4. Brent Slayton died while servingin active duty in 2007. Today, Brent Slaytons widow,Sarah, and two sons receive 40% of their income

from Social Security survivors benefits.

One of the youngest members of his Airborne Schoolclass to jump, Army Specialist E-4 Brent Slayton helda top secret security clearance and had receivednumerous military intelligence awards during hisdistinguished career. Just 24 years old in 2007 and inhis fifth year of military service, he died while servingin active duty at Colorados Fort Carson, where heand his family were stationed

At the time of his death, Brents wife, Sarah, alreadyhad her hands fullworking full-time and caring forthe couples two young children, boys ages 5 and 6.Their younger son, diagnosed with autism, epilepsyand Attention-Deficit Hyperactivity Disorder (ADHD),received Supplemental Security Income (SSI) andrequired Sarahs special attention and care. And notlong before Brents death, the couples third child diedduring delivery in an Army hospital.

My husbands military salary was barely enough toraise a family on to begin with, which is why our sonwas getting SSI and I was working full-time. Evenwhen you add up our VA and Social Security benefitsnow, its less than what my husband was making,says Sarah. And every couple of years, our VA benefits go down.

After her husbands sudden death, I had to learnhow to do it by myself, she explains. Today, at theage of 29, Sarah describes life after Brents death:Im a single mom with two boys, 8 and almost10, one with special needs. Since 2008, Ive beenworking part-time and going to college full-time. I

knew I had to go back to college for a better future.

Social Security benefits are drastically importantto the well-being of her sons, Sarah says, Its 40percent of our income. I dont know how we wouldhave made ends meet without it. What differencewould a small percentage cut, say 10 percent, havemade to their lives? I couldnt have gone back toschool to better myself at all. You have to think about

how much child care costs. Its so expensive; whenyoure a single mom, every dime counts everysingle penny counts. When I moved off post after

my husband passed away, my landlord asked howmuch I made a month. When I told her, she said, Idont know how you survive; I make more than that ina week. Sarah exhales and adds, And in situationslike mine, my children have been through somethingtraumatic. Its extremely hard for me to budgetfor sports like baseball and soccer. Theyre reallyexpensive for us, but I have to do it because my sonsneed things that are positive for them, to keep themon the right track.

When asked whether the Veteran Administrationsdeceased veterans life insurance payment coversa lot of costs for surviving families, Sarah quicklyput those benefits in context: Theres expensesyou dont realize unless youve been through itfuneral costs beyond what the Army covers, grievingprograms for the kids to attend, moving expenses,on your own helping your children buy their first carsand go to college someday. Most importantly, the lifeinsurance is there to help give the surviving spousethe time he or she needs with their children whiletaking care of final affairs and learning to take care ofeverything alone. Sarah adds, The [political leaders]who talk about cutting benefits make more [personalincome] in one year than we get when our husbandsdie.

When asked what she thinks of members ofCongress who propose cuts in guaranteed SocialSecurity benefits for future young survivors likeherself as a way to reduce government spending,Sarah says: The people in Washington who aremore fortunate want to take benefits away so it canmake them look good. I see lots of single moms like

myself struggling to go to college, or who want to goback to school and cant because they dont havechildcare help. If Congress wants to do somethingabout government spending, then maybe they shouldhelp single parents go back to school and betterthemselves, maybe give them a way to feed theirkids while theyre doing it. [Members of Congressconsidering benefit cuts] are not thinking about thesechildren at all.

S Sl y , 29 ears o , ennessee


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We built our Medicare system because it is by far thebest way to provide Americas seniors and peoplewith disabilities with affordable health care they cancount on. For nearly half a century, Medicare hasgiven seniors and people with disabilities access tocritical health care. It protects beneficiaries and theirfamilies against health-related expenditures thatmight otherwise overwhelm their financesor worse,force them to forego medical treatment needed tosurvive.

Private health insurance companies, which must

generate returns for their shareholders, were notand are notwilling or able to insure seniors andpeople with disabilities at affordable rates. That isbecause seniors and people with disabilities havegreater medical needs and thus are more costly thanthe young and healthy. Prior to Medicare, only abouthalf of seniors had health insurance. Those who wereinsured paid nearly three times as much as youngerpeople, even though they had, on average, only halfas much income. 49

Without Medicare, many people would not be able toafford basic medical services. Medicare beneficiariesare mainly people of modest means. Half hadincomes below $22,000 a year in 2010. 50 Already

more than one-quarter of many beneficiaries SocialSecurity benefit is eaten up by out-of-pocket healthcare costs. 51

Medicare worksfor seniors and people withdisabilities, as well as people with end-stage renaldisease (ESRD) and Amyotrophic Lateral Sclerosis(ALS, or Lou Gehrigs disease). The programprovides significant hospital, physician, medicaltesting, pharmaceutical, rehabilitation, medicalequipment and other important services to seniors,people with disabilities and people with ESRD and

ALS.52 Medicare provided health care coverage to48.7 million Americans in 2011, of whom over 8 outof 10 (40.4 million) were aged 65 or older; and 1 outof 6 (8.3 million) were severely disabled workers.53 The average expenditure per Medicare beneficiary in2011 was $12,042. 54

Medicare consists of four parts, each of whichprovides different medical benefits. Medicare Part A,the Hospital Insurance (HI) program, covers in-patienthospital as well as select kinds of skilled nursingfacility services, home health and hospice care. HIis earned during ones working years, and paid forby insurance contributions of 2.9 percent of wages,divided equally between employers and employees. 55*

Medicare Part B, the Supplemental MedicalInsurance (SMI) program, helps pay for physicianand preventive care services. SMI is a voluntaryprogram, funded by premiums, generally deductedfrom beneficiaries Social Security checks, and from

general revenue.56

(Medicaid covers the premium

M d W kS

* Starting in 2013, the Affordable Care Act levies an additional 0.9percentage point Hospital Insurance tax on earned income for householdswith incomes exceeding $200,000 for singles and $250,000 for marriedcouples filing jointly. In addition, it would add a 3.8 percent nearnedIncome Medicare Contribution for such high-income households tounearned income including interest, dividends, annuities, royalties andrents (excluding income from active participation in S corporations).White House, Title IX. Revenue Provisions,Health Re orm Details, 2012.http://www.whitehouse.gov/health-care-meeting/proposal/titleix/ targeted-healthcare-tax
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and out-of-pocket costs for those low-incomebeneficiaries who are enrolled in Medicaid.)

Medicare Part C, also known as the Medicare Advantage program, allows beneficiaries to enrollin a private insurance plan, in lieu of Medicare Parts

A and B. These private plans receive paymentsfrom Medicare to cover physician and hospitalservice, and in most cases, prescription drugbenefits. Medicare Advantage Plans cost more forthe same services as provided under Parts A andB.57 According to the White House, Medicare paysMedicare Advantage insurance companies over$1,000 more per person on average than traditionalMedicare.58 These extra costs result not only inhigher government outlays but also higher Part Bpremiums for those enrolled in traditional Medicare.

The Patient Protection and Affordable Care Act (ACA)of 2010 includes provisions which seek to make thecosts of Part C closer to those of Part A and PartB.59 About 11.5 million Medicare beneficiaries wereenrolled in Medicare Advantage as of April 2010one-quarter (24.5 percent) of all beneficiaries. 60

Medicare Part D, the prescription drug benefit,covers most outpatient prescription drugs. Part D

benefits are provided by private plans that contractwith Medicare and are purchased voluntarily byMedicare beneficiaries. They exist independently,or as part of a Medicare Advantage plan. Part D isfunded by beneficiary premiums, generally deductedfrom beneficiaries Social Security checks, and fromgeneral revenue. In addition, states are required topay premiums for low-income beneficiaries who areenrolled in Part D programs. 27.6 million beneficiarieswere enrolled in a Part D plan in 20104 out of 10(41.7 percent) of all beneficiaries. 61*

As health care costs skyrocket, our Medicare systemis more critical than ever. Medicare does a better

job of controlling health care costs than privatehealth insurance plans. While Medicares costsper person increased by about 4.7 percent a year

from 1999 to 2009, the costs of similar benefitsunder private insurance rose 6.9 percentnearly50 percent more. 62 [Figure 4] Medicares superiorcost-control record is no coincidence; it is a functionof Medicares concentrated purchasing power. AsProfessor Jacob Hacker of Yale niversity notes,Medicare is capable of using its concentratedpurchasing power to pioneer new payment methodsthat bring down costs. Hacker cites Medicaresimplementation of a prospective payment systemand a resource-based physician fee schedule in1983, and volume controls on Medicare physicianspending in the 1990s, as examples of Medicaressuccess in pioneering payment methods thatreduced underlying health care costs. 63

Even though the traditional Medicare program, Parts A and B, covers people who, on average, have morehealth care claims and more expensive medicalconditions than private insurance, its administrativecosts are lower than those of private health

insurance plans. Medicares administrative costswere less than 2 percent of its total expendituresin 2011.64 Private health insurances administrative

FIG RE 4

verage nn a ncrease in Spen ingon ommon Bene its,* 19992009

Source: Center for Medicare & Medicaid Services, 2010

Medicare Private Health Insurance

4.7%

6.9%

*Common benefits refers to benefits commonly covered byMedicare and private health insurance.

*As of January 1, 2011, the Affordable Care Act ensures that seniors whoreach the prescription drug coverage gap, known commonly as the donuthole, will receive discounts on brand-name and generic prescription drugscovered by Medicare Part D that increase gradually until the coverage gapis completely closed in 2020. Medicare.gov, Closing the Coverage GapMedicare Prescription Drugs Are Becoming More Affordable, January2012. http://www.medicare.gov/publications/pubs/pdf/11493.pdf
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costs, which include additional costs such asadvertising, retained profit to insurers and taxespaid by insurers, are generally much higher. TheCongressional Budget Office (CBO) estimated thatin 2007 these administrative costs varied from about7 percent for large employer plans with 1,000 ormore covered employees to as much as 30 percentfor insurance sponsored by very small firms orpurchased by individuals. 65 CBO estimated thatwhile Medicare paid about $150 per person enrolled,large employer plans paid about $300 per personenrolled, and small employers and individuals paidroughly $1,000 per person enrolled, on average. 66 The traditional Medicare Program, Parts A & B, isalso administered more efficiently than Medicare

Advantage, Part C, which is provided by privateinsurers who contract with Medicare. An analysis by

CBO shows that administrative costs accounted forless than 2 percent of expenditures in the traditionalMedicare program, compared to 11 percent in theMedicare Advantage program in 2005. 67

Maintaining our Medicare system is simple. As healthcare costs increase system-wide, Medicares costsrise as well. It is primarily as a result of system-widecost increases, that Medicare has significant long-term funding challenges. The solution is to slowthe growth of health care costs for everyone, asother developed countries have donenot to cutMedicares benefits. Cutting Medicares benefitssimply shifts costs to the sickest and oldest amongus, forcing some seniors and people with disabilitiesto forego treatment, living shorter, less healthyandmore medically costlylives as a result.

Medicare Works for Tennessees Economy Medicare provided $10.3 billion in benefits in

200925.6 percent of all health care spending in

the state. 68 The average expenditure per Medicarebeneficiary was $10,125. 69

Medicare Works for Tennessee Residents Medicare insured 1,020,977 Tennesseans in

20091 out of 6 (16.2 percent) state residents. 70

Medicare Works for Tennessees Seniors 807,683 of Tennessees 1,020,977 Medicare

beneficiaries were aged 65 or older in 20098 out of 10 (79.1 percent) beneficiaries. 71

Medicare Works for TennesseesPeople with Disabilities 213,294 of Tennessees 1,020,977 Medicare

beneficiaries were people with disabilities in20091 out of 5 (20.9 percent) beneficiaries. 72

Medicare Works for TennesseesResidents with End-Stage-Renal Disease

(ESRD) End-stage-renal disease (ESRD) occurs when

a persons kidneys stop functioning at a levelneeded for everyday life. People suffering fromESRD generally must undergo dialysis treatmentor receive a kidney transplant, which are bothprohibitively expensive.73

Medicare Works for TennesseesResidents with Amyotrophic LateralSclerosis (ALS) Amyotrophic Lateral Sclerosis, more commonly

known as ALS, or Lou Gehrigs disease, is anervous system disease that gradually shutsdown all muscles in a persons body, eventuallyresulting in death from respiratory failure. 74 ManyTennessee residents with ALS would impoverishthemselves or their families without the help ofMedicare.

Seniors and people with disabilities cannot be

economically secure if they are one illness away frombankruptcy. Medicare should be strengthened, notcut. As private sector health insurance continues torise in cost, Medicare is more important than ever.


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We built our Medicaid system to provide health carefor low-income families, children, seniors and peoplewith disabilities. For nearly half a century, Medicaidhas provided critical health coverage for low-income

Americans. While Medicaid originally only insured Americans receiving cash welfare assistance,Congress expanded it over the years to help insurethose left behind by the private insurance system. * Itis a lifeline for those who have nowhere else to go. 75 Medicaid insured 62.6 million Americans in 2009.76 Like Medicare, it is an important source of fundingfor rural hospitals and inner-city health care facilities.

Medicaid is essential because private healthinsurance is unaffordable for millions of Americans.Private health insurance costs have risendramatically in recent years. Average annualpremiums for a family with employer-sponsoredhealth insurance rose to $15,073 in 2011a 9percent increase from the previous year. 77

Medicaid is especially crucial to people in need ofcommunity- and institutionally-based long-term careservices. Medicare does not cover most long-termcare costs, and private insurance plans that coverlong-term care are often prohibitively expensive. Asa result, many individuals exhaust their assets underthe weight of steep long-term care costs, and havenowhere to turn but Medicaid. In short order, long-term care patients and their families can go from themiddle class to a life of poverty in which they needassistance.

Two-thirds of all Medicaid spending is for seniorsand people with disabilities. 78 One out of every fourseniors and people with disabilities depended onMedicaid in 201016 million people. That includes15.4 percent of all seniors (6.3 million) and 44.6percent of people with disabilities (9.8 million).79

Medicaid is also crucially important to children, whoare about half of its beneficiaries nationwide. 80 Morethan one in four of the nations children receive theirhealth insurance through Medicaid. 81

Maintaining our Medicaid system, like our Medicaresystem, is simple. As health care costs increasesystem-wide, Medicaids costs rise as well. It isprimarily as a result of system-wide cost increasesthat Medicaid has significant long-term fundingchallenges. The solution is to slow the growth ofhealth care costs for everyone, as other developedcountries have donenot to cut Medicaids benefits.Cuts in federal funding to Medicaid will shift costs to

states, if they have the funds to pick up the shortfall,or worse, to individuals and families who can least

M d d W kS

*The Affordable Care Acts expansion of Medicaid and Childrens HealthInsurance Program (CHIP) eligibility alone is projected to result in theenrollment of an additional 32 million Americans in Medicaid and CHIPby 2022. Congressional Budget Office, Table 3. March 2012 Estimateof the Effects of the Affordable Care Act on Health Insurance Coverage,Updated Estimates or the Insurance Coverage Provisions o the

A ordable Care Act, March 2012. http://www.cbo.gov/sites/default/files/ cbofiles/attachments/03-13-Coverage%20Estimates.pdf
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afford it. More troubling still, it may make life-savingmedical care inaccessible for those who need it.

Medicaid Works for Tennessees Economy Medicaid provided $7.3 billion in benefits in

200918.1 percent of all health care spending inthe state. 82 The average expenditure per Medicaidbeneficiary was $4,853. 83

Medicaid Works for Tennessee Residents Medicaid insured 1,502,364 Tennesseans in

20091 out of 4 (23.9 percent) state residents. 84

Medicaid Works for Tennessees Children Medicaid insured 759,069 children in 2009

half (51.1 percent) children in the state. 85

Medicaid Works for Tennessees Seniors 149,440 of Tennessees 1,502,364 Medicaid

beneficiaries were aged 65 or older in 20091 out of 10 (9.9 percent) beneficiaries. 86

Medicaid Works for Tennessees Peoplewith Disabilities 307,943 of Tennessees 1,502,364 Medicaid

beneficiaries were people with disabilities in20091 out of 5 (20.5 percent) beneficiaries. 87

Medicaid Works for TennesseesLong-Term Care Residents Medicaid provided $1.9 billion in long-term care

benefits for Tennessee residents in 2009. Thatincludes:o $652 million in home health care services

(34.3 percent)o $974 million to nursing home facilities

(51.3 percent)

o $6 million to mental health facilities(0.3 percent)

o $267 million to intermediate care facilities forthe intellectually disabled (14.1 percent). 88

Medicaid insured the vast majority of Tennesseeresidents who opt for nursing home care. 20,200of Tennessees 32,100 nursing home residentswere Medicaid beneficiaries in 20102 out of 3(62.9 percent) residents. 89 The average annualcost of nursing home care for a semiprivate roomin Tennessee was $62,400 in 2010. 90 Given thehigh cost of nursing home care, many Tennesseeresidents would not be able to afford it withoutMedicaid.

Medicaid Works for TennesseeDuring Economic Recessions

Because Medicaid eligibility is contingent uponhaving low income, the program expands toaccommodate those who have lost jobs or earningsduring a recession. Nationwide, between June 2008and June 2009, the height of the Great Recession,monthly Medicaid enrollment rose by 3.3 million.That amounts to a 79 percent increase from theaverage annual enrollment rate between 2000and 2007. While there are several factors that fuelMedicaid enrollment, experts believe that job lossesand resulting losses of employer-based insuranceand declining income, cause more people to qualifyfor Medicaid.91

As financially strapped states cut Medicaid, the lastthing the nations seniors, people with disabilities,and low-income children need is for the federalgovernment to cut the program at the national level.Like Social Security and Medicare, this vital programshould be strengthened, not cut.


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The large run-up in federal deficits in recentyears resulted primarily from huge tax cuts in

2001 and 2003; the unpaid costs of the Iraq and Afghanistan wars; the Great Recession, whichdramatically reduced tax collections and increasedunemployment compensation and other spending;the economic stimulus and recovery spending; andthe Wall Street bank bailout. 92 [Figure 5] By law,Social Security can only pay benefits if it has theincome to cover its costs. Its income is primarily theresult of insurance contributions paid by hardworking

Americans and their employers. It does not haveborrowing authority which is why it never has andnever will contribute to federal budget deficits.

Likewise, large anticipated yearly increases in healthcare expenditures, public and private, reflect long-term structural problems in the nations health care

system. Compared to other industrial democracies,the nited States expends roughly twice as much

per person on health care generally without providingcoverage for all our citizens. While the nations recenthealth care reform is expected to bend the cost curveand to expand coverage, health care expenditures arestill expected to rise for many years, well in excess ofinflation. Thats bad for consumers, employers andthe economy, but it is not the fault of Medicare andMedicaid. In fact, Medicare is the most efficient partof the health care system, averaging just 2 percentin administrative costs compared to about 7 percentfor large group plans and as much as 30 percent forplans purchased by individuals. 93

To reduce the federal debt, Congress should belooking at its causes. It should not cut Social Security,Medicare, and Medicaid, which were built to protectworking persons and their families against lostwages and the high cost of health care, and whichare so vital to the economic security of our nation.

Social Security, Medicare and Medicaid represent

the best of Americas values, including caring foraging parents and neighbors, reward for hard work,personal responsibility and dignity. In Tennessee,these programs spend about $33.5 billion a year,providing benefits to an average of 1 out of 5residents for each program. 94 It is no surprise thatpoll after poll shows that Americans overwhelminglysupport these programs and do not want to seethem cut. Cutting them would weaken the economicsecurity of all Americans. While that would be badpolicy anytime, it would be disastrous in this time ofwidespread economic loss.

The old, the disabled and todays workers have astake in preserving these foundational systemsfor themselves, their families, their children andgrandchildren. And politicians have the opportunityto maintain and improve these paramountachievements for future generations, just as previousCongresses and presidents have done for us.

luS

FIG RE 5

a ses o ecent n-upin fe era de icits

Source: Center for Economic and Policy Research, 2012

n Wars in Iraq and Afghanistann Bush-era tax cutsn Recocvery measuresn TARP, Fannie and Freddien Economic downturn

B i l l i o n s o

f d o

l l a r s

1600

1400

1200

1000

800

600

400

200

0

-200

-400

2001 2003 2005 2007 2009 2011

ACT AL DEFICITS

DEFICITS WITHO T THESE FACTORS


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ppen ix 1: Socia Sec rit Wor s or ennessees ongressiona districts

SC SS D S C S

1 2 3 4 5 6 7 8 9

otal annual

benefts($ in millions)* $15,737M $2,133M $1,941M $1,961M $2,065M $1,402M $1,771M $1,658M $1,699M $1,108M

umber oresidents instate/ congressionaldistrict

6,346,105 684,093 723,798 692,346 688,008 707,420 788,754 792,605 658,258 610,823

umber oresidentsreceivingSocial Security benefts

1,251,947 175,044 149,406 154,268 170,414 104,541 140,440 125,320 140,389 92,125

Percent oresidentsreceivingSocial Security benefts

19.7% 25.6% 20.6% 22.3% 24.8% 14.8% 17.8% 15.8% 21.3% 15.1%

Women 642,006 N/A N/A N/A N/A N/A N/A N/A N/A N/A

Retired workers

756,708 101,025 94,459 92,748 101,322 66,201 85,879 80,418 83,059 51,597

Disabled workers

230,168 35,991 25,015 29,069 32,410 17,954 25,742 18,611 26,910 18,466

Widow(er)s 104,318 15,261 12,421 13,016 14,619 8,373 10,965 9,833 11,708 8,122

Spouses 49,737 8,210 6,482 6,532 7,390 3,336 4,991 5,283 4,928 2,585

Children 111,016 14,557 11,029 12,903 14,673 8,677 12,863 11,175 13,784 11,355

Sources: S Census Bureau, Profle o General Population and Housing Characteristics: 2010, 2011.SSA, Tennessee, Congressional Statistics, December 2010, 2011.SSA, Table 5.J5.1Number by state or other area and sex, December 2010, Annual Statistical Supplement, 2011, February 2012.

*The annual bene ts for the Congressional districts were calculated by taking the monthly bene ts and multiplying by 12. The state annual bene ts number isthe sum of the congressional district numbers and is not necessarily consistent with state totals cited elsewhere in the report.

S O C I A L S E C R I T Y B E N E F I C I A R I E S B Y

C A T E G O R Y


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Endnotes

1 Complete citations for the sources of the numbers included in Figure 1 can be found where the numbers appear elsewhere in the report. Allof the statistical data used in Figure 1, as well as the rest of the report, are the most current data available. Some data were available in morerecent years than others. For sets of data partially available for one year and partially available for another, the most recent common year waschosen. As a result, nearly all numbers relating to Social Security date to 2010, nearly all numbers related to Medicare date to 2009, and nearlyall numbers related to Medicaid date to FY2009. When data from other years are used, the report says so explicitly.2 While Social Security and Medicare bene ts are funded entirely by the federal government, Medicaid is partially funded by stategovernments, and sometimes local governments.

3 There were 56 million bene ciaries nationwide as of May 2012. Except where otherwise noted, the rest of the Social Security data referencedin this report date to 2010, the most recent common year in which those data were available. Total Social Security bene ciaries in individualstates dating to 2010 will not add up to this gure. Social Security Administration (SSA), Table 2. Social Security Bene ts, May 2012, Monthly Statistical Snapshot, May 2012 , June 2012. http://www.ssa.gov/policy/docs/quickfacts/stat_snapshot/#table2 4 Average annual bene t amounts calculated by dividing total annual bene ts by total bene ciaries. Total annual bene ts from SSA, Table 5.J1Estimated total annual bene ts paid, by state or other area and program, 2010 (in millions of dollars), Annual Statistical Supplement , 2011 [herein, Ann. Stat. Supp. ], February 2012 . http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2 Total bene ciariesfrom SSA, Table 5.J2Number, by state or other area, program, and type of bene t, December 2010, Ann. Stat Supp. , February 2012. http:// www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j15 Households refers to aged units, which are married couples living together of whom at least one is aged 65 or older, or unmarried personsaged 65 or older. SSA, Table 9.A1, Income o the Population, 55 or Older , 2010 , August 2012. http://www.ssa.gov/policy/docs/statcomps/ income_pop55/2010/sect09.html#table9.a16 Center on Budget & Policy Priorities (CBPP), Social Security Keeps 20 Million Americans Out of Poverty, A State-by-State Analysis,

August, 2010. http://www.cbpp.org/ les/8-11-10socsec.pdf7 Social Security Trustees, 2012 Social Security Trustees Report , April 25, 2012, p. 11. http://www.ssa.gov/oact/tr/2012/tr2012.pdf 8 CBPP, What the 2012 Trustees Report Shows About Social Security, Figure 1, May 10, 2012. http://www.cbpp.org/cms/index.cfm?fa=view&id=37749 White House, Of ce of Management and Budget, Table 1.1 Summary o Receipts, Outlays and Surpluses or Defcits: 1789-2017 , 2012.http://www.whitehouse.gov/omb/budget/Historicals10 Social Security does not contribute to the de cit, because bene ts can only be paid from revenue collected by the Social Security trustfundsthe Old-Age and Survivors Insurance (OASI) trust fund and Disability Insurance (DI) trust fundwhich are completely separate fromthe general budget. Social Security Trustees, Table II.B1, 2012 Social Security Trustees Report , April 25, 2012, p. 6. http://www.ssa.gov/oact/ tr/2012/tr2012.pdf. In 2010 and 2011, the General Fund transferred money to the Social Security trust funds in order to replace revenue lost dueto a temporary two-percentage-point payroll tax reduction. The payroll tax cut, and the General Fund transfer that resulted, was a temporarystimulus measure that will expire at the end of the year. It never fundamentally changed Social Securitys self-sustaining funding structure.

The trust funds do not have borrowing authority, and therefore, cannot de cit-spend. In the event that trust fund revenues fall short ofwhat is needed to pay 100 percent of bene ts, then, by law, bene ts could not be paid in full and on time. That is why, if Congress does nothingto shore up the programs nances by 2033, Social Security will only have suf cient revenue to pay about three-quarters of scheduled bene tsthrough 2086. Social Security Trustees, Table II.D2, 2012 Social Security Trustees Report , April 25, 2012, p. 11 http://www.ssa.gov/oact/tr/2012/ tr2012.pdf This modest funding shortfall is often cited as evidence that the program is nancially unsustainable, or in de cit. In fact, it is justthe opposite: it attests to Social Securitys self-sustaining funding structure that bars it from de cit-spending or borrowing from the general

budget in any way.11 Total bene ciaries from SSA, Table 5.J2Number, by state or other area, program, and type of bene t, December 2010, Ann. Stat. Supp.,February 2012. http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2 State population data from .S. Census Bureau,Pro le of General Population and Housing Characteristics: 2010, 2010 Demographic Profle Data , 2011. http://fact nder2.census.gov/faces/ tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1&prodType=table12 Total annual bene ts from SSA, Table 5.J1Estimated total annual bene ts paid, by state or other area and program, 2010 (in millions ofdollars), Ann. Stat. Supp. , February 2012. http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j1 Bene ts equivalentpercentage of Gross Domestic Product (GDP) calculated using state GDP gures from Bureau of Economic Analysis, Gross Domestic Productby State (millions of current dollars), September 29, 2011. http://bea.gov/iTable/iTable.cfm?ReqID=70&step=1&isuri=1&acrdn=113 Average bene t found by dividing total spending by total bene ciaries. Total annual bene ts from Social Security Administration (SSA),Table 5.J1Estimated total annual bene ts paid, by state or other area and program, 2010 (in millions of dollars), Ann. Stat. Supp. , February2012. http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j1 Total bene ciaries from SSA, Table 5.J2Number, by stateor other area, program, and type of bene t, December 2010, Ann. Stat. Supp. , February 2012. http://www.ssa.gov/policy/docs/statcomps/ supplement/2011/5j.html#table5.j214 CBPP, Social Security Keeps 20 Million Americans Out of Poverty, A State-by-State Analysis, August, 2010. http://www.cbpp.org/ les/8-11-10socsec.pdf Total number of state residents lifted out of poverty, which does not appear in CBPPs report, was made available to Social

Security Works by the reports authors, Arloc Sherman and Paul N. Van de Water. The state-level data re ect an average from 2006-2008, andtherefore do not add up to the national totals, which date to 2008.15 For the purposes of this analysis, seniors describes individuals aged 65 or older. Herein, all references to seniors will re ect thisde nition.16 SSA, Table 5.J2Number, by state or other area, program and type of bene t, December 2010, Ann. Stat. Supp. , February 2012. http:// www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2 17 For the purposes of this analysis, typical is used to describe the median bene t. Herein, all references to typical will re ect thisdescription. Monthly median bene t multiplied by 12 to calculate annual gure. SSA, Table 5.J6Percentage distribution of monthly bene t forretired workers, by state or other area and monthly bene t, December 2010, Ann. Stat. Supp. , February 2012. http://www.ssa.gov/policy/docs/ statcomps/supplement/2011/5j.html#table5.j618 SSA, Table 5.J2Number, by state or other area, program, and type of bene t, December 2010, Ann. Stat. Supp. , February 2012. http:// www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j219 CBPP, Social Security Keeps 20 Million Americans Out of Poverty, A State-by-State Analysis, August, 2010. http://www.cbpp.org/ les/8-11-10socsec.pdf The state-level data re ect an average from 2006-2008, and therefore do not add up to the national totals, which date to 2008.
http://www.ssa.gov/policy/docs/quickfacts/stat_snapshot/#table2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j1http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j1http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a1http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a1http://www.cbpp.org/files/8-11-10socsec.pdfhttp://www.ssa.gov/oact/tr/2012/tr2012.pdfhttp://www.cbpp.org/cms/index.cfm?fa=view&id=3774http://www.cbpp.org/cms/index.cfm?fa=view&id=3774http://www.whitehouse.gov/omb/budget/Historicalshttp://www.ssa.gov/oact/tr/2012/tr2012.pdfhttp://www.ssa.gov/oact/tr/2012/tr2012.pdfhttp://www.ssa.gov/oact/tr/2012/tr2012.pdfhttp://www.ssa.gov/oact/tr/2012/tr2012.pdfhttp://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1&prodType=tablehttp://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j1http://bea.gov/iTable/iTable.cfm?ReqID=70&step=1&isuri=1&acrdn=1http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j1http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.cbpp.org/files/8-11-10socsec.pdfhttp://www.cbpp.org/files/8-11-10socsec.pdfhttp://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j6http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j6http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.cbpp.org/files/8-11-10socsec.pdfhttp://www.cbpp.org/files/8-11-10socsec.pdfhttp://www.cbpp.org/files/8-11-10socsec.pdfhttp://www.cbpp.org/files/8-11-10socsec.pdfhttp://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j6http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j6http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.cbpp.org/files/8-11-10socsec.pdfhttp://www.cbpp.org/files/8-11-10socsec.pdfhttp://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j1http://bea.gov/iTable/iTable.cfm?ReqID=70&step=1&isuri=1&acrdn=1http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j1http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1&prodType=tablehttp://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/oact/tr/2012/tr2012.pdfhttp://www.ssa.gov/oact/tr/2012/tr2012.pdfhttp://www.ssa.gov/oact/tr/2012/tr2012.pdfhttp://www.ssa.gov/oact/tr/2012/tr2012.pdfhttp://www.whitehouse.gov/omb/budget/Historicalshttp://www.cbpp.org/cms/index.cfm?fa=view&id=3774http://www.cbpp.org/cms/index.cfm?fa=view&id=3774http://www.ssa.gov/oact/tr/2012/tr2012.pdfhttp://www.cbpp.org/files/8-11-10socsec.pdfhttp://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a1http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a1http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j1http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j1http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/quickfacts/stat_snapshot/#table2


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20 CBPP, Social Security Keeps 20 Million Americans Out of Poverty, A State-by-State Analysis, August, 2010. http://www.cbpp.org/ les/8-11-10socsec.pdf The state-level data re ect an average from 2006-2008, and therefore do not add up to the national totals, which date to 2008.21 SSA, Table 5.J5.1Number, by state or other area, race, and sex, December 2010, Ann. Stat. Supp. , February 2012. http://www.ssa.gov/ policy/docs/statcomps/supplement/2011/5j.html#table5.j5.1 Percentage of women receiving bene ts calculated using total female populationfrom .S. Census Bureau, Age groups and Sex: 2010, 2010 Census Summary File 2 . http://fact nder2.census.gov/faces/tableservices/jsf/ pages/productview.xhtml?pid=DEC_10_SF1_QTP1&prodType=table22 SSA, Table 5.J2Number, by state or other area, program, and type of bene t, December 2010, Ann. Stat. Supp. , February 2012. http:// www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j223 CBPP, Ibid. The number and percentage of women aged 65 or older lifted out of poverty, which do not appear in CBPPs report, weremade available by the reports authors, Arloc Sherman and Paul N. Van de Water. The state-level data re ect an average from 2006-2008, andtherefore do not add up to the national totals, which date to 2008.24 CBPP, Ibid. The number and percentage of women aged 65 or older lifted out of poverty, which do not appear in CBPPs report, weremade available by the reports authors, Arloc Sherman and Paul N. Van de Water. The state-level data re ect an average from 2006-2008, andtherefore do not add up to the national totals, which date to 2008.25 The number of Social Security disability bene ciaries cited here includes only those disabled workers receiving disability bene ts. It does notinclude those disabled workers and disabled adult children who receive Old-Age (retirement) and Survivors bene ts. Herein, any use of theterm disabled worker will refer only to those disabled workers receiving disability bene ts.26 SSA, Table 5.J8Percentage distribution of disabled workers, by state or other area and monthly bene t, December 2010, Ann. Stat.Supp. , February 2012. http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j827 Monthly median bene t multiplied by 12 to calculate annual gure. SSA, Ibid.28 nless otherwise speci ed as children under 18 to the exclusion of all others, the term children used in this section is consistent with theSocial Security Administrations use of the term to include three groups: children under age 18; students aged 18-19, which refers to childrenages 18 and 19 who are matriculated in an institution of secondary education; and disabled adult children, which refers to those adults whohave been disabled since before they reached age 18.29 .S. Census Bureau, Age Groups and Sex: 2010, 2010 Summary File 2 , 2011. http://fact nder2.census.gov/faces/tableservices/jsf/pages/

productview.xhtml?pid=DEC_10_SF2_QTP1&prodType=table Data on percentage of children insured from SSA, Survivors Bene ts, 2011, p. 4.http://ssa.gov/pubs/10084.pdf30 SSA, Table 5.J10Number of children, by state or other area and type of bene t, December 2010, Ann. Stat. Supp. , February 2012. http:// www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j1031 Association of American Retired Persons (AARP), Grandfacts: State fact sheets for grandparents and other relatives raising children, 2011.http://www.aarp.org/relationships/friends-family/grandfacts-sheets/ 32 SSA, Table 5.J5.1Number, by state or other area, race, and sex, December 2009, Annual Statistical Supplement, 2010 , 2010. http:// www.ssa.gov/policy/docs/statcomps/supplement/2010/5j.html#table5.j5.1 African American population from .S. Census Bureau, SelectedPopulation Pro le in the nited States, 2007-2009 American Community Survey 3-Year Estimates . http://fact nder2.census.gov/faces/ tableservices/jsf/pages/productview.xhtml?pid=ACS_09_3YR_S0201&prodType=table33 SSA, Table 9.A3, Income o the Population 55 or Older , 2010 , March 2012. http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/ sect09.html#table9.a334 SSA, Table 5.A1Number and average monthly bene t, by type of bene t and race, December 2009, Annual Statistical Supplement, 2010 ,February 2011. http://www.ssa.gov/policy/docs/statcomps/supplement/2010/5a.html#table5.a135 The term households as it is used here refers to households reporting income in the past 12 months. Households receiving SocialSecurity bene ts are those households listed as receiving Social Security income. .S. Census Bureau, Selected Population Pro le,

2008-2010 American Community Survey 3-Year Estimates . http://fact nder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=table 36 SSA, Table 9.A3, Income o the Population 55 or Older , 2010 , March 2012. http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/ sect09.html#table9.a337 SSA, Social Security is Important to Hispanics, January 2012. http://www.ssa.gov/pressof ce/factsheets/hispanics-alt.pdf38 The term households as it is used here refers to households reporting income in the past 12 months. Households receiving SocialSecurity bene ts are those households listed as receiving Social Security income. .S. Census Bureau, Selected Population Pro le,

2008-2010 American Community Survey 3-Year Estimates , 2011. http://fact nder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=table39 SSA, Social Security is Important to American Indians and Alaska Natives, January 2012. http://www.ssa.gov/pressof ce/factsheets/ amerindian-alt.pdf40 SSA, Social Security is Important to American Indians and Alaska Natives, January 2012. http://www.ssa.gov/pressof ce/factsheets/ amerindian-alt.pdf41 The term households as it is used here refers to households reporting income in the past 12 months. Households receiving SocialSecurity bene ts are those households listed as receiving Social Security income. For states in which there are large numbers of Asian

American residents as well as Native Hawaiian and Paci c Islander residents, the numbers of bene ciaries and residents were added tocalculate percentage of total Asian American, Native Hawaiian and Paci c Islander residents receiving bene ts. .S. Census Bureau, SelectedPopulation Pro le, 2008-2010 American Community Survey 3-Year Estimates , 2011. http://fact nder2.census.gov/faces/tableservices/jsf/ pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=table42 SSA, Table 9.A3, Income o the Population 55 or Older , 2010 , March 2012. http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/ sect09.html#table9.a343 SSA, Social Security is Important to Asian Americans and Paci c Islanders, January 2012. http://www.ssa.gov/pressof ce/factsheets/ asian-alt.pdf44 .S. Department of Agricultures Economic Research Service (ERS), designates counties as rural or urban based on population density,grading them on a scale of 1 to 9, with 1 being the most urban and 9 being the most rural. Counties are considered rural if they are designated4 or higher. For the purposes of this report, the authors used both the ERSs 9-point scale, and the binary abbreviation of these codes, whichcodes rural counties 0 and urban counties 1.
http://www.cbpp.org/files/8-11-10socsec.pdfhttp://www.cbpp.org/files/8-11-10socsec.pdfhttp://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j5.1http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j5.1http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_SF1_QTP1&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_SF1_QTP1&prodType=tablehttp://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j8http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_SF2_QTP1&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_SF2_QTP1&prodType=tablehttp://ssa.gov/pubs/10084.pdfhttp://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j10http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j10http://www.aarp.org/relationships/friends-family/grandfacts-sheets/http://www.ssa.gov/policy/docs/statcomps/supplement/2010/5j.html#table5.j5.1http://www.ssa.gov/policy/docs/statcomps/supplement/2010/5j.html#table5.j5.1http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_09_3YR_S0201&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_09_3YR_S0201&prodType=tablehttp://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a3http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a3http://www.ssa.gov/policy/docs/statcomps/supplement/2010/5a.html#table5.a1http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=tablehttp://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a3http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a3http://www.ssa.gov/pressoffice/factsheets/hispanics-alt.pdfhttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=tablehttp://www.ssa.gov/pressoffice/factsheets/amerindian-alt.pdfhttp://www.ssa.gov/pressoffice/factsheets/amerindian-alt.pdfhttp://www.ssa.gov/pressoffice/factsheets/amerindian-alt.pdfhttp://www.ssa.gov/pressoffice/factsheets/amerindian-alt.pdfhttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=tablehttp://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a3http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a3http://www.ssa.gov/pressoffice/factsheets/asian-alt.pdfhttp://www.ssa.gov/pressoffice/factsheets/asian-alt.pdfhttp://www.ssa.gov/pressoffice/factsheets/asian-alt.pdfhttp://www.ssa.gov/pressoffice/factsheets/asian-alt.pdfhttp://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a3http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a3http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=tablehttp://www.ssa.gov/pressoffice/factsheets/amerindian-alt.pdfhttp://www.ssa.gov/pressoffice/factsheets/amerindian-alt.pdfhttp://www.ssa.gov/pressoffice/factsheets/amerindian-alt.pdfhttp://www.ssa.gov/pressoffice/factsheets/amerindian-alt.pdfhttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=tablehttp://www.ssa.gov/pressoffice/factsheets/hispanics-alt.pdfhttp://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a3http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a3http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=tablehttp://www.ssa.gov/policy/docs/statcomps/supplement/2010/5a.html#table5.a1http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a3http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/sect09.html#table9.a3http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_09_3YR_S0201&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_09_3YR_S0201&prodType=tablehttp://www.ssa.gov/policy/docs/statcomps/supplement/2010/5j.html#table5.j5.1http://www.ssa.gov/policy/docs/statcomps/supplement/2010/5j.html#table5.j5.1http://www.aarp.org/relationships/friends-family/grandfacts-sheets/http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j10http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j10http://ssa.gov/pubs/10084.pdfhttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_SF2_QTP1&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_SF2_QTP1&prodType=tablehttp://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j8http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_SF1_QTP1&prodType=tablehttp://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_SF1_QTP1&prodType=tablehttp://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j5.1http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j5.1http://www.cbpp.org/files/8-11-10socsec.pdfhttp://www.cbpp.org/files/8-11-10socsec.pdf


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45 County-level population data from .S. Census Bureau, Pro le of General Population and Housing Characteristics: 2010, 2010 DemographicProfle Data . http://fact nder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1&prodType=table Bene ciary datafrom SSA, Table 4. Number of bene ciaries in current payment status, by county, type of bene t, and sex of bene ciaries aged 65 or older, December2010, OASDI Benefciaries by State and County, 2010 , August 2011. http://www.ssa.gov/policy/docs/statcomps/oasdi_sc/index.html46 Total personal income: Bureau of Economic Analysis (BEA), Regional Economic Accounts: Local Area Personal Income, Personal income inCA 05N Personal income by major source and earnings by NAICS industry. http://bea.gov/regional/reis/ Social Security income: BEA, RegionalEconomic Accounts: Local Area Personal Income, Old-age, Survivors and Disability Insurance (OASDI) bene ts in CA 35 Personal current trans er receipts . http://bea.gov/regional/reis/ BEA data were used for total annual Social Security bene ts rather than the gures available from the SSA in order to be consistent with the denominator of Personal income, which came from BEA. For other purposes in the report, such ascalculating the average bene t and average retirement bene t in rural counties, SSA data were used.47 SSA, Of ce of the Chief Actuary, Robert Baldwin and Sharon Chu, Actuarial Note 2011.6: A Death and Disability Life Table for InsuredWorkers Born in 1991, February 2012. The term retirement age refers to the Full Retirement Age at which workers become eligible for fullretirement bene ts for Social Security. http://www.ssa.gov/OACT/NOTES/ran6/index.html48 SSA, Of ce of the Chief Actuary, Orlo R. Nichols, The Insurance Value and Potential Survivor and Disability Bene ts for an Il lustrativeWorker, Memo to Alice Wade, Deputy Chief Actuary of Social Security, August 2008. http://socialsecurity-works.org/wp-content/ uploads/2012/03/Illustrative_Survivor_and_Disabilitycase_2008.pdf49 National Academy of Social Insurance (NASI), Medicare Finances: Findings of the 2012 Trustees Report, April 2012, p. 1. http://www.nasi.org/sites/default/ les/research/Medicare_Finances_Findings_of_the_2012_Trustees_Report.pdf 50 Kaiser Family Foundation (KFF), Projecting Income and Assets: What Might the Future Hold for the Next Generation of MedicareBene ciaries? June 2011. http://www.kff.org/medicare/upload/8172.pdf51 Social Security Works calculation based on projected out-of-pocket health care costs in 2014 under current law, and projected SocialSecurity bene ts of retired worker with average earnings of $43,560. Out-of-pocket costs projection from KFF, Raising the Age o MedicareEligibility: A Fresh Look Following Implementation o Health Re orm , p. 9-10, July 2011. http://www.kff.org/medicare/upload/8169.pdf Theestimated Social Security bene t is a projection for 2015, the closest date to 2014 available. Social Security Trustees, Table VI.F10. AnnualScheduled Bene t Amounts for Retired Workers With Various Pre-Retirement Earnings Patterns Based on Intermediate Assumptions, Calendar

Years 2011-85, 2011 Social Security Trustees Report , May 13, 2011, p. 201. http://www.ssa.gov/oact/tr/2011/tr2011.pdf52 People with severe disabilities become eligible for Medicare coverage only after receiving Social Security Disability Insurance (DI) bene tsfor 24 months. People with End-Stage-Renal Disease (ESRD) and Lou Gehrigs disease become eligible for Medicare as soon as they qualify forMedicare. Kaiser Family Foundation (KFF), Medicare: a Primer , April 2010, p. 2. http://www.kff.org/medicare/upload/7615-03.pdf53 There were 48.7 million bene ciaries nationwide in 2011. Except where otherwise noted, the rest of the Medicare data referenced in thisreport date to 2009, the most recent common year in which those data were available. Total Medicare bene ciaries in individual states datingto 2009 will not add up to this gure. Medicare Trustees, 2012 Medicare Trustees Report , April 23, 2012, p. 6. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2012.pdf54 Average expenditure per bene ciary is average bene t per enrollee. Medicare Trustees, 2012 Medicare Trustees Report , Table II.B1Medicare Data for Calendar Year 2011, p. 10. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ ReportsTrustFunds/Downloads/TR2012.pdf55 KFF, Medicare: a Primer , April 2010, p. 1. http://www.kff.org/medicare/upload/7615-03.pdf 56 KFF, Ibid.57 Medicare Payment Advisory Board (Medpac), Report to the Congress: Medicare Payment Policy, Chapter 4 , March 2010. http://www.medpac.gov/chapters/Mar10_Ch04.pdf58 White House, Of ce of the Press Secretary, The Affordable Care Act: Strengthening Medicare, Combating Misinformation and Protecting

Americas Senior, June 8, 2010. http://www.whitehouse.gov/the-press-of ce/affordable-care-act-strengthening-medicare-combating-misinformation-and-protecting-59 White House, Of ce of the Press Secretary, Ibid.60 KFF, Medicare: a Primer , April 2010, p. 1. http://www.kff.org/medicare/upload/7615-03.pdf Percentage of total Medicare bene ciariesenrolled in Medicare Advantage calculated using total Medicare bene ciaries gure for 2010 in source.61 KFF, Ibid. Percentage calculation done by the author.62 Center for Medicare & Medicaid Services (CMS), Table 13, National Health Expenditure Data . https://www.cms.gov/ nationalhealthexpenddata/downloads/tables.pdf Presentation of data done according to the method employed by Jacob S. Hacker for Figure 2in The Case or Public Plan Choice in National Health Re orm , 2009. http://institute.ourfuture.org/ les/Jacob_Hacker_Public_Plan_Choice.pdf63 Hacker, The Case or Public Plan Choice in National Health Re orm , 2009, p. 6. http://institute.ourfuture.org/ les/Jacob_Hacker_Public_Plan_Choice.pdf64 Medicare Trustees, Table II.B1Medicare Data for Calendar Year 2011, 2012 Medicare Trustees Report , April 2012, p. 10. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2012.pdf Figure re ects totaladministrative expenses of Medicare Parts A, B, and D, but not Part C, for which that information was not available.65 Congressional Budget Of ce (CBO), Key Issues in Analyzing Major Health Insurance Proposals, December 2008, p. 70. http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf66 CBO, Ibid, p. 94. http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf67 Medicare Advantages administrative costs are expected to decline from the gure cited above as a result of reforms passed in the PatientProtection and Affordable Care Act (ACA) of March 2010. CBO, Designing a Premium Support System for Medicare, December 2006, p. 12.http://www.cbo.gov/ftpdocs/76xx/doc7697/12-08-Medicare.pdf68 KFF, Medicare Spending Estimates by State of Residence (in millions), 2009, December 2011. http://www.statehealthfacts.org/ comparemaptable.jsp?ind=620&cat=6 Total health care spending from: KFF, Health Care Expenditures by State of Residence (in millions),2009, December 2011. http://www.statehealthfacts.org/comparemaptable.jsp?ind=592&cat=569 Average bene t found by dividing total spending by total bene ciaries. KFF, Medicare Spending Estimates by State of Residence (inmillions), 2009, December 2011. http://www.statehealthfacts.org/comparemaptable.jsp?ind=620&cat=6 KFF, Distribution of MedicareBene ciaries by Eligibility Category, 2009, 2010. http://www.statehealthfacts.org/comparetable.jsp?ind=293&cat=670 KFF, Distribution of Medicare Bene ciaries by Eligibility Category, 2009, 2010. http://www.statehealthfacts.org/comparetable.

jsp?ind=293&cat=6 State population data from .S. Census Bureau, General Demographic Characteristics, 2009 Population Estimates .http://fact nder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2009_DP1&prodType=table
http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1&prodType=tablehttp://www.ssa.gov/policy/docs/statcomps/oasdi_sc/index.htmlhttp://bea.gov/regional/reis/http://bea.gov/regional/reis/http://www.ssa.gov/OACT/NOTES/ran6/index.htmlhttp://socialsecurity-works.org/wp-content/uploads/2012/03/Illustrative_Survivor_and_Disabilitycase_2008.pdfhttp://socialsecurity-works.org/wp-content/uploads/2012/03/Illustrative_Survivor_and_Disabilitycase_2008.pdfhttp://www.nasi.org/sites/default/files/research/Medicare_Fina

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