Social Security, Medicare and Medicaid Work For New York

Social Security, Medicare and Medicaid Work for neW york
www.StrengthenSocialSecurity.org
Our Social Security, Medicare and Medicaid Work for America series of 50 state reports includes much information that public officials, members of the press, and advocates will find useful. In addition to providing information about the programs history, character and vitality, as well as compelling, real-life stories, each report includes statistics about the number of people who receive benefits, the types of benefits they receive and 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 New Yorks 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 Medicaid Data for New Yorks Counties, toward the back of the report, just before the end notes.
ACKNOWLEDGMENTS
Like our Social Security, Medicare and Medicaid, this report is the product of the foresight and hard work of many people. Social Security Works partnered closely with the Alliance for Retired Americans who are coordinating the release of this report in New York. We are grateful to the following people for writing, designing and producing this report: Daniel Marans, Policy Director of Social Security Works (SSW), is the principal author and lead researcher, whose commitment to excellence, along with that of Alex Lawson, SSWs Executive Director, drove the project to its successful conclusion. Michael Phelan, SSWs Deputy Director managed the actual production of 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 Molly Checksfield, SSWs Legislative and Policy Associates, played a crucial role in the reports completion, performing a significant amount of the initial research, drafting the appendices, and editing and verifying the data in the report. Tom Arnold-Forster, National Academy of Social Insurance Summer Policy Fellow, proofread the data. Very importantly, we want to acknowledge our appreciation to Bernice Jorge and Abney and Amelia Montgomery for generously sharing their stories and views about the importance of Social Security and Medicare in their lives. The Center for Economic Policy and Research provided the invaluable analysis and graph showing the causes of the recent run-up in federal deficits. We would also like to acknowledge the staff of the Kaiser Family Foundation for their assistance in finding and understanding the Medicare and Medicaid data in the report, especially Research Associates Lindsay Donaldson 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 and access to poverty data analyzed by the Center. Alice Wade, Deputy Chief Actuary of the Social Security Administration, with the help of Virginia Reno, Vice President for Income Security at the National Academy of Social Insurance, graciously provided data on the value of Social 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 local economies. We hope the report is useful to you as you work to strengthen Social Security in this 77th anniversary year. Please contact the Social Security Works Communications Director, Don Owens, if you have questions about this report: dowens@socialsecurity-works.org. Nancy Altman and Eric Kingson Founding Co-directors, Social Security Works Co-chairs, Strengthen Social Security Coalition The Alliance for Retired Americans is a grassroots organization representing more than 4 million retirees and seniors nationwide. Headquartered in Washington, DC, the Alliances mission is to advance public policy that protects the health 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, especially disadvantaged and at-risk populations, and, in so doing, to promote social justice for current and future generations of 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 state organizations, representing more than 50 million Americans. The Coalition is united around core principles, which include that Social Security benefits should not be cut and, instead, should be increased for those who are most disadvantaged, and the belief that our nations Social Security, Medicare and Medicaid systems are fundamental to the well-being of Americas families and to the type of nation we are. www.strengthensocialsecurity.org
introduction and SuMMary

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 the average 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 structure intended to lessen the force of possible future depressions. It will act as a protection to future Administrations against the necessity of going deeply into debt to furnish relief to the needy. The law will flatten out the peaks and valleys of deflation and of inflation. It is, in short, a law that will take care of human needs and at the same time provide for the united States an economic structure of vastly greater soundness. Franklin D. Roosevelt, August 14, 1935
In 1935, when President Franklin D. Roosevelt signed the Social Security Act into law he called it a cornerstone, the foundation of a structure to be maintained and built upon by and for future generations. Social Security could not protect all Americans against every risk, but, as the President said, it could lessen the consequences of lost earnings in old age for workers and their families. Since then, we have built our Social Security structure carefully and deliberately. In 1939, we added Survivors Insurance benefits for widows and dependent children, eventually extending it to widowers as well. Disability Insurance benefits were added in 1956, followed by Medicare and Medicaid in 1965. The automatic cost-of-living adjustment (COLA) was added in 1972, designed to maintain the purchasing power of benefits no matter how long someone lives. We built,
maintained and strengthened these institutions for a reason: to enable working men and women to protect themselves and their families. We built them because we, as a nation, value hard work, personal responsibility, and human dignity; we care for our parents, our children, our spouses, our neighbors and ourselves. This report reveals the success of these institutions for New York and the nation. The numbers tell part of the story: how many people receive benefits in New York, in its congressional districts and its counties; how many dollars flow into these jurisdictions in a year; the types of benefits and the types of people who receive benefits. Perhaps more importantly, the report presents the stories of hard-working New Yorkers and their families whose lives are immeasurably better because of the protections they have earned.
FIGuRE 11
Social Security, Medicare and Medicaids impact on the economy and Population of new york
PROGRAM BENEFICIARIES IN NEW YORK PERCENT OF RESIDENTS RECEIVING BENEFITS AVERAGE BENEFIT TOTAL ANNuAL BENEFITS2
Social Security Medicare Medicaid
3,280,575 2,915,477 5,208,135
16.9 percent 14.9 percent 26.7 percent
$13,641 $11,690 $9,479
$44.8 billion $34.1 billion $49.4 billion
Sources: Social Security Administration, 2011; u.S. Census Bureau; Kaiser Family Foundation, 2011; Economic Policy Institute, 2011.
As you read through this report, think of the people you know. Family members who live in dignity in old age because they can count on a monthly Social Security check that they or another family member have earned. Think of that older person who has Medicare, and with it the peace of mind that he or she can receive medical care without becoming bankrupt. Think of a family you know who is able to care for a functionally disabled child at home because Medicaid is there. Think of a grandparent, a parent, an older aunt, uncle, cousin or family friend, whose life savings may have been lost paying for nursing home care, but who is still able to receive that care because of Medicaid. Think, too, of how these institutions, like the nations highway system, are part of a rich legacy by those who came before, a legacy that keeps working in good times and bad. Throughout the past few difficult years, Social Security, Medicare, and Medicaid have been even more vital than before for New York residents, and the lifeblood of many small businesses, hospitals and nursing homes and home caregivers. Virtually all of the jobs our Social Security, Medicare, and Medicaid systems support stay in America. As important as these programs protections are today, the need for Social Security, Medicare and Medicaid programs will only increase in coming
years. The population of persons aged 65 and over is growing. Income growth is slow for most of todays workers. Jobs are less secure, and many workers have sustained substantial losses of home equity and other savings. Furthermore, employers, who historically have offered supplements to Social Security, are increasingly terminating traditional pension plans and either not replacing them, or replacing them with far more risky and inadequate 401(k) savings accounts. Cutting these programs would threaten our families economic security and health and deepen our jobs crisis. Indeed, the nation should be thinking about expanding, not cutting, these programs and the protections they provide. They, like our highways, are so fundamental to our family and community life, and, in an increasingly uncertain environment, ever more important to middle-aged and young workers and those who will follow. We are much wealthier as a nation than we were in 1935, 1939, 1956, 1965, or 1972, when these structures were begun and improved. Now it is our turn to maintain and build upon that structure, as those who came before have done. It is our turn to preserve and improve these valuable systems for ourselves and for those who follow. It is our turn to build a legacy for our nations children and grandchildren so when they become workers, they will have the economic security that Social Security, Medicare, and Medicaid provide.
Social Security WorkS

We built our Social Security system because it is the 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 our nation has endured wars, political crises and severe economic recessions, Social Security has never missed a payment; it has paid every dollar of earned benefits, on time and in full. In the wake of the greatest financial crisis since the Great Depression, the risks of investing money on Wall Street or in real estate have never been clearer. Since 2008, millions of Americans have seen their savings wiped out, as the value of 401(k)s and home equity have plummeted. Meanwhile, Social Security continues to prove reliable. That is why our Social Security system is now more important than ever. In a world of risky investment schemes and unpredictable markets, Social Security is a fortress of security and reliability. In this uncertain world, where no one is invulnerable to the tragedy of premature death or serious and permanent disability, Social Security is there to cushion the economic blow of such tragedies. Today, 56 million Americans receive benefits each monthretired and disabled workers, their families, and surviving family members.3 Its benefits to New York residents, and all Americans, are very modest, but vital; the average national benefit was $12,982 a year in 2010.4 These benefits are the building block of the retirement income 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 for 90 percent or more of their income.5 The program lifted 20 million Americans out of poverty in 2008, including one million children.6 Social Security can pay all benefits in full and on time for the next twenty years. After that, if Congress were not to act, it could still pay more than 75 cents
on every dollar of earned benefits.7 The shortfall is equivalent to 1 percent of Gross Domestic Product (GDP), which is roughly the amount of revenues that would be lost to the federal budget from extending the George W. Bush-era tax cuts benefitting the richest 2 percent of American householdsthose with taxable income above $250,000 a year.8 All we need to maintain our Social Security system is a simple adjustment: have everyone, including millionaires and billionaires, pay the same rate as ordinary Americans. While the vast majority of Americans must make payroll tax contributions on all of their wages, millionaires and billionaires only do so on the first $110,100 of their earnings this year. Asking all Americans to pay the same rate would come very close to closing Social Securitys entire projected 75-year funding gap. While the federal budget has run a deficit in every year but five over the last half century, Social Security is not allowed to pay benefits unless it has the funds to cover every penny of the cost, and is not allowed to borrow any shortfall.9 That means that Social Security does not, and, by law, cannot add a penny to the federal deficit or debt (which is simply the accumulation of annual deficits).10 Maintaining our Social Security system has nothing to do with reducing the federal budget deficit, and therefore should be off the table in deficit talks. It should not be part of any deficit reduction legislation considered by our nations leaders.
Social Security Works for New Yorks Residents and Economy

Social Security provided benefits to 3,280,575 people in 2010, 1 out of 6 residents (16.9 percent).11 New York residents received Social Security benefits totaling $44.8 billion in 2010, an amount equivalent to 4 percent of the states annual GDP (the total value of all goods and services produced).12
3
FIGuRE 2
FIGuRE 3
Poverty rate for Beneficiaries 65 and older With and Without Social Security, 20062008
49.3% 45%
new yorks Social Security Beneficiaries, 2010
15% Disabled Workers 7.4% Widow(er)s 65.5% Retired Workers 4.2% Spouses 7.9% Children
12.5%
MA 15.5%
65+
Women 65+
n Poverty rate without Social Security n Poverty rate with Social Security
Source: Center on Budget & Policy Priorities Source: Social Security Administration, 2012
The average Social Security benefit in 2010 was $13,641.13 Social Security lifted 1,108,000 New York residents out of poverty in 2008.14
Social Security Works for New Yorks Women

Social Security provided benefits to 1,714,404 New York women in 2010, 1 out of 6 women (17.1 percent).21 Social Security provided benefits to 137,763 spouses in 2010, 1 out of 25 (4.2 percent) of all beneficiaries.22 [Figure 3] Social Security lifted out of poverty 493,000 New York women aged 65 and older in 2008.23 Without Social Security, the poverty rate of elderly women would have increased from 1 out of 6 (15.5 percent) to half (49.3 percent).24 [Figure 2]
Social Security Works for New Yorks Seniors15

Social Security provided benefits to 2,148,469 retired workers in 2010, two-thirds (65.5 percent) of beneficiaries.16 [Figure 3] The typical benefit received by a retired worker in New York was $15,004 in 2010.17 Social Security provided benefits to 244,220 widow(er)s in 2010, 1 out of 13 (7.4 percent) of all beneficiaries.18 [Figure 3] Social Security lifted out of poverty 813,000 New York residents aged 65 and older in 2008.19 Without Social Security, the elderly poverty rate in New York would have increased from 1 out of 8 (12.5 percent) to more than 4 out of 10 (45 percent).20 [Figure 2]
Social Security Works for New Yorks Workers with Disabilities25

Social Security provided disability benefits for 490,662 workers in 2010, 1 out of 6 (15 percent) of all beneficiaries.26 [Figure 3] The typical benefit received by a disabled worker beneficiary in New York was $12,580 in 2010.27
Social Security Works for New Yorks Children28

Social Security is the major life and disability insurance protection for more than 95 percent of New Yorks 4,324,929 children.29 Social Security provided benefits to 259,461 children in 2010,30 and it is the most important source of income for the 439,654 children living in New Yorks grandfamilies, which are households headed by a grandparent or other relative.31
BERNiCE JORGE
When I was growing up, there was no Social Security. There was a need for it, but we didnt have it until 1935. When we were growing up there was no help for families that were poorno welfare, no food stamps, no safety net. We helped each other. My mother said we all had to work and go to school. I was brought up in an area where when people said their child completed school, they meant elementary school. I had to work after school and in the summers. I finished high school at 17 and moved to New York to work. My childhood sweetheart went the year before. My goal was to help my siblings go to schooland they all did. I helped them go to college and get degrees. My siblings came to New York, too, and my husband was able to get them jobs in the garment district. Later, when my mother became ill, she came up and I took care of her until she died. Im so happy I was able to help my brothers and sisters. I worked; I married my childhood sweetheart, and raised two children. When I retired in 1993, I took Social Security immediately. All my siblings received Social Security. There are three of us left, and my youngest sister just started to collect last year. Im so grateful that I was able to work at a job where I could contribute to Social Security, plus have a pension. Our two children are grown up now and on their own. My husband passed away ten years ago. My Social Security and pension are enough to meet my needs. Im selfsufficient, independent. I dont have to rely on ANYONEmy kids or anyone else. I dont think I could have made it without Social Security.
Social Security Works for New Yorks African Americans

In New York, Social Security provided benefits to 421,053 African Americans in 2009, 1 out of 8 (13 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 unmarried individuals receiving benefits, on average, in 2010. Social Security was 90 percent of the total income for half (49.4 percent) of these African American elderly households.33 Nationwide, 3 out of 10 (32.1 percent) of all African American beneficiaries received disability benefits in 2009; for white beneficiaries it was about half of that number (15.9 percent).34
Social Security Works for New Yorks Latinos

In New York, Social Security provided benefits to 1 out of 5 (19.4 percent) Latino households in 2010, 196,034 households.35 Nationwide, Social Security provided more than three-quarters (77 percent) of the total income of Latino elderly couples and unmarried individuals receiving benefits, on average, in 2010. Social Security was 90 percent of the income for more than half (55.1 percent) of these Latino elderly households.36 The Social Security Administration estimates that Latinos receive a higher rate of return on their Social Security contributions than the overall populationthe highest of any group. Thats because they tend to have lower lifetime income, longer life expectancies, higher incidence of disability and larger families.37
Social Security Works for New Yorks American indians and Alaska Natives
In New York, Social Security provided benefits to 1 out of 4 (25.6 percent) American Indian and Alaska Native households in 2010, 15,432 households.38 Nationwide, Social Security provided 90 percent of the income for 15 percent of elderly American Indian and Alaska Native married couples, and 57 percent of elderly unmarried persons in 2010.39 Since Social Security has a higher income replacement rate for workers with lower earnings, Social Security replaces more of American Indians and Alaska Natives pre-retirement earnings than the overall population. The median earnings of workingage American Indians and Alaska Natives are about $34,000, compared to $41,500 for all working-age people. Social Security provides average benefits of about $13,206 and $11,265 annually for American Indian and Alaska Native men and women aged 65 and older, respectively.40
Social Security Works for New Yorks Asian Americans

In New York, Social Security provided benefits to 1 out of 7 (15.3 percent) Asian American households in 2010, 72,297 households.41 Nationwide, Social Security provided twothirds (68.9 percent) of the total income for Asian American households with beneficiaries aged 65 and older, on average, in 2010. Social Security was 90 percent of the income for 4 out of 10 (41.7 percent) of these Asian American elderly households.42 Nationwide, Asian Americans and Pacific Islanders receive a high rate of return from Social Security because of their long life expectancies. An Asian American or Pacific Islander man aged 65 in 2010, can expect to live until age 85, compared to age 82 for all men. An Asian American or Pacific Islander woman of the same age can expect to live until age 88, compared to age 85 for all women.43
DABNEY AND AMELiA MONTGOMERY

Dabney Montgomery, age 87, and his wife of 39 years, Amelia, live in New York City. A quartermaster with the 96th Air Service Group, he was deployed to Italy in 1943, among a group of path-breaking African American soldiers now known as the Tuskegee Airman. Dabney holds a Congressional Medal of Honor for his service with the Tuskegee Airmen, who, in his words put the lie to those white Americans at the time who didnt believe black men were capable of performing such service: The Tuskegee Airmens record of success in escorting bombers during World War II is unmatched by any other fighter group. Returning home from the war, Dabney was turned away when he tried to register to vote in his hometown of Selma, Alabama. Not one to give up on his beliefs easily, he was active in the Civil Rights Movement. Following his bachelors of arts degree in religious education from Livingstone College, he met Reverend Martin Luther King, Jr. in Boston when Corretta Scott King and Dabney were both students at The Boston Conservatory of Music, she a student of voice and he of dance. Witness to the Marches on Washington and New York City, Dabney was one of Dr. Kings bodyguards during the historic 1965 March on Selma, the social action that paved the way for the 1965 Voting Rights Act. After an accident ended his promising dance career, Dabney joined the City of New York as an employee, first with the Department of Social Services and then the Housing Authority. Always active in bettering the world, Dabney volunteered for 50 years with Harlem youth several days a week after work and on weekends. A member of the International Brotherhood of Teamsters, Local 237, he retired as a Housing Assistant in management and began receiving Social Security retirement benefits at age 65 in 1988. After retirement, Dabney worked part-time in social work helping the elderly, both because he enjoyed it and to supplement the couples income. Today, he and Amelia continue their lifelong commitment to volunteer work and community participation. Almost 70 percent of the Montgomerys income comes from Social Security, with the rest from Dabneys employer pension. Even though our income is very modest, says Dabney, we felt secure because we had money put aside in Amelias IRA [Individual Retirement Account] that we werent touching. Im 19 years older than my wife, and we knew that Amelia would need those savings to supplement her Social Security income when I depart from this earth. But, by 2003, those savings were gone. The financial advisor they trusted, who had assured the couple their account was adequately diversified, proved to have been guiding them to financial ruin. An incredulous tone underlies Amelias voice: By the end of 2003, it was lost. All of it, completely gone. The Montgomerys hope their story serves as a lesson about the importance of preserving todays level of guaranteed Social Security benefits. What do Dabney and Amelia think of the argument that Social Security benefits promised under current law should be scaled back for tomorrows retirees in order to reduce the federal deficit or control government spending? Amelias indignation is unmistakable: The people saying this dont have to worry about money; these politicians dont have to worry about food, healthcare, losing their homes. Dabney adds, These politicians who want to cut or privatize Social Security have it made financially. Its nothing but pretense when politicians use concern for future generations to dictate to the rest of us how much more of our money Wall Street will be gambling with. Theyre trying to tell us how many more years people will have to work before they can retire [and] how much less seniors can have to live on. Could the Montgomerys and future retirees like themselves live on less? I worked 72 years. My wife and I have to budget carefully to make it from one check to another. We own our home, but we had to do major repairs, and that has to come out of our checks. If we had to live on just 5 or 10 percent less Social Security right now, wed have to cut back on everythinghome repairs, heat, food, a decent standard of living. A few dollars doesnt sound like much to a u.S. Senator. For me, its the difference between having the money to hire someone to shovel our steps in the winter or not. At age 87, I cant shovel snow anymore. Dabney continues, We missed those few dollars from not getting a cost of living increase [from Social Security] this year. Our checks didnt go up this year but prices did; the cost of milk has gone up; heating oil has gone up. We worry about those things, but what I worry about most is my wife. I worked for 72 years. Weve worked and saved and budgeted our money carefully throughout the 39 years of our marriage, and when I depart from this life, I dont know what Amelia is going to do, how shes going to make ends meet.
Social Security Works for New Yorks Rural Communities44

Social Security is more important to rural New Yorkers than to other New Yorkers. Over 1 out of 5 (22 percent) rural New Yorkers received Social Security compared with 1 out of 6 (16.5 percent) non-rural New Yorkers in 2010.45 Social Security is more important to the local economies of New Yorks rural counties than to its non-rural counties. Total personal income in New Yorks 26 rural counties was $52 billion in 2010 of which $4.4 billion, or 8.4 percent, was from Social Security. By comparison, total personal income in the states 36 non-rural counties was $890.5 billion, of which $40.4 billion, or 4.5 percent, was from Social Security.46
Social Security is the most valuable disability and life insurance protection for most New York workers. Nationwide, an estimated 3 out of 10 workingaged men and 1 out of 4 workingaged women will become severely disabled before reaching retirement age. An estimated 1 out of 11 workingaged men and 1 out of 20 workingaged women will die before reaching retirement age.47 A 30-year-old worker who earns about $30,000 and who has a spouse and two young children, receives Social Security insurance protection equivalent to private disability and life insurance policies worth $465,000 and $476,000, respectively.48 Social Security is a commitment made to all Americans that has withstood the test of time. It represents the best of American valuesrewarding hard work, honoring our parents, caring for our neighbors, and taking responsibility for ourselves and our families. Social Security is based on a promise that if you pay in, then you earn the right to guaranteed benefits.
Social Security Works for New Yorks Working Families

Through their hard work and payroll tax contributions, nearly all New York workers earn Social Securitys retirement, disability and survivorship protections for themselves and their families.
Medicare WorkS
We built our Medicare system because it is by far the best way to provide Americas seniors and people with disabilities with affordable health care they can count on. For nearly half a century, Medicare has given seniors and people with disabilities access to critical health care. It protects beneficiaries and their families against health-related expenditures that might otherwise overwhelm their financesor worse, force them to forego medical treatment needed to survive. Private health insurance companies, which must generate returns for their shareholders, were not and are notwilling or able to insure seniors and people with disabilities at affordable rates. That is because seniors and people with disabilities have greater medical needs and thus are more costly than the young and healthy. Prior to Medicare, only about half of seniors had health insurance. Those who were insured paid nearly three times as much as younger people, even though they had, on average, only half as much income.49 Without Medicare, many people would not be able to afford basic medical services. Medicare beneficiaries are mainly people of modest means. Half had incomes below $22,000 a year in 2010.50 Already more than one-quarter of many beneficiaries Social Security benefit is eaten up by out-of-pocket health care costs.51 Medicare worksfor seniors and people with disabilities, as well as people with end-stage renal disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrigs disease). The program provides significant hospital, physician, medical testing, pharmaceutical, rehabilitation, medical equipment and other important services to seniors, people with disabilities and people with ESRD and ALS.52 Medicare provided health care coverage to 48.7 million Americans in 2011, of whom over 8 out of 10 (40.4 million) were aged 65 or older; and 1 out of 6 (8.3 million) were severely disabled workers.53 The average expenditure per Medicare beneficiary in 2011 was $12,042.54 Medicare consists of four parts, each of which provides different medical benefits. Medicare Part A, the Hospital Insurance (HI) program, covers in-patient hospital as well as select kinds of skilled nursing facility services, home health and hospice care. HI is earned during ones working years, and paid for by insurance contributions of 2.9 percent of wages, divided equally between employers and employees.55* Medicare Part B, the Supplemental Medical Insurance (SMI) program, helps pay for physician and preventive care services. SMI is a voluntary program, funded by premiums, generally deducted from beneficiaries Social Security checks, and from general revenue.56 (Medicaid covers the premium
* Starting in 2013, the Affordable Care Act levies an additional 0.9 percentage point Hospital Insurance tax on earned income for households with incomes exceeding $200,000 for singles and $250,000 for married couples filing jointly. In addition, it would add a 3.8 percent unearned Income Medicare Contribution for such high-income households to unearned income including interest, dividends, annuities, royalties and rents (excluding income from active participation in S corporations). White House, Title IX. Revenue Provisions, Health Reform Details, 2012. http://www.whitehouse.gov/health-care-meeting/proposal/titleix/ targeted-healthcare-tax Social Security, Medicare and Medicaid Work for neW york 9
and out-of-pocket costs for those low-income beneficiaries who are enrolled in Medicaid.) Medicare Part C, also known as the Medicare Advantage program, allows beneficiaries to enroll in a private insurance plan, in lieu of Medicare Parts A and B. These private plans receive payments from Medicare to cover physician and hospital service, and in most cases, prescription drug benefits. Medicare Advantage Plans cost more for the same services as provided under Parts A and B.57 According to the White House, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than traditional Medicare.58 These extra costs result not only in higher government outlays but also higher Part B premiums for those enrolled in traditional Medicare. The Patient Protection and Affordable Care Act (ACA) of 2010 includes provisions which seek to make the costs of Part C closer to those of Part A and Part B.59 About 11.5 million Medicare beneficiaries were enrolled in Medicare Advantage as of April 2010 one-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 contract with Medicare and are purchased voluntarily by Medicare beneficiaries. They exist independently, or as part of a Medicare Advantage plan. Part D is funded by beneficiary premiums, generally deducted from beneficiaries Social Security checks, and from general revenue. In addition, states are required to pay premiums for low-income beneficiaries who are enrolled in Part D programs. 27.6 million beneficiaries were 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 system is more critical than ever. Medicare does a better job of controlling health care costs than private health insurance plans. While Medicares costs per person increased by about 4.7 percent a year from 1999 to 2009, the costs of similar benefits under private insurance rose 6.9 percentnearly 50 percent more.62 [Figure 4] Medicares superior cost-control record is no coincidence; it is a function of Medicares concentrated purchasing power. As Professor Jacob Hacker of Yale university notes, Medicare is capable of using its concentrated purchasing power to pioneer new payment methods that bring down costs. Hacker cites Medicares implementation of a prospective payment system and a resource-based physician fee schedule in 1983, and volume controls on Medicare physician spending in the 1990s, as examples of Medicares success in pioneering payment methods that reduced underlying health care costs.63 Even though the traditional Medicare program, Parts A and B, covers people who, on average, have more health care claims and more expensive medical conditions than private insurance, its administrative costs are lower than those of private health insurance plans. Medicares administrative costs were less than 2 percent of its total expenditures in 2011.64 Private health insurances administrative
*As of January 1, 2011, the Affordable Care Act ensures that seniors who reach the prescription drug coverage gap, known commonly as the donut hole, will receive discounts on brand-name and generic prescription drugs covered by Medicare Part D that increase gradually until the coverage gap is completely closed in 2020. Medicare.gov, Closing the Coverage Gap Medicare Prescription Drugs Are Becoming More Affordable, January 2012. http://www.medicare.gov/publications/pubs/pdf/11493.pdf 10
FIGuRE 4
average annual increase in Spending on common Benefits,* 19992009

6.9%
4.7%
Medicare
Private Health Insurance
*Common benefits refers to benefits commonly covered by Medicare and private health insurance.
Source: Center for Medicare & Medicaid Services, 2010
costs, which include additional costs such as advertising, retained profit to insurers and taxes paid by insurers, are generally much higher. The Congressional Budget Office (CBO) estimated that in 2007 these administrative costs varied from about 7 percent for large employer plans with 1,000 or more covered employees to as much as 30 percent for insurance sponsored by very small firms or purchased by individuals.65 CBO estimated that while Medicare paid about $150 per person enrolled, large employer plans paid about $300 per person enrolled, and small employers and individuals paid roughly $1,000 per person enrolled, on average.66 The traditional Medicare Program, Parts A & B, is also administered more efficiently than Medicare Advantage, Part C, which is provided by private insurers who contract with Medicare. An analysis by CBO shows that administrative costs accounted for less than 2 percent of expenditures in the traditional Medicare program, compared to 11 percent in the Medicare Advantage program in 2005.67 Maintaining our Medicare system is simple. As health care costs increase system-wide, Medicares costs rise as well. It is primarily as a result of system-wide cost increases, that Medicare has significant longterm funding challenges. The solution is to slow the growth of health care costs for everyone, as other developed countries have donenot to cut Medicares benefits. Cutting Medicares benefits simply shifts costs to the sickest and oldest among us, forcing some seniors and people with disabilities to forego treatment, living shorter, less healthyand more medically costlylives as a result.
Medicare Works for New York Residents

Medicare insured 2,915,477 New Yorkers in 20091 out of 6 (14.9 percent) state residents.70
Medicare Works for New Yorks Seniors

2,446,039 of New Yorks 2,915,477 Medicare beneficiaries were aged 65 or older in 2009 8 out of 10 (83.9 percent) beneficiaries.71
Medicare Works for New Yorks People with Disabilities

469,438 of New Yorks 2,915,477 Medicare beneficiaries were people with disabilities in 20091 out of 6 (16.1 percent) beneficiaries.72
Medicare Works for New Yorks Residents with End-Stage-Renal Disease (ESRD)
End-stage-renal disease (ESRD) occurs when a persons kidneys stop functioning at a level needed for everyday life. People suffering from ESRD generally must undergo dialysis treatment or receive a kidney transplant, which are both prohibitively expensive.73
Medicare Works for New Yorks Residents with Amyotrophic Lateral Sclerosis (ALS)
Amyotrophic Lateral Sclerosis, more commonly known as ALS, or Lou Gehrigs disease, is a nervous system disease that gradually shuts down all muscles in a persons body, eventually resulting in death from respiratory failure.74 Many New York residents with ALS would impoverish themselves or their families without the help of Medicare. Seniors and people with disabilities cannot be economically secure if they are one illness away from bankruptcy. Medicare should be strengthened, not cut. As private sector health insurance continues to rise in cost, Medicare is more important than ever.
Medicare Works for New Yorks Economy

Medicare provided $34.1 billion in benefits in 200920.9 percent of all health care spending in the state.68 The average expenditure per Medicare beneficiary was $11,690.69
11
Medicaid WorkS
We built our Medicaid system to provide health care for low-income families, children, seniors and people with disabilities. For nearly half a century, Medicaid has 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 insure those left behind by the private insurance system.* It is 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 funding for rural hospitals and inner-city health care facilities. Medicaid is essential because private health insurance is unaffordable for millions of Americans. Private health insurance costs have risen dramatically in recent years. Average annual premiums for a family with employer-sponsored health insurance rose to $15,073 in 2011a 9 percent increase from the previous year.77 Medicaid is especially crucial to people in need of community- and institutionally-based long-term care services. Medicare does not cover most long-term care costs, and private insurance plans that cover long-term care are often prohibitively expensive. As a result, many individuals exhaust their assets under the weight of steep long-term care costs, and have nowhere to turn but Medicaid. In short order, longterm care patients and their families can go from the middle class to a life of poverty in which they need assistance. Two-thirds of all Medicaid spending is for seniors and people with disabilities.78 One out of every four seniors and people with disabilities depended on Medicaid in 201016 million people. That includes 15.4 percent of all seniors (6.3 million) and 44.6 percent of people with disabilities (9.8 million).79 Medicaid is also crucially important to children, who are about half of its beneficiaries nationwide.80 More than one in four of the nations children receive their health insurance through Medicaid.81 Maintaining our Medicaid system, like our Medicare system, is simple. As health care costs increase system-wide, Medicaids costs rise as well. It is primarily as a result of system-wide cost increases that Medicaid has significant long-term funding challenges. The solution is to slow the growth of health care costs for everyone, as other developed countries 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
*The Affordable Care Acts expansion of Medicaid and Childrens Health Insurance Program (CHIP) eligibility alone is projected to result in the enrollment of an additional 32 million Americans in Medicaid and CHIP by 2022. Congressional Budget Office, Table 3. March 2012 Estimate of the Effects of the Affordable Care Act on Health Insurance Coverage, Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act, March 2012. http://www.cbo.gov/sites/default/files/ cbofiles/attachments/03-13-Coverage%20Estimates.pdf Social Security, Medicare and Medicaid Work for neW york 12
afford it. More troubling still, it may make life-saving medical care inaccessible for those who need it.
Medicaid Works for New Yorks Economy

Medicaid provided $49.4 billion in benefits in 200930.3 percent of all health care spending in the state.82 The average expenditure per Medicaid beneficiary was $9,479.83
Medicaid Works for New York Residents

Medicaid insured 5,208,135 New Yorkers in 20091 out of 4 (26.7 percent) state residents.84
Medicaid Works for New Yorks Children

Medicaid insured 2,000,744 children in 2009 4 out of 10 (45.5 percent) children in the state.85
o $351 million to mental health facilities (1.6 percent) o $4 million to intermediate care facilities for the intellectually disabled (16.9 percent).88 Medicaid insured the vast majority of New York residents who opt for nursing home care. 78,920 of New Yorks 109,110 nursing home residents were Medicaid beneficiaries in 20103 out of 4 (72.3 percent) residents.89 The average annual cost of nursing home care for a semiprivate room in New York was $122,600 in 2010.90 Given the high cost of nursing home care, many New York residents would not be able to afford it without Medicaid.
Medicaid Works for New Yorks Seniors

591,892 of New Yorks 5,208,135 Medicaid beneficiaries were aged 65 or older in 2009 1 out of 9 (11.4 percent) beneficiaries.86
Medicaid Works for New York During Economic Recessions

Because Medicaid eligibility is contingent upon having low income, the program expands to accommodate those who have lost jobs or earnings during a recession. Nationwide, between June 2008 and June 2009, the height of the Great Recession, monthly Medicaid enrollment rose by 3.3 million. That amounts to a 79 percent increase from the average annual enrollment rate between 2000 and 2007. While there are several factors that fuel Medicaid enrollment, experts believe that job losses and resulting losses of employer-based insurance and declining income, cause more people to qualify for Medicaid.91 As financially strapped states cut Medicaid, the last thing the nations seniors, people with disabilities, and low-income children need is for the federal government to cut the program at the national level. Like Social Security and Medicare, this vital program should be strengthened, not cut.
Medicaid Works for New Yorks People with Disabilities

669,882 of New Yorks 5,208,135 Medicaid beneficiaries were people with disabilities in 20091 out of 8 (12.9 percent) beneficiaries.87
Medicaid Works for New Yorks Long-Term Care Residents

Medicaid provided $21.3 billion in long-term care benefits for New York residents in 2009. That includes: o $9.7 billion in home health care services (45.7 percent) o $7.6 billion to nursing home facilities (35.8 percent)
13
concluSion
The large run-up in federal deficits in recent years resulted primarily from huge tax cuts in 2001 and 2003; the unpaid costs of the Iraq and Afghanistan wars; the Great Recession, which dramatically reduced tax collections and increased unemployment compensation and other spending; the economic stimulus and recovery spending; and the Wall Street bank bailout.92 [Figure 5] By law, Social Security can only pay benefits if it has the income to cover its costs. Its income is primarily the result of insurance contributions paid by hardworking Americans and their employers. It does not have borrowing authority which is why it never has and never will contribute to federal budget deficits. Likewise, large anticipated yearly increases in health care expenditures, public and private, reflect longterm structural problems in the nations health care
FIGuRE 5
system. Compared to other industrial democracies, the united States expends roughly twice as much per person on health care generally without providing coverage for all our citizens. While the nations recent health care reform is expected to bend the cost curve and to expand coverage, health care expenditures are still expected to rise for many years, well in excess of inflation. Thats bad for consumers, employers and the economy, but it is not the fault of Medicare and Medicaid. In fact, Medicare is the most efficient part of the health care system, averaging just 2 percent in administrative costs compared to about 7 percent for large group plans and as much as 30 percent for plans purchased by individuals.93 To reduce the federal debt, Congress should be looking at its causes. It should not cut Social Security, Medicare, and Medicaid, which were built to protect working persons and their families against lost wages and the high cost of health care, and which are so vital to the economic security of our nation. Social Security, Medicare and Medicaid represent the best of Americas values, including caring for aging parents and neighbors, reward for hard work, personal responsibility and dignity. In New York, these programs spend about $128.2 billion a year, providing benefits to an average of 1 out of 5 residents for each program.94 It is no surprise that poll after poll shows that Americans overwhelmingly support these programs and do not want to see them cut. Cutting them would weaken the economic security of all Americans. While that would be bad policy anytime, it would be disastrous in this time of widespread economic loss. The old, the disabled and todays workers have a stake in preserving these foundational systems for themselves, their families, their children and grandchildren. And politicians have the opportunity to maintain and improve these paramount achievements for future generations, just as previous Congresses and presidents have done for us.
14
causes of recent run-up in federal deficits

1600 1400 1200 1000
Billions of dollars
ACTuAL DEFICITS
800 600 400 200 0 -200 -400 2001 DEFICITS WITHOuT THESE FACTORS 2003 2005 2007 2009 2011
n Wars in Iraq and Afghanistan n Bush-era tax cuts n Recocvery measures n TARP, Fannie and Freddie n Economic downturn
Source: Center for Economic and Policy Research, 2012
appendix 1: Social Security Works for new yorks congressional districts (Page 1/2)
CONGRESSIONAL DISTRICTS 2
$1,745M $1,908M $1,726M $1,427M $1,032M $1,188M $1,300M $1,426M $949M $877M $773M $1,570M $1,549M
State total 3 4 5 6 7 8 9 10 11 12 13 14
15
$1,052M
total annual benefits ($ in millions)*
$44,457M
$1,981M
Number of residents in state/ congressional district 679,893 645,508 663,407 670,130 651,764 667,632 713,512 660,306 677,721 632,408 672,358
19,378,102
705,559
686,525
652,681
639,873
Number of residents receiving Social Security benefits 117,725 124,666 114,670 100,190 82,337 94,566 95,386 103,747 81,555 72,134
3,280,575
133,599
75,811
113,899
96,127
89,209
SOCIAl SeCurItY BeNeFICIArIeS BY CAtegOrY
Percent of residents receiving Social Security benefits 17.3% 19.3% 17.3% 15.0% 12.6% 14.2% 13.4% 15.7% 12.0% N/A 78,100 15,722 8,644 5,025 10,234 8,904 7,654 3,891 5,702 5,132 6,116 3,237 7,686 10,305 9,064 7,486 5,209 15,016 13,518 8,110 12,627 14,784 6,672 4,454 7,238 84,739 79,302 74,587 53,578 61,418 66,004 12,344 6,275 4,036 6,727 N/A N/A N/A N/A N/A N/A N/A 71,965 12,581 8,244 5,503 5,454 N/A 48,385 15,396 5,627 3,043 9,104
16.9%
18.9%
11.4%
11.3%
16.6%
14.7%
13.9%
Women
1,714,404
N/A
N/A 47,342 11,643 4,272 2,592 6,285
N/A 46,078 13,181 5,986 4,297 6,269
N/A 70,001 18,789 9,445 5,859 9,805
N/A 73,914 8,101 6,507 4,240 3,365
N/A 57,145 16,120 5,892 3,376 6,676
Retired workers
2,148,469
88,463
Disabled workers
490,662
18,842
Widow(er)s
244,220
10,141
Spouses
137,763
5,347
Children
259,461
10,806
Sources: uS Census Bureau, Profile of General Population and Housing Characteristics: 2010, 2011. SSA, New York, 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 benefits for the Congressional districts were calculated by taking the monthly benefits and multiplying by 12. The state annual benefits number is the sum of the congressional district numbers and
15
is not necessarily consistent with state totals cited elsewhere in the report.
appendix 1: Social Security Works for new yorks congressional districts (Page 2/2)
CONGRESSIONAL DISTRICTS 17
$1,428M $1,813M $1,764M $2,026M $1,733M $1,807M $1,700M $1,771M $1,870M $1,951M $1,858M $1,607M $1,938M
State total 18 19 20 21 22 23 24 25 26 27 28 29
16
total annual benefits ($ in millions)*
$44,457M
$687M
Number of residents in state/ congressional district 678,558 674,825 699,959 683,198 679,193 679,297 664,245 657,222 668,869 674,804 629,271 611,838
19,378,102
693,819
663,727
Number of residents receiving Social Security benefits 102,065 115,213 118,092 149,560 129,959 136,183 136,099 140,394 136,149 139,338
3,280,575
71,512
141,185
125,108
144,097
SOCIAl SeCurItY BeNeFICIArIeS BY CAtegOrY
Percent of residents receiving Social Security benefits 15.0% 17.1% 16.9% 21.9% 19.1% 20.0% 20.5% 21.4% 20.4% N/A 69,717 14,166 6,507 3,595 8,080 6,661 10,524 11,528 5,044 4,461 5,771 4,267 10,648 7,958 8,335 11,015 9,726 9,853 4,988 12,217 10,652 15,772 21,983 19,837 23,056 84,898 79,000 99,263 85,481 86,069 80,701 25,144 11,513 6,528 12,213 N/A N/A N/A N/A N/A N/A N/A 89,608 23,386 10,055 5,064 12,281 N/A 89,597 20,759 9,634 4,979 11,180
16.9%
10.3%
20.6%
22.4%
20.4%
21.7%
Women
1,714,404
N/A
N/A 93,220 19,226 11,433 5,946 9,513
N/A 87,500 23,423 12,742 6,000 11,520
N/A 71,470 27,046 9,697 4,160 12,735
N/A 95,522 21,816 10,550 5,681 10,528
Retired workers
2,148,469
35,402
Disabled workers
490,662
17,622
Widow(er)s
244,220
5,433
Spouses
137,763
3,320
Children
259,461
9,735
Sources: uS Census Bureau, Profile of General Population and Housing Characteristics: 2010, 2011. SSA, New York, 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 benefits for the Congressional districts were calculated by taking the monthly benefits and multiplying by 12. The state annual benefits number is the sum of the congressional district numbers and
16
is not necessarily consistent with state totals cited elsewhere in the report.
appendix 2: Social Security, Medicare, and Medicaid data by county, in new yorks counties (Page 1/3)
SoCial SeCuRitY BeNefitS, 2010 SoCial SeCuRitY BeNefiCiaRieS BY ChaRaCteRiStiC, 2010* MeDiCaRe
NeW YoRK CouNtY DeMogRaPhiCS, 2010
County
$54,047 $53,783 $41,384 $32,674 $43,920 $41,266 $48,453 $39,981 $46,130 $41,418 $44,193 $50,620 $41,903 $40,252 $68,831 $46,773 $42,053 $41,062 $39,939 $47,387 $45,070 $45,474 $42,876 $43,448 $42,047 14.3% 22.9% 15.6% 10.6% 17.2% 8,514 1,130 10,856 12,981 287,633 12.1% 9,390 15.6% 17.3% 23.4% 16.8% 11.2% 11.5% 15.6% 8,901 16.0% 16.1% 6,880 13.3% 13.0% 7,143 18.1% 23.1% 21.2% 23.9% 21.2% 23.6% 31.4% 23.8% 17.8% 12.0% 14.3% 144,364 15.7% 21.5% 8.2% 40,304 13.5% 18.4% 12.3% 9,321 19.4% 23.8% 14.8% 6,458 13.1% 18.9% $117,828,000 $146,832,000 $788,783,000 $2,679,761,000 $117,272,000 $130,228,000 $165,878,000 $170,300,000 $154,446,000 $20,859,000 $191,280,000 $252,950,000 $3,602,300,000 9.5% 11,463 18.2% 23.3% $198,653,000 15.7% 10,952 13.3% 21.1% $215,233,000 17,340 14,685 9,340 11,420 54,615 197,455 9,105 10,920 13,260 12,760 11,640 1,520 15,335 20,720 301,475 16.0% 8,403 16.6% 24.5% $153,369,000 12,370 15.6% 13,943 15.7% 23.4% $267,814,000 20,820 12,715 7,805 10,080 9,960 6,025 7,505 35,175 123,250 5,915 6,330 8,295 8,455 7,500 1,165 9,935 12,095 189,045 17.3% 22,381 16.6% 23.6% $407,697,000 31,820 20,230 12.6% 12,235 15.3% 20.0% $209,383,000 16,030 10,450 2,530 5,335 4,035 2,210 3,490 2,080 1,645 1,725 8,200 31,270 1,300 1,895 2,355 1,920 1,945 120 2,495 3,830 49,795 15.0% 12,419 15.5% 23.0% $230,218,000 18,445 11,370 3,340 16.5% 32,844 16.4% 23.0% $605,103,000 46,050 29,470 7,480 3,385 1,435 1,220 2,555 1,580 835 1,515 990 640 885 3,880 18,150 805 895 940 1,010 885 120 1,155 1,760 22,445 30.0% 145,882 10.5% 12.7% $2,053,736,000 176,450 101,610 35,675 12,770 17.2% 7,443 15.2% 21.7% $132,487,000 10,635 6,680 1,760 855 500 7,330 1,775 740 595 1,315 740 465 860 495 300 510 2,065 8330 380 530 390 505 425 60 555 1010 14190 13.2% 42,314 13.9% 18.4% $772,988,000 55,860 37,615 8,305 4,070 1,685 15.0% 2,617,943 13.5% 16.9% $44,771,353,000 3,280,575 2,148,469 490,662 244,220 137,763 259,461 4,185 840 19,065 3,940 1,560 1,235 2,385 1,750 1,055 1,395 1,160 730 795 5,295 16,455 705 1,270 1,280 875 885 55 1,195 2,025 26,005
Rural-urban Median Population Continuum household Code (2003) income % in Poverty Children annual total Benefits total Beneficiaries Retired Workers Disabled Widow(er)s Spouses Workers
Population over age 65
% of Population over age 65
% of Population Receiving Benefits
% Receiving Medicare, 2010

15.3% 15.2% 17.7% 11.9% 20.1% 20.0% 17.1% 20.3% 19.6% 20.4% 17.3% 20.1% 15.6% 19.9% 16.1% 18.7% 20.3% 16.6% 18.1% 19.1% 19.5% 27.2% 18.5% 14.7% 12.2%
total (62 counties)
19,378,102
N/a
Albany
304,204
Allegany
48,946
Bronx
1,385,108
Broome
200,600
Cattaraugus
80,317
Cayuga
80,026
Chautauqua
134,905
Chemung
88,830
Chenango
50,477
Clinton
82,128
Columbia
63,096
Cortland
49,336
Delaware
47,980
Dutchess
297,488
erie
919,040
essex
39,370
Franklin
51,599
Fulton
55,531
genesee
60,079
greene
49,221
Hamilton
4,836
Herkimer
64,519
Jefferson
116,229
Kings
2,504,700
17
*State totals do not equal the sum of county figures, because individual county figures provided by SSA are rounded.
County
$41,093 $50,094 $50,270 $49,564 $40,035 $90,294 $63,188 $44,006 $46,409 $50,298 $53,137 $65,512 $44,783 $44,371 $42,837 $82,585 $52,486 $51,720 $69,163 $79,798 $40,008 $65,508 $52,062 $47,350 $46,870 13.1% 13.3% 12.0% 7.0% 29,994 23,083 5,220 3,116 17.4% 15,553 11.6% 41,841 13.4% 13.9% 13.7% 14.9% 15.9% 17.0% 12.1% 59,344 12.7% 13.5% 21,607 13.6% 15.1% 286,146 12.8% 13.5% 18.9% 17.3% 16.6% 21.6% 18.8% 20.2% 19.9% 24.9% 6.2% 12,417 12.5% 16.6% 15.7% 10,281 16.5% 22.3% 16.9% 15,400 12.6% 20.9% 14.0% 6,178 14.4% 21.2% $120,160,000 $333,097,000 $178,011,000 $253,457,000 $3,921,960,000 $406,320,000 $1,156,612,000 $787,201,000 $301,628,000 $583,594,000 $420,072,000 $83,507,000 $58,939,000 11.4% 40,985 11.0% 15.8% $820,602,000 10.1% 16,612 15.4% 21.4% $315,852,000 23,095 58,920 9,070 25,525 13,900 16,515 300,695 30,170 81,015 51,725 24,185 41,385 31,210 6,520 4,570 14.1% 65,578 14.0% 19.6% $1,261,074,000 91,750 15.1% 38,168 16.3% 22.7% $665,794,000 53,205 32,700 59,435 15,885 36,470 5,640 14,580 9,235 11,140 208,100 19,765 48,235 36,550 13,620 28,520 20,310 4,215 2,950 14.1% 34,388 15.9% 23.3% $683,390,000 50,345 30,665 16.6% 214,153 13.5% 14.9% $3,341,459,000 235,805 168,185 30,350 9,075 9,250 14,950 3,235 9,970 1,650 5,290 2,020 2,215 36,960 5,005 14,340 5,375 4,780 5,455 4,610 1,000 800 6.2% 204,681 15.3% 18.3% $3,822,548,000 244,900 172,055 26,110 17.1% 8,329 16.6% 25.0% $156,887,000 12,550 8,160 1,970 890 19,535 14,660 4,450 3,915 6,730 1,520 4,280 685 2,040 995 1,095 21,530 2,255 6,525 3,185 2,320 3,065 2,365 535 345 15.1% 103,594 13.9% 19.6% $2,053,604,000 145,920 96,335 23,420 9,760 11.5% 10,239 13.9% 18.3% $176,320,000 13,440 8,710 2,040 1,095 525 5150 470 11555 8865 2205 1980 3305 815 2035 345 1,160 515 635 15,730 950 3,885 2,015 1,350 1,650 1,155 275 170 13.5% 8,985 13.7% 19.5% $173,696,000 12,780 8,490 2,020 900 460 15.0% 4,076 15.0% 19.3% $63,664,000 5,235 3,180 825 480 310 440 910 1,070 11,255 1,060 15,640 13,750 3,945 5,360 7,325 1,640 6,165 750 2,455 1,135 1,430 18,380 2,195 8,035 4,600 2,115 2,695 2,770 495 300

16.7% 16.3% 16.3% 16.7% 21.4% 16.7% 15.1% 19.7% 19.9% 16.9% 18.2% 13.3% 16.6% 17.0% 19.4% 13.8% 13.1% 16.3% 14.8% 15.0% 18.3% 15.5% 19.6% 18.1% 18.9%
lewis
27,087
livingston
65,393
Madison
73,442
Monroe
744,344
Montgomery
50,219
Nassau
1,339,532
New York
1,585,873
Niagara
216,469
Oneida
234,878
Onondaga
467,026
Ontario
107,931
Orange
372,813
Orleans
42,883
Oswego
122,109
Otsego
62,259
Putnam
99,710
Queens
2,230,722
rensselaer
159,429
richmond
468,730
rockland
311,687
St. lawrence
111,944
Saratoga
219,607
Schenectady
154,727
Schoharie
32,749
Schuyler
18,343
18
*State totals do not equal the sum of county figures, because individual county figures provided by SSA are rounded.
County
$45,961 $45,231 $81,235 $43,882 $50,043 $50,156 $51,194 $50,269 $46,629 $50,213 $76,993 $46,846 $43,820 17.0% 4,216 16.6% 22.8% $74,866,000 10.8% 5,723 13.6% 20.5% $112,994,000 9.0% 139,122 14.7% 16.8% $2,491,960,000 10.6% 13,363 14.3% 22.8% $282,824,000 21,350 159,370 8,655 5,775 12.0% 9,707 15.4% 21.1% $170,264,000 13,330 10.4% 11,247 17.1% 25.2% $221,638,000 16,585 10,810 8,300 13,350 116,155 5,475 3,925 12.5% 27,044 14.8% 20.6% $514,805,000 37,585 24,290 19.6% 10,929 10.8% 14.4% $204,102,000 14,600 10,025 2,100 6,125 2,615 2,290 3,320 16,150 1,480 845 9.8% 8,032 15.7% 22.2% $148,825,000 11,370 7,410 1,710 19.1% 11,455 14.8% 21.7% $219,281,000 16,845 10,430 2,940 1,150 860 945 2,745 1,235 1,065 1,295 11,070 680 395 6.6% 201,793 13.5% 18.1% $4,020,646,000 270,480 177,720 38,255 20,505 14.4% 15,718 15.9% 22.8% $287,102,000 22,555 13,815 4,075 1,835 895 11,170 575 605 550 1,360 675 595 710 6,560 365 215 14.0% 5,472 15.5% 21.5% $97,200,000 7,575 4,960 1,305 505 230 575 1,930 22,830 1,750 785 980 3,065 1,250 1,080 2,675 9,435 655 395

16.6% 19.4% 15.7% 18.2% 17.4% 12.4% 17.4% 21.6% 18.3% 18.9% 15.5% 16.5% 20.1%
Seneca
35,251
Steuben
98,990
Suffolk
1,493,350
Sullivan
77,547
tioga
51,125
tompkins
101,564
ulster
182,493
Warren
65,707
Washington
63,216
Wayne
93,772
Westchester
949,113
Wyoming
42,155
Yates
25,348
*State totals do not equal the sum of county figures, because individual county figures provided by SSA are rounded. Population: uS Census Bureau, Profile of General Population and Housing Characteristics: 2010, 2010 Demographic Profile Data, 2010. http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml Rural-Urban Continuum Codes: united States Department of Agriculture, Economic Research Service (ERS), Measuring Rurality: Rural-urban Continuum Codes, 2003. http://www.ers.usda.gov/data-products/rural-urbancontinuum-codes 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 designated 4 or higher. Median Household Income: uS Census Bureau, Table 1: 2010 Poverty and Median Income Estimates - Counties, November 2011. http://www.census.gov/did/www/saipe/data/statecounty/data/2010.html Percentage of Households in Poverty: uS Census Bureau, Table 1: 2010 Poverty and Median Income Estimates - Counties, November 2011. http://www.census.gov/did/www/saipe/data/statecounty/data/2010.html Population Aged 65 or Older: uS Census Bureau, Age Groups and Sex: 2010, 2010 Census Summary File 1, 2011. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_SF1_ QTP1&prodType=table Total Annual Social Security Benefits: Bureau of Economic Analysis (BEA), Regional Economic Accounts: Local Area Personal Income, Old-age, Survivors and Disability Insurance (OASDI) benefits, CA 35 Personal current transfer receipts. http://bea.gov/regional/reis/ BEA data were used for total annual Social Security benefits rather than the figures 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 as calculating the average benefit and average retirement benefit in rural counties, SSA data were used. Social Security Beneficiaries by Characteristic: Social Security Administration (SSA), Table 4. Number of beneficiaries in current-payment status, by county, type of benefit, and sex of beneficiaries aged 65 or older, December 2010, OASDI Beneficiaries by State and County, 2010, June 2011. http://www.ssa.gov/policy/docs/statcomps/oasdi_sc/2010/index.html Percentage of Population Receiving Medicare: Center for Medicare and Medicaid Services (CMS), Beneficiaries Receiving Medicare: Total Beneficiaries by State and County, 2010. http://www.cms.gov/Research-StatisticsData-and-Systems/Statistics-Trends-and-Reports/MedicareEnrpts/Downloads/County2010.pdf
19
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. All of 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 more recent years than others. For sets of data partially available for one year and partially available for another, the most recent common year was chosen. As a result, nearly all numbers relating to Social Security date to 2010, nearly all numbers related to Medicare date to 2009, and nearly all 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 benefits are funded entirely by the federal government, Medicaid is partially funded by state governments, and sometimes local governments. 3 There were 56 million beneficiaries nationwide as of May 2012. Except where otherwise noted, the rest of the Social Security data referenced in this report date to 2010, the most recent common year in which those data were available. Total Social Security beneficiaries in individual states dating to 2010 will not add up to this figure. Social Security Administration (SSA), Table 2. Social Security Benefits, May 2012, Monthly Statistical Snapshot, May 2012, June 2012. http://www.ssa.gov/policy/docs/quickfacts/stat_snapshot/#table2 4 Average annual benefit amounts calculated by dividing total annual benefits by total beneficiaries. Total annual benefits from SSA, Table 5.J1 Estimated total annual benefits 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 beneficiaries from SSA, Table 5.J2Number, by state or other area, program, and type of benefit, December 2010, Ann. Stat Supp., February 2012. http://www.ssa.gov/ policy/docs/statcomps/supplement/2011/5j.html#table5.j1 5 Households refers to aged units, which are married couples living together of whom at least one is aged 65 or older, or unmarried persons aged 65 or older. SSA, Table 9.A1, Income of the Population, 55 or Older, 2010, August 2012. http://www.ssa.gov/policy/docs/statcomps/income_ pop55/2010/sect09.html#table9.a1 6 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/files/8-11-10socsec.pdf 7 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=3774 9 White House, Office of Management and Budget, Table 1.1 Summary of Receipts, Outlays and Surpluses or Deficits: 1789-2017, 2012. http://www. whitehouse.gov/omb/budget/Historicals 10 Social Security does not contribute to the deficit, because benefits can only be paid from revenue collected by the Social Security trust fundsthe Old-Age and Survivors Insurance (OASI) trust fund and Disability Insurance (DI) trust fundwhich are completely separate from the 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 due to a temporary two-percentagepoint payroll tax reduction. The payroll tax cut, and the General Fund transfer that resulted, was a temporary stimulus 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 deficit-spend. In the event that trust fund revenues fall short of what is needed to pay 100 percent of benefits, then, by law, benefits could not be paid in full and on time. That is why, if Congress does nothing to shore up the programs finances by 2033, Social Security will only have sufficient revenue to pay about three-quarters of scheduled benefits through 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 financially unsustainable, or in deficit. In fact, it is just the opposite: it attests to Social Securitys self-sustaining funding structure that bars it from deficit-spending or borrowing from the general budget in any way. 11 Total beneficiaries from SSA, Table 5.J2Number, by state or other area, program, and type of benefit, December 2010, Ann. Stat. Supp., February 2012. http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2 State population data from u.S. Census Bureau, Profile of General Population and Housing Characteristics: 2010, 2010 Demographic Profile Data, 2011. http://factfinder2.census.gov/faces/ tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1&prodType=table 12 Total annual benefits from SSA, Table 5.J1Estimated total annual benefits paid, by state or other area and program, 2010 (in millions of dollars), Ann. Stat. Supp., February 2012. http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j1 Benefits equivalent percentage of Gross Domestic Product (GDP) calculated using state GDP figures from Bureau of Economic Analysis, Gross Domestic Product by State (millions of current dollars), September 29, 2011. http://bea.gov/iTable/iTable.cfm?ReqID=70&step=1&isuri=1&acrdn=1 13 Average benefit found by dividing total spending by total beneficiaries. Total annual benefits from Social Security Administration (SSA), Table 5. J1Estimated total annual benefits paid, by state or other area and program, 2010 (in millions of dollars), Ann. Stat. Supp., February 2012. http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j1 Total beneficiaries from SSA, Table 5.J2Number, by state or other area, program, and type of benefit, December 2010, Ann. Stat. Supp., February 2012. http://www.ssa.gov/policy/docs/statcomps/ supplement/2011/5j.html#table5.j2 14 CBPP, Social Security Keeps 20 Million Americans Out of Poverty, A State-by-State Analysis, August, 2010. http://www.cbpp.org/files/8-1110socsec.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 reflect an average from 2006-2008, and therefore 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 reflect this definition. 16 SSA, Table 5.J2Number, by state or other area, program and type of benefit, 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 benefit. Herein, all references to typical will reflect this description. Monthly median benefit multiplied by 12 to calculate annual figure. SSA, Table 5.J6Percentage distribution of monthly benefit for retired workers, by state or other area and monthly benefit, December 2010, Ann. Stat. Supp., February 2012. http://www.ssa.gov/policy/docs/statcomps/ supplement/2011/5j.html#table5.j6 18 SSA, Table 5.J2Number, by state or other area, program, and type of benefit, December 2010, Ann. Stat. Supp., February 2012. http://www. ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2 19 CBPP, Social Security Keeps 20 Million Americans Out of Poverty, A State-by-State Analysis, August, 2010. http://www.cbpp.org/files/8-1110socsec.pdf The state-level data reflect an average from 2006-2008, and therefore do not add up to the national totals, which date to 2008. 20 CBPP, Social Security Keeps 20 Million Americans Out of Poverty, A State-by-State Analysis, August, 2010. http://www.cbpp.org/files/8-1110socsec.pdf The state-level data reflect an average from 2006-2008, and therefore do not add up to the national totals, which date to 2008. Social Security, Medicare and Medicaid Work for neW york 20
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 benefits calculated using total female population from u.S. Census Bureau, Age groups and Sex: 2010, 2010 Census Summary File 2. http://factfinder2.census.gov/faces/tableservices/jsf/pages/ productview.xhtml?pid=DEC_10_SF1_QTP1&prodType=table 22 SSA, Table 5.J2Number, by state or other area, program, and type of benefit, December 2010, Ann. Stat. Supp., February 2012. http://www. ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j2 23 CBPP, Ibid. The number and percentage of women aged 65 or older lifted out of poverty, which do not appear in CBPPs report, were made available by the reports authors, Arloc Sherman and Paul N. Van de Water. The state-level data reflect an average from 2006-2008, and therefore 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, were made available by the reports authors, Arloc Sherman and Paul N. Van de Water. The state-level data reflect an average from 2006-2008, and therefore do not add up to the national totals, which date to 2008. 25 The number of Social Security disability beneficiaries cited here includes only those disabled workers receiving disability benefits. It does not include those disabled workers and disabled adult children who receive Old-Age (retirement) and Survivors benefits. Herein, any use of the term disabled worker will refer only to those disabled workers receiving disability benefits. 26 SSA, Table 5.J8Percentage distribution of disabled workers, by state or other area and monthly benefit, December 2010, Ann. Stat. Supp., February 2012. http://www.ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j8 27 Monthly median benefit multiplied by 12 to calculate annual figure. SSA, Ibid. 28 unless otherwise specified as children under 18 to the exclusion of all others, the term children used in this section is consistent with the Social Security Administrations use of the term to include three groups: children under age 18; students aged 18-19, which refers to children ages 18 and 19 who are matriculated in an institution of secondary education; and disabled adult children, which refers to those adults who have been disabled since before they reached age 18. 29 u.S. Census Bureau, Age Groups and Sex: 2010, 2010 Summary File 2, 2011. http://factfinder2.census.gov/faces/tableservices/jsf/pages/ productview.xhtml?pid=DEC_10_SF2_QTP1&prodType=table Data on percentage of children insured from SSA, Survivors Benefits, 2011, p. 4. http://ssa.gov/pubs/10084.pdf 30 SSA, Table 5.J10Number of children, by state or other area and type of benefit, December 2010, Ann. Stat. Supp., February 2012. http://www. ssa.gov/policy/docs/statcomps/supplement/2011/5j.html#table5.j10 31 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 u.S. Census Bureau, Selected Population Profile in the united States, 2007-2009 American Community Survey 3-Year Estimates. http://factfinder2.census.gov/faces/tableservices/jsf/pages/ productview.xhtml?pid=ACS_09_3YR_S0201&prodType=table 33 SSA, Table 9.A3, Income of the Population 55 or Older, 2010, March 2012. http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/ sect09.html#table9.a3 34 SSA, Table 5.A1Number and average monthly benefit, by type of benefit and race, December 2009, Annual Statistical Supplement, 2010, February 2011. http://www.ssa.gov/policy/docs/statcomps/supplement/2010/5a.html#table5.a1 35 The term households as it is used here refers to households reporting income in the past 12 months. Households receiving Social Security benefits are those households listed as receiving Social Security income. u.S. Census Bureau, Selected Population Profile, 2008-2010 American Community Survey 3-Year Estimates. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_ S0201&prodType=table 36 SSA, Table 9.A3, Income of the Population 55 or Older, 2010, March 2012. http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/ sect09.html#table9.a3 37 SSA, Social Security is Important to Hispanics, January 2012. http://www.ssa.gov/pressoffice/factsheets/hispanics-alt.pdf 38 The term households as it is used here refers to households reporting income in the past 12 months. Households receiving Social Security benefits are those households listed as receiving Social Security income. u.S. Census Bureau, Selected Population Profile, 2008-2010 American Community Survey 3-Year Estimates, 2011. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_ S0201&prodType=table 39 SSA, Social Security is Important to American Indians and Alaska Natives, January 2012. http://www.ssa.gov/pressoffice/factsheets/ amerindian-alt.pdf 40 SSA, Social Security is Important to American Indians and Alaska Natives, January 2012. http://www.ssa.gov/pressoffice/factsheets/ amerindian-alt.pdf 41 The term households as it is used here refers to households reporting income in the past 12 months. Households receiving Social Security benefits 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 Pacific Islander residents, the numbers of beneficiaries and residents were added to calculate percentage of total Asian American, Native Hawaiian and Pacific Islander residents receiving benefits. u.S. Census Bureau, Selected Population Profile, 2008-2010 American Community Survey 3-Year Estimates, 2011. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview. xhtml?pid=ACS_10_3YR_S0201&prodType=table 42 SSA, Table 9.A3, Income of the Population 55 or Older, 2010, March 2012. http://www.ssa.gov/policy/docs/statcomps/income_pop55/2010/ sect09.html#table9.a3 43 SSA, Social Security is Important to Asian Americans and Pacific Islanders, January 2012. http://www.ssa.gov/pressoffice/factsheets/asian-alt.pdf 44 u.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 designated 4 or higher. For the purposes of this report, the authors used both the ERSs 9-point scale, and the binary abbreviation of these codes, which codes rural counties 0 and urban counties 1. 45 County-level population data from u.S. Census Bureau, Profile of General Population and Housing Characteristics: 2010, 2010 Demographic Profile Data. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1&prodType=table Beneficiary data from SSA, Table 4. Number of beneficiaries in current payment status, by county, type of benefit, and sex of beneficiaries aged 65 or older, December 2010, OASDI Beneficiaries by State and County, 2010, August 2011. http://www.ssa.gov/policy/docs/statcomps/oasdi_sc/index. html Social Security, Medicare and Medicaid Work for neW york 21
46 Total personal income: Bureau of Economic Analysis (BEA), Regional Economic Accounts: Local Area Personal Income, Personal income in CA 05N Personal income by major source and earnings by NAICS industry. http://bea.gov/regional/reis/ Social Security income: BEA, Regional Economic Accounts: Local Area Personal Income, Old-age, Survivors and Disability Insurance (OASDI) benefits in CA 35 Personal current transfer receipts. http://bea.gov/regional/reis/ BEA data were used for total annual Social Security benefits rather than the figures 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 as calculating the average benefit and average retirement benefit in rural counties, SSA data were used. 47 SSA, Office of the Chief Actuary, Robert Baldwin and Sharon Chu, Actuarial Note 2011.6: A Death and Disability Life Table for Insured Workers Born in 1991, February 2012. The term retirement age refers to the Full Retirement Age at which workers become eligible for full retirement benefits for Social Security. http://www.ssa.gov/OACT/NOTES/ran6/index.html 48 SSA, Office of the Chief Actuary, Orlo R. Nichols, The Insurance Value and Potential Survivor and Disability Benefits for an Illustrative Worker, 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.pdf 49 National Academy of Social Insurance (NASI), Medicare Finances: Findings of the 2012 Trustees Report, April 2012, p. 1. http://www.nasi.org/ sites/default/files/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 Medicare Beneficiaries? June 2011. http://www.kff.org/medicare/upload/8172.pdf 51 Social Security Works calculation based on projected out-of-pocket health care costs in 2014 under current law, and projected Social Security benefits of retired worker with average earnings of $43,560. Out-of-pocket costs projection from KFF, Raising the Age of Medicare Eligibility: A Fresh Look Following Implementation of Health Reform, p. 9-10, July 2011. http://www.kff.org/medicare/upload/8169.pdf The estimated Social Security benefit is a projection for 2015, the closest date to 2014 available. Social Security Trustees, Table VI.F10.Annual Scheduled Benefit 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.pdf 52 People with severe disabilities become eligible for Medicare coverage only after receiving Social Security Disability Insurance (DI) benefits for 24 months. People with End-Stage-Renal Disease (ESRD) and Lou Gehrigs disease become eligible for Medicare as soon as they qualify for Medicare. Kaiser Family Foundation (KFF), Medicare: a Primer, April 2010, p. 2. http://www.kff.org/medicare/upload/7615-03.pdf 53 There were 48.7 million beneficiaries nationwide in 2011. Except where otherwise noted, the rest of the Medicare data referenced in this report date to 2009, the most recent common year in which those data were available. Total Medicare beneficiaries in individual states dating to 2009 will not add up to this figure. Medicare Trustees, 2012 Medicare Trustees Report, April 23, 2012, p. 6. http://www.cms.gov/Research-Statistics-Data-andSystems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2012.pdf 54 Average expenditure per beneficiary is average benefit per enrollee. Medicare Trustees, 2012 Medicare Trustees Report, Table II.B1 Medicare Data for Calendar Year 2011, p. 10. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ ReportsTrustFunds/Downloads/TR2012.pdf 55 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.pdf 58 White House, Office 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-office/affordable-care-act-strengthening-medicare-combating-misinformation-andprotecting59 White House, Office 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 beneficiaries enrolled in Medicare Advantage calculated using total Medicare beneficiaries figure 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 2 in The Case for Public Plan Choice in National Health Reform, 2009. http://institute.ourfuture.org/files/Jacob_Hacker_Public_Plan_Choice.pdf 63 Hacker, The Case for Public Plan Choice in National Health Reform, 2009, p. 6. http://institute.ourfuture.org/files/Jacob_Hacker_Public_Plan_ Choice.pdf 64 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 reflects total administrative expenses of Medicare Parts A, B, and D, but not Part C, for which that information was not available. 65 Congressional Budget Office (CBO), Key Issues in Analyzing Major Health Insurance Proposals, December 2008, p. 70. http://www.cbo.gov/ ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf 66 CBO, Ibid, p. 94. http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf 67 Medicare Advantages administrative costs are expected to decline from the figure cited above as a result of reforms passed in the Patient Protection 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.pdf 68 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=5 69 Average benefit found by dividing total spending by total beneficiaries. KFF, Medicare Spending Estimates by State of Residence (in millions), 2009, December 2011. http://www.statehealthfacts.org/comparemaptable.jsp?ind=620&cat=6 KFF, Distribution of Medicare Beneficiaries by Eligibility Category, 2009, 2010. http://www.statehealthfacts.org/comparetable.jsp?ind=293&cat=6 70 KFF, Distribution of Medicare Beneficiaries by Eligibility Category, 2009, 2010. http://www.statehealthfacts.org/comparetable. jsp?ind=293&cat=6 State population data from u.S. Census Bureau, General Demographic Characteristics, 2009 Population Estimates. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2009_DP1&prodType=table 71 KFF, Distribution of Medicare Beneficiaries by Eligibility Category, 2009, 2010. http://www.statehealthfacts.org/comparetable. jsp?ind=293&cat=6 2009 was the most current year with data available on the breakdown of Medicare beneficiaries by category. 72 KFF, Distribution of Medicare Beneficiaries by Eligibility Category, 2009, 2010. http://www.statehealthfacts.org/comparetable. jsp?ind=293&cat=6 2009 was the year with the most current data available on the breakdown of Medicare beneficiaries by category. Social Security, Medicare and Medicaid Work for neW york 22
73 National Institutes of Health, u.S. National Library of Medicine (NLM), End-stage kidney disease, 2011. http://www.nlm.nih.gov/medlineplus/ ency/article/000500.htm 74 NLM, Amyotrophic Lateral Sclerosis, 2011. http://www.nlm.nih.gov/medlineplus/amyotrophiclateralsclerosis.html 75 KFF, Medicaid: a Primer, June 2010, p. 3. http://www.kff.org/medicaid/upload/7334-04.pdf 76 In the case of Medicaid, 2009 refers to data from FY2009. Except where otherwise noted, Medicaid data referenced in this report date to FY2009, the most recent common year in which those data were available. KFF, Total Medicaid Enrollment FY2009, 2012. http://www.statehealthfacts.org/ comparemaptable.jsp?ind=198&cat=4 77 KFF, Employer Health Benefits: 2011 Annual Survey, September 27, 2012, p. 1. http://ehbs.kff.org/pdf/2011/8225.pdf 78 KFF, Medicaid: a Primer, June 2010, p. 23. http://www.kff.org/medicaid/upload/7334-04.pdf 79 Families uSA, Tables 1-2, Cutting Medicaid: Harming Seniors and People with Disabilities Who Need Long-Term Care, May 2011, pp. 3-4. http:// familiesusa2.org/assets/pdfs/long-term-care/Cutting-Medicaid.pdf 80 KFF, Medicaid: a Primer, June 2010, p. 23. http://www.kff.org/medicaid/upload/7334-04.pdf 81 KFF, Medicaid: a Primer, June 2010, p. 1. http://www.kff.org/medicaid/upload/7334-04.pdf 82 As noted previously, aside from the total national Medicaid enrollees included in the introduction of the Medicaid section of this report, all Medicaid figures, unless otherwise noted, date to FY2009, the most recent common year in which data were available. KFF, Total Medicaid Spending, FY2009, 2012, unpublished; Data provided to Social Security Works by Lindsay Donaldson, Research Associate at the Kaiser Family Foundation. Medicaids percent of total health care found by dividing total Medicaid spending by total health care expenditures. KFF, Health Care Expenditures by State of Residence (in millions), 2009, 2010. http://www.statehealthfacts.org/comparemaptable.jsp?ind=592&cat=5 Medicaid spending figure includes portion of funding that comes from state and local governments. 83 Average found by dividing total spending by total beneficiaries. KFF, Total Medicaid Spending, FY2009, 2012, unpublished; Data provided to Social Security Works by Lindsay Donaldson, Research Associate at the Kaiser Family Foundation. KFF, Total Medicaid Beneficiaries 2009, 2010. http://www.statehealthfacts.org/comparetable.jsp?ind=198&cat=4 84 KFF, Total Medicaid Enrollment FY 2009, 2012. http://www.statehealthfacts.org/comparetable.jsp?ind=198&cat=4 State population data from u.S. Census Bureau, General Demographic Characteristics, 2009 Population Estimates. http://factfinder2.census.gov/faces/tableservices/jsf/ pages/productview.xhtml?pid=PEP_2009_DP1&prodType=table 85 KFF, Distribution of Medicaid Enrollees by Enrollment Group, FY2009, 2012. http://www.statehealthfacts.org/comparemaptable. jsp?ind=200&cat=4 Childrens population data from u.S. Census Bureau, Children Characteristics, 2009 American Community Survey 1-Year Estimates. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_09_1YR_S0901&prodType=table 86 KFF, Distribution of Medicaid Enrollees by Enrollment Group, FY2009, 2012. http://www.statehealthfacts.org/comparemaptable.jsp?typ=1&i nd=200&cat=4&sub=52. 87 KFF, Distribution of Medicaid Enrollees by Enrollment Group, FY2009, 2012. http://www.statehealthfacts.org/comparemaptable.jsp?typ=1&i nd=200&cat=4&sub=52. 88 KFF, Medicaid Long-Term Care Funding by Category, FY2009, 2012, unpublished; Data provided to Social Security Works by Lindsay Donaldson, Research Associate at the Kaiser Family Foundation. 89 Data on Medicaids coverage of nursing home residents, as well as the cost of nursing home rooms in each state, date to 2010. Had 2009 data been available, they would have been used for the sake of consistency with the other state-level benefit and beneficiary data. Families uSA, Table 3, Cutting Medicaid: Harming Seniors and People With Disabilities Who Need Long-Term Care, May 2011. http://familiesusa2.org/assets/pdfs/long-term-care/ Cutting-Medicaid.pdf 90 Families uSA, Table 5, Cutting Medicaid: Harming Seniors and People With Disabilities Who Need Long-Term Care, May 2011. http://familiesusa2. org/assets/pdfs/long-term-care/Cutting-Medicaid.pdf 91 KFF, Medicaid: a Primer, June 2010, p. 25. 92 Center for Economic and Policy Research (CEPR), u.S. Budget Deficits 2001-2011. Analysis of Congressional Budget Office data. First published here. 93 Medicare Trustees, Table II.B1Medicare Data for Calendar Year 2011, 2012 Medicare Trustees Report, April 23, 2012, p. 10. http://www.cms.gov/ Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2012.pdf Figure reflects total administrative expenses of Medicare Parts A, B, and D, but not Part C, for which that information was not available. Congressional Budget Office (CBO), Key Issues in Analyzing Major Health Insurance Proposals, December 2008, p. 70. http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf 94 Total benefits figure reflects the sum of total annual spending by Social Security, Medicare and Medicaid in the state, each of which is individually sourced in the report. Average ratio of residents receiving benefits from Social Security, Medicare or Medicaid, is an average of the percentages of residents receiving benefits from each of the three programs.
23
key factS aBout Social Security, Medicare & Medicaid in neW york
Social Security, Medicare and Medicaid work for New York residents of all ages and backgrounds. This report, Social Security, Medicare & Medicaid Work for New York shows that:
Social Security Works for New Yorks Residents and Economy

Social Security provided benefits to 3,280,575 New Yorkers in 2010, 1 out of 6 residents, including 2,148,469 retired workers, 490,662 disabled workers, 244,220 widow(er)s, 137,763 spouses, and 259,461 children. [Figure 3] Social Security provided benefits totaling over $44.8 billion in 2010, an amount equivalent to 4 percent of the states annual GDP (the total value of all goods and services produced). The average Social Security benefit in 2010 was $13,641. Social Security lifted 1,108,000 New York residents out of poverty in 2008.
Social Security Works for New Yorks Women

Social Security provided benefits to 1,714,404 women residents in 2010, 1 out of 6 women. Without Social Security, the poverty rate of elderly women would increase from 1 out of 6 to half.
Social Security Works for New Yorks People of Color

Social Security provided benefits to 421,053 African Americans in New York in 2009, 1 out of 8 African American residents. It provided benefits to 1 out of 5 Latino households in New York in 2010, 196,034 households.
Medicare Works for New Yorks Residents and Economy

2,915,477 New Yorkers received Medicare benefits in 20091 out of 6 state residents. Medicare provided $34.1 billion in benefits in 200920.9 percent of all health care spending in the state. The average expenditure per Medicare beneficiary was $11,690.
Medicare Works for New Yorks Seniors and People with Disabilities
2,446,039 of New Yorks 2,915,477 Medicare beneficiaries were aged 65 or older in 20098 out of 10 beneficiaries. 469,438 of New Yorks 2,915,477 Medicare beneficiaries were people with disabilities in 20091 out of 6 beneficiaries.
Medicaid Works for New Yorks Residents and Economy

5,208,135 New Yorkers received Medicaid benefits in 20091 out of 4 state residents. A total of $49.4 billion in Medicaid benefits were paid in 200930.3 percent of all health care spending in the state. The average expenditure per Medicaid beneficiary was $9,479.
Medicaid Works for New Yorks Seniors, People with Disabilities and Long-Term Care Residents
591,892 of New Yorks 5,208,135 Medicaid beneficiaries were aged 65 or older in 20091 out of 9 beneficiaries. 669,882 of New Yorks 5,208,135 Medicaid beneficiaries were people with disabilities in 20091 out of 8 beneficiaries. Medicaid provided $21.3 billion in long-term care benefits for New York residents in 2009, including providing nursing home care for 78,920 nursing home residents, 3 out of 4 of state residents enrolled in nursing homes.
Social Security, Medicare and Medicaid Work for neW york 24

Social Security, Medicare and Medicaid Work For New York

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Social Security, Medicare and Medicaid Work For New York

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Social Security, Medicare and Medicaid Work for neW york

introduction and SuMMary

Social Security Medicare Medicaid

3,280,575 2,915,477 5,208,135

16.9 percent 14.9 percent 26.7 percent

$13,641 $11,690 $9,479

$44.8 billion $34.1 billion $49.4 billion