Social Security Beneficiaries Research Articles

The Impact of Salmon Bias on the Hispanic Mortality Advantage: New Evidence from Social Security Data

A great deal of research has focused on factors that may contribute to the Hispanic mortality paradox in the United States. In this paper, we examine the role of the salmon bias hypothesis - the selective return of less-healthy Hispanics to their country of birth - on mortality at ages 65 and above. These analyses are based on data drawn from the Master Beneficiary Record and NUMIDENT data files of the Social Security Administration. These data provide the first direct evidence regarding the effect of salmon bias on the Hispanic mortality advantage. Although we confirm the existence of salmon bias, it is of too small a magnitude to be a primary explanation for the lower mortality of Hispanic than NH white primary social security beneficiaries. Longitudinal surveys that follow individuals in and out of the United States are needed to further explore the role of migration in the health and mortality of foreign-born US residents and factors that contribute to the Hispanic mortality paradox.

Oral health service utilization by elderly beneficiaries of the Mexican Institute of Social Security in México city.

BackgroundThe aging population poses a challenge to Mexican health services. The aim of this study is to describe recent oral health services utilization and its association with socio-demographic characteristics and co-morbidity in Mexican Social Security beneficiaries 60 years and older.MethodsA sample of 700 individuals aged 60+ years was randomly chosen from the databases of the Mexican Institute of Social Security (IMSS). These participants resided in the southwest of Mexico City and made up the final sample of a cohort study for identifying risk factors for root caries in elderly patients. Sociodemographic variables, presence of cognitive decline, depression, morbidity, medication consumption, and utilization of as well as reasons for seeking oral health services within the past 12 months were collected through a questionnaire. Clinical oral assessments were carried out to determine coronal and root caries experience.ResultsThe sample consisted of 698 individuals aged 71.6 years on average, of whom 68.3% were women. 374 participants (53.6%) had made use of oral health services within the past 12 months. 81% of those who used oral health services sought private medical care, 12.8% sought social security services, and 6.2% public health services. 99.7% had experienced coronal caries and 44.0% root caries. Female sex (OR = 2.0), 6 years' schooling or less (OR = 1.4), and caries experience in more than 22 teeth (OR = 0.6) are factors associated with the utilization of these services.ConclusionAbout half the elderly beneficiaries of social security have made use of oral health services within the past 12 months, and many of them have to use private services. Being a woman, having little schooling, and low caries experience are factors associated with the use of these services.

The United States Can Afford the Boomers

In their recent book Aging Nation, Schulz and Binstock (2006) referred to of doom--academics, political figures, and journalists who argue that nation cannot afford retirement of baby boomers. As proof of their belief, these often point to projections showing a growing of older adults and a relative decline in of individuals of working age. Although they are not always consistent, merchants' underlying message is that we face a fiscal cancer that could have catastrophic consequences for our country (U.S. Heading for Financial Trouble, 2007).This is often accompanied by recommendations that we (partially) privatize social security and Medicare. This column examines these arguments and considers their implications for social workers. UNDERSTANDING DEPENDENCY RATIOS Underlying much of concern about population aging are projected changes in dependency ratios (Gee, 2002). One of best known of these is beneficiary-to-covered-worker ratio, which shows of social security beneficiaries supported by each 100 workers (individuals 20 to 64) (Reno 8: Lavery, 2006).This ratio is expected to rise from 29 in 2000 to 46 in 2030. Although these figures have generated much alarm, they are somewhat misleading. Specifically, they overlook that older adults are not only dependent age group. A more sophisticated measure is total age-dependency ratio, which includes not only older adults, but also individuals under age of 20 (Reno & Lavery, 2006).This gives us a much different perspective. It shows that we have already experienced worst of demographic shifts. In 1960 each 100 working-age people supported 90 dependents (people age 65 and older plus those under age 20); in 2030, they will support only 79. The point, of course, is that although aging population will increase, there will be many fewer young people than when boomers were growing up (Schulz & Binstock, 2006). Now, some might argue that we cannot really compare young people with older adults. After all, older adults are supported by government programs funded with tax dollars, whereas children generally receive support from their parents. This is true, but it misses point. The fundamental issue is our society's ability to support its dependents (Schulz & Binstock, 2006). Parents do support their children, but as taxpayers, they also finance programs that support older adults. Moreover, children are recipients of tax dollars. Public education, which primarily benefits young people, is financed by state and local governments (Reno & Lavery, 2006). This is not a negligible expense. Proportionally, increased spending on public schools to educate boomers was much greater than amount that will be needed to support them in retirement. Between 1950 and 1975, share of gross domestic product (GDP) going to public education increased by 2.8 percent; in contrast, between 2005 and 2030, share devoted to social security spending will increase by only 1.8 percent (Reno & Lavery). Furthermore, although the boomers came into world with nothing (Leone, 2005), they will leave behind tremendous financial and other resources. The total dependency ratio suggests that future is not as bleak as merchants of doom have argued (Schulz & Binstock, 2006).Yet, this ratio is also limited. Like beneficiary-to-covered-worker ratio, total age-dependency ratio is too abstract, that is, it considers older adults and young people as categories, not in terms of their actual lives. In reality, some older adults and young people are employed, and some working-age people are not (Reno & Lavery, 2006). A more useful measure is consumer-to-worker support ratio, which considers total of consumers, including working people, in relation to number of workers of all ages (Reno & Lavery, 2006, p. …

Effectiveness of the Ticket to Work Program for Beneficiaries who are Blind or have Low Vision: Comparisons with other Beneficiaries

The Ticket to Work (TTW) program began in 13 states in February 2002, and nationwide implementation was completed in fall 2004. This federally funded program is meant to assist persons who receive disability benefits from the Social Security Administration (SSA) in obtaining employment, with the ultimate goal of terminating SSA benefits and thereby providing a cost savings for the government (Livermore et al., 2003). Other goals of the program are to increase beneficiaries' choice of providers of rehabilitation services and to improve the quality of rehabilitation services by providing for competition among service providers. With its focus on employment, the TTW program would seem to be an excellent opportunity for beneficiaries who are blind or have low vision, since lower levels of employment are a well-known problem for them compared to persons without disabilities and persons with most other types of disabilities (Houtenville, 2003; Kirchner, Schmeidler, & Todorov, 1999). However, the manner in which the program has been implemented has caused professionals in the field of blindness rehabilitation to voice concerns about whether the program is effective with beneficiaries who are blind or have low vision. This concern stems primarily from the fact that the program has not provided incentives to serve beneficiaries who are more severely disabled (that is, those who may require more time and assistance to become employed). How THE PROGRAM WORKS Under the Ticket to Work program, eligible social security beneficiaries with disabilities--those who are receiving either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)--are given a ticket that can be used to obtain rehabilitation services from an employment network. Employment networks is the term used by the SSA to describe the organizations that provide services to beneficiaries in the TTW program. Employment networks can be nonprofit private, for-profit private, or public organizations, and all state vocational rehabilitation agencies are considered employment networks under the TTW program. The goal of the rehabilitation services that employment networks provide to beneficiaries must be employment. A beneficiary selects the employment network that he or she wants to work with and assigns the ticket to it. After the ticket is assigned, an individual work plan is developed, which specifies what each party will do to help the beneficiary obtain employment. After the beneficiary agrees with the work plan, he or she begins to receive rehabilitation services. If the beneficiary is dissatisfied with the services received, he or she has the option of unassigning a ticket and reassigning it to another employment network or vocational rehabilitation agency. Progress toward employment is monitored under the program 24 months after a ticket is assigned and every 12 months thereafter (see Capella-McDonnall, 2005, for a more detailed overview of the program). EMPLOYMENT NETWORKS' CHOICE OF PROVIDING SERVICES One concern of professionals in the field of visual impairment and blindness about the TTW program is that employment networks have the option of refusing services to beneficiaries for any reason. Therefore, employment networks could choose not to serve persons who are blind or have low vision. (Note that state vocational rehabilitation agencies are required to provide services to all eligible beneficiaries.) Some reasons why employment networks may choose not to serve beneficiaries who are blind or have low vision are that these beneficiaries may require a higher level of earnings to terminate benefits, may be more likely to need expensive services and assistive technology, may be perceived as difficult to place, and require assistance from persons with specialized training in blindness rehabilitation (Cavenaugh, 1999, 2000; Gallagher, 1988; Spungin, 1997). Survey research on the attitudes of employment networks in the first 13 states toward serving beneficiaries who are blind or have low vision found that employment networks do have these concerns, although such concerns did not prevent some of them from accepting tickets from beneficiaries (Capella-McDonnall, 2005). …

Evaluation and Future Prospect of U.S. Return to Work Policies for Social Security Beneficiaries

Evaluation and Future Prospect of U.S. Return to Work Policies for Social Security Beneficiaries

Options to Liberalize Social Security Disabled Widow(er)s Benefits

Each month, 200,000 widows and 6,000 widowers receive Social Security disabled widow(er)s benefits, each benefit averaging about $550. Among the most economically at-risk Social Security beneficiaries, their benefits are permanently reduced. This paper reviews the legislative history of the disabled widow(er)s benefit, identifying key decisions that gave shape to this benefit. Social Security program data and six years of Current Population Survey data (March Annual Demographic Files, 1995-2000) are used to profile the economic status of current and potential disabled widows. The analysis, including comparison with other widows, provides strong evidence of economic need among disabled widows with, for example, 44% of disabled widow beneficiaries, ages 50-59, having below-poverty incomes compared with 15% of like-aged non-disabled widows. We conclude that serious consideration should be given to extending eligibility to all widow(er)s disabled before the normal retirement age; to providing a benefit equal to 100% of the deceased spouse's private insurance amount (PIA); to eliminating the unnecessarily restrictive seven-year rule; and to protecting beneficiaries from losing their eligibility to Medicaid. Even in the context of today's heated Social Security debate, we suggest that a rare opportunity may exist to garner bipartisan support for meaningful, low-cost improvements, in a benefit that primarily targets women.

Does assigning a representative payee reduce substance abuse?

Background Approximately 700,000 Social Security beneficiaries in the U.S. with psychiatric disabilities have been assigned a representative payee to manage their funds but it is unclear how those judged to need a payee differ from others and whether payee assignment improves clinical outcomes, especially substance abuse. Methods Participants in this observational 12-month cohort study ( n = 1457) received SSI or SSDI and had serious mental illness. They were subsequently enrolled at eighteen community-based sites that provided Assertive Community Treatment. Social Security administrative records were used to determine whether a payee had been assigned. Results At baseline, participants who were assigned a payee were more likely to have schizophrenia and had more severe clinician-rated drug and alcohol use than those not assigned a payee. In GEE models that adjusted for these and other potentially confounding covariates, participants assigned a payee between 4 and 12 months after program entry subsequently used significantly more psychiatric services than participants not assigned payees but showed no greater reduction in substance use. Conclusions Although substance use is associated with being assigned a payee, substance use does not decline substantially following payee assignment. Participants assigned payees made greater subsequent use of psychiatric services, suggesting the potential for benefit from payee assignment.

The Ticket to Work Program: Employment Networks’ Views on Serving Beneficiaries who are Blind or Visually Impaired

This article reports on a survey of the opinions of employment networks (ENs) about serving social security beneficiaries who are blind or visually impaired under the Ticket to Work program. Although most of the 267 ENs who participated in the survey expressed concerns about working with those who are blind or visually impaired, they did not seem to be biased against working with this population based solely on their disability type.

Changing Approaches of Social Protection: Social Assistance Reform in Urban China

The article will examine the latest development of China's urban social assistance reform. Under the impact of the dual processes of globalisation and the deepening market transition, China's social security reform is increasingly taking a new safety net approach to assist the urban poor, instead of relying mainly on social insurance provision. The minimum living security project for urban residents is one of the approaches supplementing social insurance in social protection. In 2002, about one-third of social security beneficiaries were supported by the newly developed social assistance project. The changing approach does not mean that the government is withdrawing from its responsibility for social insurance to the urban workers, but reflects the changing goals and means of social policies. This indicates that China's social welfare system is shifting towards a new residual welfare model.

Accounting for Social Security and Its Reform

How well did the Social Security system do last year? According to the most recent annual report prepared by system's Board of Trustees, the Social Security trust funds showed a $165.4 billion net increase in assets in 2002 and reported accumulated reserves of nearly $1.4 trillion by year end. Unfortunately, these glowing reports are a cash-flow illusion, revealing only the difference between the system's annual cash receipts and its yearly payments for benefits and administrative expenses. Were the finances of the Social Security system restated under principles of accrual accounting, which recognizes commitments to make future payments when those obligations are actually incurred, the Social Security trust funds would have had to report a loss of several hundred billion dollars in 2002. Moreover, as of December 31, 2002, an accrual-based balance sheet of the Social Security system would have revealed more than $14.0 trillion of accrued liabilities to Social Security participants and beneficiaries. Even allowing for the system's $1.4 trillion of accumulated reserves as well as the value of excess future taxes to be paid by current participants over the rest of their working lives, the Social Security trust funds had unfunded obligations on the order of $10.5 trillion as of year-end 2002. This implicit debt of the Social Security system is several times greater than the explicit debt burden of the federal government and is growing by hundreds of billions of dollars each year. In addition to misrepresenting the magnitude of the Social Security system's looming financial crisis, the current accounting system for Social Security distorts public debate over Social Security reform proposals and confuses the relationship between Social Security and the rest of the federal budget. Accrual accounting, in contrast, would provide a clearer picture of the true state of the Social Security's current financial shortfall and the extent to which the system's burden on future generations is increasing each year. Accrual accounting would also create political incentives for our leaders to address Social Security's difficulties in a timely manner, and enhance the quality of public debate over the relative merits of competing reform proposals.

How Important are Wages to the Elderly? Evidence from the New Beneficiary Data System and the Social Security Earnings Test

More than 40 percent of Social Security beneficiaries continue to work after age 65. This research investigates the extent to which these individuals substitute labor across periods in response to anticipated wage changes induced by the Social Security earnings test. While we find that a disproportionate number of individuals choose earnings within a few percentage points of the earnings limit, we find no evidence that these individuals substitute labor supply between ages 69 and 70 when, in our sample, the tax on earnings falls from 50 percent to zero.

Social Security and the family: addressing unmet needs in an underfunded system

As the baby boom generation gets closer to retirement, the debate over Social Security reform becomes more urgent. Unfortunately, policymakers remain fixated on individual accounts and other ways for the system to accumulate more savings. This narrow focus ignores an equally important, if not more important, challenge--how to address the needs of those who have been left out as demographics and work habits have changed the structure of the American family. In this book, budget experts and social scientists examine the history of family benefits in Social Security and show how changes in the retired population have affected the nature of these benefits and their ability to serve the elderly. They examine the current structure of spousal and survivors benefits and evaluate a variety of reform proposals--including individual accounts--that could improve the living standards of the neediest Social Security beneficiaries. It is essential analysis for anyone concerned about the future of America's most successful social program.

Gender and Racial Inequities in Retirement Resources

ABSTRACT Two waves of a Social Security Beneficiary survey were analyzed to consider differences in the retirement resources of women and men based on marital status and race/ethnicity. Despite increased workforce participation the economic situation of single women, including white women, worsened over time. A bifurcation in retirement resources was found, with men relying more on private income sources and women depending more on Social Security. Current retirement policies based on privatization will continue to adversely impact women who work at low-paying jobs, receive lower wages, and live longer than men.

Does Aid Matter? Measuring the Effect of Student Aid on College Attendance and Completion

Does student financial aid increase college attendance, or simply subsidize costs for infra-marginal students? Settling the question empirically is a challenge, because aid is correlated with many characteristics that influence schooling decisions. A shift in financial aid policy that affects some youth but not others can provide an identifying source of variation in aid. In 1982, Congress eliminated the Social Security student benefit program, which at its peak provided grants totaling $3.9 billion a year (amounts are in constant 2000 dollars) to one out of eight college students. I use difference-in-differences analysis to evaluate the effect of this program on schooling outcomes. Using the death of a parent to proxy for Social Security beneficiary status, I find that the college attendance of the affected group dropped by more than a third, and schooling by two-thirds of a year. Offering $1,000 of grant aid increases the probability of attending college by 3.6 percentage points and years of completed schooling by a tenth of a year. Aid eligibility also appears to have a positive impact on school quality.

Does Aid Matter? Measuring the Effect of Student Aid on College Attendance and Completion

Does student aid increase college attendance or simply subsidize costs for infra-marginal students? Settling the question empirically is a challenge, because aid is correlated with many characteristics that influence educational investment decisions. A shift in financial aid policy that affects some youth but not others can provide an identifying source of variation in aid. In 1982, Congress eliminated the Social Security Student Benefit Program, which at its peak provided grants totaling $3.7 billion a year to one out of ten college students. Using the death of a parent as a proxy for Social Security beneficiary status, I find that offering $1,000 ($1998) of grant aid increases educational attainment by about 0.16 years and the probability of attending college by four percentage points. The elasticities of attendance and completed years of college with respect to schooling costs are 0.7 to 0.8. The evidence suggests that aid has a 'threshold effect': a student who has crossed the hurdle of college entry with the assistance of aid is more likely to continue schooling later in life than one who has never attempted college. This is consistent with a model in which there are fixed costs of college entry. Finally, a cost-benefit analysis indicates that the aid program examined by this paper was a cost-effective use of government resources.

Utilization of Formal Services During the 10 Years After Retirement

As the aging of the population accelerates in the coming decades, the use of formal services by elderly persons will become an important issue. This article presents the findings of a study on the pattern of utilization of out-of-home services and in-home services among a cohort of social security beneficiaries in the 10 years after their retirement. The study found that the determinants of the use of these two types of services are distinctly different. For example, the variable health impairments is related to the use of in-home services but not out-of-home services; on the other hand, education is related to the use of out-of-home services but not in-home services. The implications of these findings for social work practice are discussed.

Towards a Negative Income Tax System for Australia

The undue complexity of the Australian tax‐transfer system is outlined as are the associated high effective marginal tax rates for many individuals and families. A negative income tax system is a possible solution to these problems.The most radical version of negative income tax is a ‘basic income/flat tax’ system which combines universal tax credits (that vary according to presence of children, disability etc.) and a flat tax rate on private income. Using NATSEM’s microsimulation model STINMOD it is found that to ensure that no current social security beneficiaries become worse off under such a system would either be very expensive to introduce or require a tax rate that is likely to be unacceptably high. Less radical versions of negative income tax are also costed, incorporating the possibility of varying tax rates, the tapering out of tax credits, and placing some restrictions on the granting of tax credits. This makes negative income tax look more feasible.The analysis does not incorporate behavioural responses. Since the motivation for a negative income tax system is largely to achieve such responses (for example, labour supply responses), this feasibility analysis might have been unduly harsh. Research is required to incorporate behavioural responses into the analysis.

Social insurance financing for long-term care: creative public policy to halt pauperization of the elderly and disabled in nursing homes

Long-term care (LTC) in institutions is one of the last major remaining gaps in the social insurance safety net provided to beneficiaries of Social Security.(1) However, Medicaid pays almost half of the costs of nursing home care after institutionalized elderly or disabled persons become impoverished. Structural reasons make it impossible for private insurance to cover institutional LTC for the bulk of the elderly and disabled. The paper demonstrates that there is an efficient, equitable and feasible social insurance solution to this serious social problem. The second section details a plan for a Medicare Part C Trust Fund to cover extended stays in nursing homes by Social Security beneficiaries (virtually the entire elderly population and most of the long-term disabled). It involves: (1) maintenance of current government funding indexed to inflation; (2) a premium taken from the cost-of-living allowances (COLAs) due to beneficiaries in the years immediately after they qualify for Social Security; (3) a substantial copayment; (4) a deductible consisting of the first three months of nursing home care; (5) a two-year waiting period between qualification for Social Security and full LTC coverage. The three revenue streams will all increase automatically with inflation. The plan is designed to cover only institutional LTC costs in order to reduce complexity, minimize the price tag and maximize its political chances. However, it could be expanded to cover home and community-based care. The second half of the analysis explores the policy justifications supporting such a plan and considers the political reasons why this carefully crafted proposal might appeal to moderate conservatives as well as to progressives.

The privatization of health care in three Latin American social security systems.

Most Latin American social security institutes are direct providers of medical care services to their beneficiaries. As many of the institutes have developed serious financial problems over the course of the last decade and a half, they have come under increasing attack for (a) exacerbating inequalities in access to and use of health care, (b) further heightening the geographic overconcentration of services, (c) focusing a disproportionate amount of resources on high technology, curative care to the near total exclusion of primary health care, and (d) being administratively top heavy and, more generally, inefficient. In the past few years, many Latin American countries have begun searching for methods to ameliorate these problems. This paper analyzes three recent efforts, all of which involve some degree of privatization: (1) El Salvador's partial privatization of specialty physician outpatient consultations, (2) Peru's minor surgery and its decentralized ambulatory care programme, and (3) Nicaragua's "administrative services only' approach wherein social security beneficiaries choose to join a certified public or private provider organization for one year, and, on behalf of the individual, social security pays the organization a fixed, annual, per capita fee to provide all health care for the enrollee. The paper also identifies political and technical considerations, as well as health care market characteristics that have shaped these efforts and that condition their likelihood of success, including: the size, composition, level of capacity utilization, degree of organization and geographic distribution of private sector resources; relative prices in the private vis-a-vis the public sector; and the size and nature of the private health insurance market. Other Latin American countries would do well to examine these factors and characteristics before embarking on efforts to reform their own social security health care delivery systems.

Social Security Spending in the United Kingdom: Bridging the North-South Economic Divide

Regional considerations have played little if any part in the development of social security policies in the United Kingdom. The spatial concentration of present social security expenditure is purely incidental and occurs simply as a result of the clustering of social security beneficiaries in particular areas. Nevertheless, by affecting regional aggregate demand these spatial transfers act to lessen the growth of regional disparities. In this paper the pattern of spatial transfers effected by social security benefits in the period 1979/80–1985/86 is described, with particular reference to transfers across the so-called north–south divide. Although not all benefits cause the transfer of resources in the same geographical direction, in 1985/86 social security transfers to the north exceeded those associated with formal regional policies.