Trump Budget Proposal For Social Security

     The White House has released its "skinny" budget proposal for fiscal year 2018, which begins on October 1, 2017. The "skinny" reference is to the limited information in the proposal. If this is adopted, Social Security's operating budget would increase by 0.2%. (See page 50). Because of inflation, this would amount to a small decrease in the agency's budget. However, "program integrity" at Social Security would increase by 26.8%. By contrast, this budget proposal calls for major decreases in spending at most agencies, a 16.2% reduction at HHS, for instance.

     This budget proposal faces widespread criticism from Republican as well as Democratic legislators and won't be adopted as proposed. However, it is a sign that to some extent the message is getting across to the White House that these is no way to make even modest cuts in Social Security's operating budget without causing dramatic and very visible problems in the agency's service delivery.

Claimant Dies After Disability Benefits Ceased

     From WATE:

A mother is mourning the loss of her daughter.

Amy Schnelle, 31, died of an epileptic seizure on February 17. She died less than half a year after the government cut her benefits, including medication....

On disability for several years, Amy Schnelle was receiving powerful anti-seizure drugs and had been seizure free since 2015. Then the United States Social Security Administration threw her a curve ball in September 2016 when they informed her she was no longer sick. ...

She appealed the decision, but while her appeal was under consideration, Amy Schnelle’s benefits stopped. Nevertheless, three of the drug manufacturers provided her with sample drugs, but one did not. Sylvia Schnelle, Amy Schnelle’s mother, said without the full supply of prescription pills, her daughter relapsed in late October. ...

Writing to Congressman Jimmy Duncan, Amy Schnelle was able to convince the government to resume her benefits. That happened in January 2017, but in February 2017, from her apartment, she texted her mother she had a “bad” seizure and asked her to “please” come. Her mother rushed to Knoxville from her home in Dandridge.

“Amy was on her stomach and she had already died. She died from a seizure,” said Sylvia Schnelle through tears. ...

Tough Way To Make A Living

     The Buffalo Law Journal reports on how difficult it is to make a living representing Social Security disability claimants. Of course, it's a lot tougher being a disabled person filing a claim with Social Security.

I Knew There Was Something Good About Trumpcare!

     Matt Fuller noticed something interesting hidden in the Congressional Budget Office (CBO) projection of the effects of the Republican plan for replacing the Affordable Care Act. The CBO is projecting that Social Security expenditures over the time period 2017-2026 would decrease by $3 billion under the GOP plan. The explanation is that more people will die under the Republican plan, about 17,000 in 2018 rising to 29,000 in 2026 alone. People can't draw Social Security benefits if they're dead.

HIV Ruling Rescinded

     Social Security is rescinding Ruling 93-2p on the evaluation of HIV. This is being done because of the adoption of a new Listing.

Central Offices Closed

     A message from Social Security:

Social Security Administration (SSA) offices at headquarters and the Baltimore Metropolitan area will be closed on Tuesday, March 14, 2017 [by a large snowfall]. ITC and Falls Church offices should continue to monitor and follow OPM guidance.

     Somebody correct me if I'm wrong but I'll guess that ITC stands for the International Trade Center, a large government office building in Washington, and I'll also guess that's where the Commissioner's office is. I've never understood why it's better for the Commissioner's office to be there rather than in Woodlawn. There must be a fair amount of time wasted by staffers who have to travel into Washington for meetings at the Commissioner's office.

Ever Heard Of HITECH?

     If you work at a hearing office, you probably already know that Social Security disability claim files have been getting longer over the last few years. Let me explain why this is happening and why it is going to get worse over the next year or two. Also, I'll explain why this has major implications for the Social Security Administration.

     The most important reason files have been getting longer is electronic medical records. It has become easier for medical providers to create and store medical records. When they were storing medical records in physical files, medical providers had incentive to keep the records concise. How do you store a 2,000 page physical file? How does a physician make use of such a huge physical file? Once things went electronic, medical files started ballooning. Medical records systems used in many physician offices and at some large providers, including the VA, regurgitate almost the entire medical history as a new medical record every time a patient sees a physician. With VA records in particular, the new material gets lost in a mass of repetition.

     Because of electronic medical records, Social Security hearing files are exploding. Files of 1,000 pages or more used to be rare. Now, they're common. Files of 2,000 pages or more were almost never seen in years past. Now, I see them on a regular basis.

     This is going to get a lot worse because of a statute that I'll bet that almost no one at Social Security has heard of -- the HITECH Act. HITECH stands for Health Information Technology for Economic and Clinical Health Act. The Act was designed to encourage physicians to convert to electronic medical records. HITECH happens to address, in passing, a couple of problems that attorneys representing Social Security claimants have had -- slow processing of requests for medical records and excessive charges for providing those records. HITECH puts a time limit on responding to requests for medical records and prohibits providers from charging more than what it actually costs them to provide medical records as long as the records are provided in an electronic format. Attorneys are rapidly switching over to making their requests for medical records under the HITECH Act. It's cutting our costs significantly and making the turnaround time on medical records requests shorter.

     Before HITECH, attorneys were careful to specify exactly what they wanted because they would be paying for each page of medical records. Now, that's no longer important. One thousand pages of medical records are no more expensive to obtain than ten. Even when an attorney makes a narrow request for medical records, providers often send far more than was requested. If you don't have to print out the records and you're not able to charge for each page, why bother sorting out exactly what the attorney requested? Just send the whole thing. And once an attorney receives medical records, even if they are records the attorney didn't ask for he or she has no alternative but to send everything to Social Security. EVERYTHING. That's what agency regulations demands. If you don't do that, you get in trouble. I recently submitted more than 850 pages of medical records recently covering about ten months of outpatient treatment for one of my clients and the medical care she was receiving wasn't all that intensive.

     So why is this important for the agency? It takes a lot longer to review a 2,000 page file than a 300 page file even if most of the 2,000 page file is of zero consequence for the disability claim. Administrative Law Judges cannot be expected to hear 40-50 cases a month and know what they're doing if they have to deal with such huge files. There's no technical fix for this. Exhorting employees to work harder isn't going to help. Social Security is running headlong into a brick wall on this one. And those foolish regulations demanding that attorneys submit EVERYTHING are just making things worse. I told you that you were trying to go after a fly with a sledgehammer but you wouldn't listen.

Denied Disability Claimants Don't Return To Work

     The Chairman of the Senate Budget Committee asked Social Security's Office of Inspector General (OIG) to gather information on Social Security disability claimants whose have been denied on the grounds that they can still work. I don't have any idea what he thought they might find. I don't see anything in the report that he's likely to find all that interesting. However, I did find this table that I find interesting:

     I find it interesting because it displays an important fact. When Social Security denies disability claims, those denied don't often return to work. When they do return to work, they seldom earn enough to support themselves because generally they're only working part time or intermittently.
     Policy makers shouldn't comfort themselves with the thought that denying so many disability claims frees people to work by preventing their dependence upon government benefits. All these denials do is make large numbers of sick people even more poor and miserable than they would be if their disability claims had been approved.