Social Security,
Medicare and Medicaid
Work for alabama
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 Alabama’s 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 Alabama’s 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 Alabama.
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, SSW’s
Executive Director, drove the project to its successful conclusion. Michael Phelan, SSW’s Deputy Director managed the actual production
of the report. We would like to thank Don Owens and Lacy Crawford, respectively, SSW’s 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, SSW’s 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 Diane Sims Foley for generously sharing her story and views about the
importance of Social Security in her life. 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 Security’s 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: [email protected].
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 Alliance’s 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 nation’s Social Security, Medicare and Medicaid systems are fundamental to
the well-being of America’s families and to the type of nation we are. www.strengthensocialsecurity.org
Social Security, Medicare and Medicaid Work for ALABama 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
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.
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.
This report reveals the success of these institutions
for Alabama and the nation. The numbers tell part
of the story: how many people receive benefits
in Alabama, 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 hardworking Alabamans and their families whose lives
are immeasurably better because of the protections
they have earned.
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,
Figure 11
Social Security, Medicare and Medicaid’s Impact on the Economy and Population of Alabama
Beneficiaries In
ALabama
Percent Of Residents
Receiving Benefits
Average Benefit
Total Annual Benefits2
1,012,056
21.2 percent
$12,565
$12.7 billion
Medicare
819,379
17.4 percent
$9,815
$8 billion
Medicaid
954,793
20.3 percent
$4,625
$4.4 billion
Program
Social Security
Sources: Social Security Administration, 2011; U.S. Census Bureau; Kaiser Family Foundation, 2011; Economic Policy Institute, 2011.
Social Security, Medicare and Medicaid Work for ALABama 1
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 nation’s
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
Alabama 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
Social Security, Medicare and Medicaid Work for ALABama years. The population of persons aged 65 and
over is growing. Income growth is slow for most of
today’s 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 nation’s
children and grandchildren so when they become
workers, they will have the economic security that
Social Security, Medicare, and Medicaid provide.
2
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 month—retired and
disabled workers, their families, and surviving family
members.3 Its benefits to Alabama 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
Social Security, Medicare and Medicaid Work for ALABama 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 households—those
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 Security’s 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 nation’s leaders.
Social Security Works for Alabama’s
Residents and Economy
• Social Security provided benefits to 1,012,056
people in 2010, 1 out of 5 residents (21.2 percent).11
• Alabama residents received Social Security
benefits totaling $12.7 billion in 2010, an amount
equivalent to 7.5 percent of the state’s 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, 2006–2008
Alabama’s Social Security Beneficiaries,
2010
52.4%
49.2%
21.3%
Disabled
Workers
AL
14.5%
10.9%
65+
Women 65+
55.4%
Retired Workers
8.9%
Widow(er)s
4.1
%S
pou
ses
10.3%
Children
n Poverty rate without Social Security
n Poverty rate with Social Security
Source: Center on Budget & Policy Priorities
• The average Social Security benefit in 2010 was
$12,565.13
• Social Security lifted 447,000 Alabama residents
out of poverty in 2008.14
Social Security Works for Alabama’s
Seniors15
• Social Security provided benefits to 560,885
retired workers in 2010, nearly 6 out of 10
(55.4 percent) of beneficiaries.16 [Figure 3]
• The typical benefit received by a retired worker in
AK
Alabama was $13,793 in 2010.17
• Social Security provided benefits to 89,755
widow(er)s in 2010, 1 out of 11 (8.9 percent) of
all beneficiaries.18 [Figure 3]
• Social Security lifted out of poverty 244,000
Alabama residents aged 65 and older in 2008.19
• Without Social Security, the elderly poverty rate
in Alabama would have increased from 1 out of 9
(10.9 percent) to half (49.2 percent).20 [Figure 2]
Social Security, Medicare and Medicaid Work for ALABama Source: Social Security Administration, 2012
Social Security Works for Alabama’s Women
• Social Security provided benefits to 514,742
Alabama women in 2010, 1 out of 5 women
(20.9 percent).21
• Social Security provided benefits to 41,283
spouses in 2010, 1 out of 25 (4.1 percent) of all
beneficiaries.22 [Figure 3]
• Social Security lifted out of poverty 137,000
Alabama women aged 65 and older in 2008.23
• Without Social Security, the poverty rate of elderly
women would have increased from 1 out of 7
(14.5 percent) to more than half (52.4 percent).24
[Figure 2]
Social Security Works for Alabama’s
Workers with Disabilities25
• Social Security provided disability benefits for
216,038 workers in 2010, 1 out of 5 (21.3 percent)
of all beneficiaries.26 [Figure 3]
• The typical benefit received by a disabled worker
beneficiary in Alabama was $11,395 in 2010.27
4
Social Security Works for Alabama’s
Children28
• Social Security is the major life and disability
insurance protection for more than 95 percent of
Alabama’s 1,132,459 children.29
• Social Security provided benefits to 104,095
children in 2010,30 and it is the most important
source of income for the 148,127 children living in
Alabama’s grandfamilies, which are households
headed by a grandparent or other relative.31
Social Security Works for Alabama’s
African Americans
• In Alabama, Social Security provided benefits to
231,623 African Americans in 2009, 1 out of 5
(18.6 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 Alabama’s Latinos
• In Alabama, Social Security provided benefits to 1
out of 11 (8.9 percent) Latino households in 2010,
3,783 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
population—the highest of any group. That’s
because they tend to have lower lifetime income,
longer life expectancies, higher incidence of
disability and larger families.37
Social Security, Medicare and Medicaid Work for ALABama Diane Sims Foley
Receiving Social Security has made a huge
positive impact on my life. I retired from
teaching school after 30 years. Now I am able
to go see my newest grandchild in Colorado
(my favorite perk), eat out occasionally, take
some trips etc. It has made me feel secure
which is a huge relief after years of just
making it.
Social Security Works for Alabama’s
American Indians and Alaska Natives
• In Alabama, Social Security provided benefits
to 3 out of 10 (31.9 percent) American Indian
and Alaska Native households in 2010, 7,285
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
working‐age 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
5
Social Security Works for Alabama’s
Asian Americans
• In Alabama, Social Security provided benefits
to 1 out of 9 (10.6 percent) Asian American
households in 2010, 2,069 households.41
• Nationwide, Social Security provided two‐thirds
(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
Social Security Works for Alabama’s
Rural Communities44
• Social Security is more important to rural
Alabamans than to other Alabamans. Nearly 1
out of 4 (23.8 percent) rural Alabamans received
Social Security compared with 1 out of 5 (19.3
percent) non-rural Alabamans in 2010.45
• Social Security is more important to the local
economies of Alabama’s rural counties than to
its non-rural counties. Total personal income in
Alabama’s 39 rural counties was $40.3 billion in
Social Security, Medicare and Medicaid Work for ALABama 2010 of which $4 billion, or 10 percent, was from
Social Security. By comparison, total personal
income in the state’s 28 non-rural counties was
$120.1 billion, of which $8.7 billion, or 7.2 percent,
was from Social Security.46
Social Security Works for Alabama’s
Working Families
• Through their hard work and payroll tax contributions,
nearly all Alabama workers earn Social Security’s
retirement, disability and survivorship protections
for themselves and their families.
• Social Security is the most valuable disability
and life insurance protection for most Alabama
workers. Nationwide, an estimated 3 out of 10
working‐aged men and 1 out of 4 working‐aged
women will become severely disabled before
reaching retirement age. An estimated 1 out of 11
working‐aged men and 1 out of 20 working‐aged
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 values—rewarding 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.
6
Medicare Works
We built our Medicare system because it is by far the
best way to provide America’s 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 finances—or 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 not—willing 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 works—for seniors and people with
disabilities, as well as people with end-stage renal
disease (ESRD) and Amyotrophic Lateral Sclerosis
(ALS, or Lou Gehrig’s 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 one’s 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 ALABama 7
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
Figure 4
Average Annual Increase in Spending
on Common Benefits,* 1999–2009
6.9%
4.7%
Medicare
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 2010—4 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 Medicare’s 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 percent—nearly
50 percent more.62 [Figure 4] Medicare’s superior
cost-control record is no coincidence; it is a function
of Medicare’s 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 Medicare’s
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 Medicare’s
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. Medicare’s administrative costs
were less than 2 percent of its total expenditures
in 2011.64 Private health insurance’s administrative
Private Health Insurance
*Common benefits refers to benefits commonly covered by
Medicare and private health insurance.
Source: Center for Medicare & Medicaid Services, 2010
Social Security, Medicare and Medicaid Work for ALABama *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
8
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, Medicare’s 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 done—not to cut
Medicare’s benefits. Cutting Medicare’s benefits
simply shifts costs to the sickest and oldest among
us, forcing some seniors and people with disabilities
to forego treatment, living shorter, less healthy—and
more medically costly—lives as a result.
Medicare Works for Alabama’s Economy
• Medicare provided $8 billion in benefits in 2009—
27.2 percent of all health care spending in the
state.68 The average expenditure per Medicare
beneficiary was $9,815.69
Social Security, Medicare and Medicaid Work for ALABama Medicare Works for Alabama Residents
• Medicare insured 819,379 Alabamans in 2009—
1 out of 6 (17.4 percent) state residents.70
Medicare Works for Alabama’s Seniors
• 623,088 of Alabama’s 819,379 Medicare
beneficiaries were aged 65 or older in 2009—
three-quarters (76 percent) beneficiaries.71
Medicare Works for Alabama’s People
with Disabilities
• 196,291 of Alabama’s 819,379 Medicare
beneficiaries were people with disabilities in
2009—1 out of 4 (24 percent) beneficiaries.72
Medicare Works for Alabama’s Residents
with End-Stage-Renal Disease (ESRD)
• End-stage-renal disease (ESRD) occurs when
a person’s 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 Alabama’s Residents
with Amyotrophic Lateral Sclerosis (ALS)
• Amyotrophic Lateral Sclerosis, more commonly
known as ALS, or Lou Gehrig’s disease, is a
nervous system disease that gradually shuts
down all muscles in a person’s body, eventually
resulting in death from respiratory failure.74 Many
Alabama 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.
9
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 2011—a 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 2010—16 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 nation’s 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, Medicaid’s 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 done—not to cut Medicaid’s 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 Act’s expansion of Medicaid and Children’s 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 ALABama 10
afford it. More troubling still, it may make life-saving
medical care inaccessible for those who need it.
Medicaid Works for Alabama’s Economy
• Medicaid provided $4.4 billion in benefits in
2009—15 percent of all health care spending in
the state.82 The average expenditure per Medicaid
beneficiary was $4,625.83
Medicaid Works for Alabama Residents
• Medicaid insured 954,793 Alabamans in 2009—
1 out of 5 (20.3 percent) state residents.84
Medicaid Works for Alabama’s Children
• Medicaid insured 469,795 children in 2009—
4 out of 10 (41.8 percent) children in the state.85
Medicaid Works for Alabama’s Seniors
o $61 million to mental health facilities
(4.1 percent)
o $38 million to intermediate care facilities for the
intellectually disabled (2.6 percent).88
• Medicaid insured the vast majority of Alabama
residents who opt for nursing home care. 15,690
of Alabama’s 22,990 nursing home residents were
Medicaid beneficiaries in 2010—2 out of 3 (68.2
percent) residents.89 The average annual cost
of nursing home care for a semi–private room
in Alabama was $60,600 in 2010.90 Given the
high cost of nursing home care, many Alabama
residents would not be able to afford it without
Medicaid.
Medicaid Works for Alabama
During Economic Recessions
Medicaid Works for Alabama’s
Long-Term Care Residents
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
• Medicaid provided $1.5 billion in long-term care
benefits for Alabama residents in 2009. That
includes:
o $440 million in home health care services
(29.8 percent)
o $938 million to nursing home facilities
(63.5 percent)
As financially strapped states cut Medicaid, the last
thing the nation’s 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.
• 120,974 of Alabama’s 954,793 Medicaid
beneficiaries were aged 65 or older in 2009—
1 out of 8 (12.7 percent) beneficiaries.86
Medicaid Works for Alabama’s
People with Disabilities
• 206,497 of Alabama’s 954,793 Medicaid
beneficiaries were people with disabilities in
2009—1 out of 5 (21.6 percent) beneficiaries.87
Social Security, Medicare and Medicaid Work for ALABama 11
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.
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 nation’s 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. That’s 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
Likewise, large anticipated yearly increases in health
care expenditures, public and private, reflect longterm structural problems in the nation’s health care
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.
Figure 5
Causes of Recent Run-Up
in Federal Deficits
1600
1400
ACTUAL DEFICITS
1200
Billions of dollars
1000
800
600
400
200
0
-200
-400
2001
DEFICITS WITHOUT THESE FACTORS
2003
n
n
n
n
n
2005
2007
2009
2011
Wars in Iraq and Afghanistan
Bush-era tax cuts
Recocvery measures
TARP, Fannie and Freddie
Economic downturn
Source: Center for Economic and Policy Research, 2012
Social Security, Medicare and Medicaid Work for ALABama Social Security, Medicare and Medicaid represent
the best of America’s values, including caring for
aging parents and neighbors, reward for hard work,
personal responsibility and dignity. In Alabama, these
programs spend about $25.2 billion a year, providing
benefits to an average of 1 out of 5 residents for
each program.94 It is no surprise that poll after poll
shows that Americans overwhelmingly support these
programs and do not want to see them cut. Cutting
them would weaken the economic security of all
Americans. While that would be bad policy anytime,
it would be disastrous in this time of widespread
economic loss.
The old, the disabled and today’s workers have a
stake in preserving these foundational systems—
for themselves, their families, their children and
grandchildren. And politicians have the opportunity
to maintain and improve these paramount
achievements for future generations, just as previous
Congresses and presidents have done for us.
12
Appendix 1: Social Security Works for Alabama’s Congressional Districts
Congressional Districts
1
2
3
4
5
6
7
Total annual benefits
($ in millions)*
$12,430M
$1,865M
$1,706M
$1,757M
$1,975M
$1,793M
$1,853M
$1,481M
Number of residents
in state/congressional
district
4,779,736
687,841
673,877
681,298
660,162
718,724
754,482
603,352
Number of residents
receiving Social
Security benefits
1,012,056
149,290
144,977
147,806
164,062
142,250
134,369
129,302
Percent of residents
receiving
Social Security
benefits
21.2%
21.7%
21.5%
21.7%
24.9%
19.8%
17.8%
21.4%
Women
514,742
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Retired
workers
560,885
83,913
81,709
80,722
88,881
84,188
80,393
61,079
Disabled
workers
216,038
28,968
31,079
35,300
36,400
26,134
23,292
34,865
Widow(er)s
89,755
13,663
12,123
11,630
15,370
12,887
12,289
11,793
41,283
6,918
5,105
4,603
7,428
6,952
6,403
3,874
104,095
15,828
14,961
15,551
15,983
12,089
11,992
17,691
Social Security Beneficiaries by category
State
Total
Spouses
Children
Sources: US Census Bureau, Profile of General Population and Housing Characteristics: 2010, 2011.
SSA, “Alabama,” Congressional Statistics, December 2010, 2011.
SSA, “Table 5.J5.1—Number 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 is not necessarily consistent with state totals cited elsewhere in the report.
Social Security, Medicare and Medicaid Work for ALABama 13
Social Security, Medicare and Medicaid Work for ALABama 14
4,779,736
54,571
182,265
27,457
22,915
57,322
10,914
20,947
118,572
34,215
25,989
43,643
13,859
25,833
13,932
14,972
49,948
54,428
13,228
11,539
37,765
13,906
80,406
50,251
43,820
71,109
79,303
38,319
104,430
17,241
31,704
26,790
9,045
15,760
17,302
101,547
53,227
658,466
Alabama (67 counties)
Autauga
Baldwin
Barbour
Bibb
Blount
Bullock
Butler
Calhoun
Chambers
Cherokee
Chilton
Choctaw
Clarke
Clay
Cleburne
Coffee
Colbert
Conecuh
Coosa
Covington
Crenshaw
Cullman
Dale
Dallas
DeKalb
Elmore
Escambia
Etowah
Fayette
Franklin
Geneva
Greene
Hale
Henry
Houston
Jackson
Jefferson
N/A
2
4
6
1
1
6
6
3
6
8
1
9
7
9
8
6
3
9
8
7
8
6
4
4
6
2
6
3
6
6
3
3
3
3
3
6
1
$40,538
$53,049
$47,618
$33,074
$35,472
$42,906
$25,969
$29,500
$37,916
$30,061
$34,410
$38,553
$32,003
$33,739
$33,035
$37,566
$40,779
$37,455
$27,855
$33,721
$33,484
$35,577
$37,948
$41,287
$26,195
$34,822
$51,013
$31,365
$36,088
$32,643
$33,649
$34,418
$27,117
$31,790
$37,851
$39,290
$36,158
$41,740
Rural-Urban Median
Continuum Household
Code (2003) Income
18.9%
11.9%
13.3%
25.3%
20.9%
16.5%
31.1%
28.1%
23.5%
28.5%
21.2%
20.4%
20.7%
24.9%
20.6%
17.8%
20.1%
19.2%
25.7%
18.6%
20.9%
20.3%
19.2%
17.8%
35.6%
20.8%
12.5%
26.1%
19.0%
27.3%
21.6%
20.3%
31.0%
24.8%
18.1%
17.9%
19.9%
18.6%
% in
Poverty
657,792
6,546
30,568
3,909
2,906
8,439
1,469
3,489
16,990
5,706
4,651
5,921
2,519
4,174
2,449
2,361
7,210
9,463
2,362
1,970
6,939
2,210
12,810
6,759
6,165
9,875
9,436
5,812
16,508
3,084
4,825
4,674
1,454
2,370
3,044
14,675
8,773
86,443
Population
over
Age 65
*State totals do not equal the sum of county figures, because individual county figures provided by SSA are rounded.
Population
County
ALABAMA County Demographics, 2010
% of
Population
Over
Age 65
13.8%
12.0%
16.8%
14.2%
12.7%
14.7%
13.5%
16.7%
14.3%
16.7%
17.9%
13.6%
18.2%
16.2%
17.6%
15.8%
14.4%
17.4%
17.9%
17.1%
18.4%
15.9%
15.9%
13.5%
14.1%
13.9%
11.9%
15.2%
15.8%
17.9%
15.2%
17.4%
16.1%
15.0%
17.6%
14.5%
16.5%
13.1%
Social Security
Social Security Beneficiaries by Characteristic,
Medicare &
Benefits, 2010
2010*
Medicaid
% of
%
%
Population
Annual Total
Total
Retired Disabled Widow(er)s Spouses Children Receiving Receiving
Receiving
Benefits
Beneficiaries Workers Workers
Medicare, Medicaid,
Benefits
2010
2011
21.2%
$12,722,389,000 1,012,056 560,885 216,038
89,755 41,283 104,095 17.5%
21.5%
18.4%
$125,575,000
10,050
5,540
2,115
845
430
1,120 14.3%
16.5%
23.1%
$566,180,000
42,065 27,340
6,455
3,290
1,885
3,090 19.2%
15.5%
24.3%
$76,311,000
6,670
3,440
1,640
570
230
790 17.8%
28.4%
22.6%
$60,920,000
5,180
2,360
1,400
505
205
710 18.3%
22.6%
21.4%
$154,659,000
12,285
6,765
2,560
1,155
635
1,170 14.2%
19.4%
18.6%
$21,839,000
2,035
1,005
515
170
50
295 14.1%
37.2%
25.0%
$59,742,000
5,230
2,800
1,200
480
165
585 20.0%
32.4%
23.6%
$325,544,000
27,935 15,015
6,495
2,490
1,035
2,900 20.7%
24.1%
27.4%
$117,973,000
9,360
5,170
2,460
650
200
880 22.5%
27.0%
27.4%
$87,204,000
7,110
3,940
1,720
535
260
655 19.0%
22.8%
21.3%
$115,245,000
9,310
4,780
2,215
900
400
1,015 15.8%
23.9%
30.7%
$52,494,000
4,255
2,025
1,085
420
210
515 23.2%
27.6%
26.3%
$82,476,000
6,790
3,415
1,455
625
370
925 22.5%
28.2%
27.1%
$44,241,000
3,780
2,090
930
285
130
345 21.6%
25.5%
24.9%
$43,947,000
3,730
2,115
835
275
130
375 19.3%
23.7%
20.7%
$124,765,000
10,355
6,150
1,985
850
435
940 16.9%
19.2%
27.0%
$189,456,000
14,680
7,875
3,230
1,455
745
1,375 21.5%
22.3%
29.4%
$44,585,000
3,895
1,930
1,020
295
150
500 22.9%
34.3%
27.2%
$38,198,000
3,140
1,570
915
215
105
335 21.5%
22.5%
27.0%
$119,666,000
10,205
6,090
2,115
820
325
855 23.3%
27.2%
26.4%
$41,219,000
3,665
2,050
830
315
115
355 21.3%
28.6%
24.4%
$243,585,000
19,615 11,165
3,825
1,975
945
1,705 19.9%
20.9%
20.6%
$120,011,000
10,365
5,620
2,335
910
480
1,020 21.0%
22.4%
24.9%
$119,114,000
10,895
5,155
2,840
910
360
1,630 22.1%
42.2%
22.3%
$187,293,000
15,890
8,800
3,510
1,355
655
1,570 17.3%
26.9%
19.6%
$196,713,000
15,505
9,050
3,075
1,240
510
1,630 16.2%
15.8%
24.3%
$112,703,000
9,325
4,880
2,140
855
410
1,040 19.3%
26.5%
25.8%
$338,060,000
26,905 13,665
6,485
2,650
1,230
2,875 20.7%
23.8%
30.1%
$62,344,000
5,195
2,835
1,205
420
190
545 20.6%
24.0%
23.4%
$88,458,000
7,430
4,045
1,615
725
350
700 20.3%
28.4%
26.5%
$82,010,000
7,105
4,120
1,555
595
240
595 22.0%
26.1%
26.9%
$25,694,000
2,435
1,060
685
225
85
380 21.0%
41.5%
27.4%
$46,931,000
4,320
1,880
1,250
375
130
685 24.1%
37.2%
26.4%
$55,442,000
4,575
2,575
1,065
380
140
415 21.4%
22.9%
22.2%
$277,901,000
22,550 13,085
4,685
1,890
785
2,105 17.1%
24.5%
25.5%
$167,654,000
13,555
7,725
2,795
1,240
590
1,205 21.6%
21.9%
20.0%
$1,742,031,000
131,660 71,855 27,780
12,830
5,025 14,165 18.3%
20.0%
Appendix 2: Social Security, Medicare, and Medicaid Data by County, in Alabama’s Counties (Page 1/2)
Social Security, Medicare and Medicaid Work for ALABama 15
14,564
92,709
34,339
140,247
82,782
11,299
21,452
334,811
21,027
30,776
93,019
412,992
23,068
229,363
119,490
10,591
19,746
32,899
22,913
52,947
83,593
195,085
13,763
82,291
41,616
194,656
67,023
17,581
11,670
24,484
Population
9
3
3
3
2
2
6
2
7
8
4
2
7
2
3
8
8
6
6
2
1
1
8
4
6
3
1
8
8
6
$32,993
$39,213
$37,365
$40,102
$49,667
$28,754
$27,041
$54,633
$33,085
$32,080
$38,859
$39,753
$31,744
$41,556
$44,859
$24,742
$31,032
$32,771
$32,584
$32,733
$48,296
$67,135
$25,586
$35,646
$34,440
$43,098
$36,044
$37,639
$21,611
$32,574
Rural-Urban Median
Continuum Household
Code (2003) Income
21.5%
17.6%
18.1%
21.3%
14.1%
30.7%
31.2%
12.7%
23.6%
20.9%
19.4%
20.5%
28.4%
21.3%
14.1%
39.5%
24.4%
30.0%
24.8%
24.1%
13.0%
9.8%
31.3%
22.7%
18.3%
18.0%
23.2%
19.6%
39.6%
20.3%
% in
Poverty
2,732
15,553
4,999
12,716
10,187
1,655
3,031
40,873
3,424
5,645
13,862
53,321
3,618
27,421
16,871
1,769
3,336
4,211
3,888
6,720
10,909
20,627
2,063
11,591
7,193
21,050
10,894
2,590
1,752
4,333
Population
over
Age 65
% of
Population
Over
Age 65
18.8%
16.8%
14.6%
9.1%
12.3%
14.6%
14.1%
12.2%
16.3%
18.3%
14.9%
12.9%
15.7%
12.0%
14.1%
16.7%
16.9%
12.8%
17.0%
12.7%
13.1%
10.6%
15.0%
14.1%
17.3%
10.8%
16.3%
14.7%
15.0%
17.7%
Social Security
Social Security Beneficiaries by Characteristic,
Medicare &
Benefits, 2010
2010*
Medicaid
% of
%
%
Population
Annual Total
Total
Retired Disabled Widow(er)s Spouses Children Receiving Receiving
Receiving
Benefits
Beneficiaries Workers Workers
Medicare, Medicaid,
Benefits
2010
2011
29.4%
$50,579,000
4,275
2,480
975
310
120
390 24.8%
26.3%
24.0%
$289,949,000
22,270 12,835
4,260
2,100
1,265
1,805 20.6%
19.0%
24.1%
$104,560,000
8,290
4,360
1,880
780
480
790 15.4%
20.9%
14.2%
$258,580,000
19,975 11,275
4,390
1,470
620
2,220 10.6%
14.9%
18.8%
$196,763,000
15,575
9,005
2,975
1,405
780
1,410 13.5%
15.9%
26.1%
$31,382,000
2,945
1,390
815
240
90
410 18.3%
36.3%
21.3%
$50,420,000
4,560
2,475
1,020
385
115
560 19.3%
30.5%
16.1%
$702,773,000
53,945 34,260
8,325
4,575
2,485
4,300 14.8%
13.7%
28.0%
$69,985,000
5,880
2,845
1,500
495
245
795 19.0%
29.3%
25.8%
$95,397,000
7,930
4,560
1,815
585
285
685 20.9%
24.6%
22.2%
$249,860,000
20,645 11,820
4,205
1,910
900
1,810 19.8%
26.0%
19.9%
$1,041,226,000
82,220 43,875 16,805
8,145
3,890
9,510 16.3%
24.0%
24.7%
$68,682,000
5,690
2,965
1,335
460
210
720 18.7%
26.4%
17.9%
$511,807,000
41,170 23,420
8,395
3,335
1,290
4,730 15.5%
25.2%
21.3%
$335,566,000
25,445 15,050
4,730
2,365
1,190
2,115 18.6%
19.9%
27.1%
$29,269,000
2,865
1,360
750
235
95
425 20.0%
42.6%
27.4%
$62,309,000
5,405
2,750
1,420
445
155
635 22.7%
28.9%
19.5%
$74,504,000
6,420
3,605
1,440
520
185
670 17.0%
25.9%
25.7%
$70,586,000
5,880
3,475
1,270
410
160
565 20.3%
24.8%
21.1%
$133,804,000
11,155
6,195
2,465
1,020
355
1,125 18.8%
28.5%
20.0%
$215,089,000
16,700
9,095
3,600
1,555
750
1,695 14.3%
17.7%
15.4%
$436,394,000
30,000 18,810
4,830
2,430
1,440
2,490 9.1%
9.0%
23.4%
$34,575,000
3,225
1,485
865
325
100
450 19.6%
36.0%
24.3%
$244,554,000
19,985
9,815
5,830
1,585
605
2,150 19.9%
28.1%
27.2%
$141,603,000
11,310
6,345
2,865
690
250
1,160 21.7%
25.6%
18.0%
$449,351,000
35,125 18,175
8,740
2,795
1,185
4,230 14.3%
18.8%
29.3%
$247,268,000
19,635
9,135
5,075
2,090
1,000
2,335 25.5%
25.2%
24.9%
$53,108,000
4,385
2,140
1,005
410
250
580 19.4%
22.5%
30.6%
$36,761,000
3,570
1,420
955
325
140
730 23.5%
48.3%
26.7%
$77,502,000
6,530
3,485
1,485
640
310
610 22.4%
25.0%
*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-urban-continuum-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 Receiving Medicare: Center for Medicare and Medicaid Services (CMS), “Beneficiaries Receiving Medicare: Total Beneficiaries by State and County,” 2010. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareEnrpts/Downloads/County2010.pdf
Percentage Receiving Medicaid: Alabama Medicaid Agency, “Medicaid Eligibles by County”, 2010. http://medicaid.alabama.gov/documents/2.0_Newsroom/2.3_Publications/2.3.1.5_Annual_Report_FY10/2.3.1.5_FY10_Eligibles-by_Category_and_County.pdf
Lamar
Lauderdale
Lawrence
Lee
Limestone
Lowndes
Macon
Madison
Marengo
Marion
Marshall
Mobile
Monroe
Montgomery
Morgan
Perry
Pickens
Pike
Randolph
Russell
St. Clair
Shelby
Sumter
Talladega
Tallapoosa
Tuscaloosa
Walker
Washington
Wilcox
Winston
County
ALABAMA County Demographics, 2010
Appendix 2: Social Security, Medicare, and Medicaid Data by County, in Alabama’s Counties (Page 2/2)
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.J2—Number, 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 funds—the
Old-Age and Survivors Insurance (OASI) trust fund and Disability Insurance (DI) trust fund—which 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-percentage-point
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 Security’s 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 program’s 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
Security’s 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.J2—Number, 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.J1—Estimated 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.
J1—Estimated 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.J2—Number, 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 CBPP’s report, was made available to Social Security
Works by the report’s 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.J2—Number, 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.J6—Percentage 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.J2—Number, 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.
Social Security, Medicare and Medicaid Work for ALABama 16
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.
21 SSA, “Table 5.J5.1—Number, 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.J2—Number, 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 CBPP’s report, were made
available by the report’s 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 CBPP’s report, were made
available by the report’s 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.J8—Percentage 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 Administration’s 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.J10—Number 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
31Association 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.J5.1—Number, 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.A1—Number 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 Agriculture’s 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 ERS’s 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 ALABama 17
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 Gehrig’s 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 America’s
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.B1—Medicare 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 Advantage’s 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
69Average 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
70KFF, “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 ALABama 18
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. Medicaid’s
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 Children’s 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
86KFF, “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.
88KFF, “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.
89Data on Medicaid’s 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.B1—Medicare 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.
Social Security, Medicare and Medicaid Work for ALABama 19
Key Facts About Social Security, Medicare & Medicaid in alabama
Social Security, Medicare and Medicaid work for Alabama residents of all ages and backgrounds.
This report, Social Security, Medicare & Medicaid Work for Alabama shows that:
Social Security Works for Alabama’s Residents and Economy
• Social Security provided benefits to 1,012,056 Alabamans in 2010, 1 out of 5 residents, including 560,885
retired workers, 216,038 disabled workers, 89,755 widow(er)s, 41,283 spouses, and 104,095 children.
[Figure 3]
• Social Security provided benefits totaling over $12.7 billion in 2010, an amount equivalent to 7.5 percent
of the state’s annual GDP (the total value of all goods and services produced).
• The average Social Security benefit in 2010 was $12,565.
• Social Security lifted 447,000 Alabama residents out of poverty in 2008.
Social Security Works for Alabama’s Women
• Social Security provided benefits to 514,742 women residents in 2010, 1 out of 5 women.
• Without Social Security, the poverty rate of elderly women would increase from 14.5 percent to 52.4 percent.
Social Security Works for Alabama’s People of Color
• Social Security provided benefits to 231,623 African Americans in Alabama in 2009, 1 out of 5 African
American residents.
• It provided benefits to 1 out of 11 Latino households in Alabama in 2010, 3,783 households.
Medicare Works for Alabama’s Residents and Economy
• 819,379 Alabamans received Medicare benefits in 2009—1 out of 6 state residents.
• Medicare provided $8 billion in benefits in 2009—27.2 percent of all health care spending in the state.
The average expenditure per Medicare beneficiary was $9,815.
Medicare Works for Alabama’s Seniors and People with Disabilities
• 623,088 of Alabama’s 819,379 Medicare beneficiaries were aged 65 or older in 2009—three-quarters
beneficiaries.
• 196,291 of Alabama’s 819,379 Medicare beneficiaries were people with disabilities in 2009—1 out of 4
beneficiaries.
Medicaid Works for Alabama’s Residents and Economy
• 954,793 Alabamans received Medicaid benefits in 2009—1 out of 5 state residents.
• A total of $4.4 billion in Medicaid benefits were paid in 2009—15 percent of all health care spending in the
state. The average expenditure per Medicaid beneficiary was $4,625.
Medicaid Works for Alabama’s Seniors, People with Disabilities
and Long-Term Care Residents
• 120,974 of Alabama’s 954,793 Medicaid beneficiaries were aged 65 or older in 2009—1 out of 8
beneficiaries.
• 206,497 of Alabama’s 954,793 Medicaid beneficiaries were people with disabilities in 2009—1 out of 5
beneficiaries.
• Medicaid provided $1.5 billion in long-term care benefits for Alabama residents in 2009, including providing
nursing home care for 15,690 nursing home residents, 2 out of 3 of state residents enrolled in nursing homes.
Social Security, Medicare and Medicaid Work for ALABama 20