Social Security, Medicare and Medicaid Work for north carolina

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 North Carolina’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 North Carolina’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 North Carolina. 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 Ann Young for generously sharing her story and views about the importance of Social Security in her life. 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 Center for Economic and Policy Research provided the invaluable analysis and graph showing the causes of the recent run-up in federal deficits. The data presented in this report speaks volumes about the importance of Social Security to families, communities and state and local economies. We hope the report is useful to you as you work to strengthen Social Security in this 77th anniversary year. Please contact the Social Security Works Communications Director, Don Owens, if you have questions about this report: dowens@socialsecurity-works.org. Nancy Altman and Eric Kingson Founding Co-directors, Social Security Works Co-chairs, Strengthen Social Security Coalition The Alliance for Retired Americans is a grassroots organization representing more than 4 million retirees and seniors nationwide. Headquartered in Washington, DC, the 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 north carolina

introduction and SuMMary
“We can never insure one-hundred percent of the population against one-hundred percent of the hazards and vicissitudes of life. But we have tried to frame a law which will give some measure of protection to the average citizen and to his family against the loss of a job and against poverty-ridden old age. This law, too, represents a cornerstone in a structure which is being built but is by no means complete. It is a structure intended to lessen the force of possible future depressions. It will act as a protection to future Administrations against the necessity of going deeply into debt to furnish relief to the needy. The law will flatten out the peaks and valleys of deflation and of inflation. It is, in short, a law that will take care of human needs and at the same time provide for the united States an economic structure of vastly greater soundness.” —Franklin D. Roosevelt, August 14, 1935

In 1935, when President Franklin D. Roosevelt signed the Social Security Act into law he called it a cornerstone, the foundation of a structure to be maintained and built upon by and for future generations. Social Security could not protect all Americans against every risk, but, as the President said, it could lessen the consequences of lost earnings in old age for workers and their families. Since then, we have built our Social Security structure carefully and deliberately. In 1939, we added Survivors Insurance benefits for widows and dependent children, eventually extending it to widowers as well. Disability Insurance benefits were added in 1956, followed by Medicare and Medicaid in 1965. The automatic cost-of-living adjustment (COLA) was added in 1972, designed to maintain the purchasing power of benefits no matter how long someone lives. We built,

maintained and strengthened these institutions for a reason: to enable working men and women to protect themselves and their families. We built them because we, as a nation, value hard work, personal responsibility, and human dignity; we care for our parents, our children, our spouses, our neighbors and ourselves. This report reveals the success of these institutions for North Carolina and the nation. The numbers tell part of the story: how many people receive benefits in North Carolina, in its congressional districts and its counties; how many dollars flow into these jurisdictions in a year; the types of benefits and the types of people who receive benefits. Perhaps more importantly, the report presents the stories of hard-working North Carolinians and their families whose lives are immeasurably better because of the protections they have earned.

FIGuRE 11

Social Security, Medicare and Medicaid’s impact on the economy and Population of north carolina
PROGRAM BENEFICIARIES IN NORTH CAROLINA PERCENT OF RESIDENTS RECEIVING BENEFITS AVERAGE BENEFIT TOTAL ANNuAL BENEFITS2

Social Security Medicare Medicaid

1,757,135 1,421,348 1,813,298

18.4 percent 14.9 percent 19.3 percent

$12,864 $9,924 $6,345

$22.6 billion $14.1 billion $11.5 billion

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

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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 North Carolina residents, and the lifeblood of many small businesses, hospitals and nursing homes and home caregivers. Virtually all of the jobs our Social Security, Medicare, and Medicaid systems support stay in America. As important as these programs’ protections are today, the need for Social Security, Medicare and Medicaid programs will only increase in coming

years. The population of persons aged 65 and over is growing. Income growth is slow for most of 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.

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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 North Carolina 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 retirement income security for middle class Americans. In 2010 two out of three households aged 65 and over relied on Social Security for half or more of their income, and over 1 out of 3 relied on Social Security for 90 percent or more of their income.5 The program lifted 20 million Americans out of poverty in 2008, including one million children.6 Social Security can pay all benefits in full and on time for the next twenty years. After that, if Congress were not to act, it could still pay more than 75 cents on every dollar of earned benefits.7 The shortfall is equivalent to 1 percent of Gross Domestic Product (GDP), which is roughly the amount of revenues that would be lost to the federal budget from extending the George W. Bush-era tax cuts benefitting the richest 2 percent of American 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 North Carolina’s Residents and Economy
• Social Security provided benefits to 1,757,135 people in 2010, 1 out of 5 residents (18.4 percent).11 • North Carolina residents received Social Security benefits totaling $22.6 billion in 2010, an amount equivalent to 5.3 percent of the state’s annual GDP (the total value of all goods and services produced).12
3

Social Security, Medicare and Medicaid Work for north carolina

FIGuRE 2

FIGuRE 3

Poverty rate for Beneficiaries 65 and older With and Without Social Security, 2006–2008
57.1% 51.7%

north carolina’s Social Security Beneficiaries, 2010

18% Disabled Workers 7% Widow(er)s 64% Retired Workers 3% Spouses 8% Children

N

10.6%
65+

13.2%
Women 65+

n Poverty rate without Social Security n Poverty rate with Social Security
Source: Center on Budget & Policy Priorities Source: Social Security Administration, 2012

• The average Social Security benefit in 2010 was $12,864.13 • Social Security lifted 671,000 North Carolina residents out of poverty in 2008.14

Social Security Works for North Carolina’s Women
• Social Security provided benefits to 917,261 North Carolina women in 2010, 1 out of 5 women (18.8 percent).21 • Social Security provided benefits to 53,195 spouses in 2010, 1 out of 30 (3 percent) of all beneficiaries.22 [Figure 3] • Social Security lifted out of poverty 283,000 North Carolina women aged 65 and older in 2008.23 • Without Social Security, the poverty rate of elderly women would have increased from 1 out of 8 (13.2 percent) to nearly 6 out of 10 (57.1 percent).24 [Figure 2]

M

Social Security Works for North Carolina’s Seniors15
• Social Security provided benefits to 1,125,816 retired workers in 2010, two-thirds (64.1 percent) of beneficiaries.16 [Figure 3] • The typical benefit received by a retired worker in North Carolina was $13,787 in 2010.17 • Social Security provided benefits to 125,013 widow(er)s in 2010, 1 out of 14 (7.1 percent) of all beneficiaries.18 [Figure 3] • Social Security lifted out of poverty 461,000 North Carolina residents aged 65 and older in 2008.19 • Without Social Security, the elderly poverty rate in North Carolina would have increased from 1 out of 9 (10.6 percent) to half (51.7 percent).20 [Figure 2]

N

Social Security Works for North Carolina’s Workers with Disabilities25
• Social Security provided disability benefits for 310,399 workers in 2010, 1 out of 6 (17.7 percent) of all beneficiaries.26 [Figure 3]

Social Security, Medicare and Medicaid Work for north carolina

4

• The typical benefit received by a disabled worker beneficiary in North Carolina was $12,576 in 2010.27

ANN YOuNG Raleigh, NC
Ann and her husband Howard of 46 years live in Raleigh; they have three children-all college graduates. She is very proud of them. Ann is very involved in her community and precinct. Her first job was at Woolworth’s in Cameron Village, where she was one of the first black women to be hired. After years of dedication and hard work with the company, Ann became the first black manager of food service at Woolworth’s in Cameron Village. Ann suffered from a brain tumor. Though the tumor was benign, the operation and treatment cost over $100,000. Medicare together with her supplemental insurance, which she was fortunate to have, paid the bills. Ann is cured and her recovery is a success, but without Medicare, Ann doesn’t know what she would have done. Ann is thankful every day of her life for Medicare and Social Security.

Social Security Works for North Carolina’s Children28
• Social Security is the major life and disability insurance protection for more than 95 percent of North Carolina’s 2,281,635 children.29 • Social Security provided benefits to 142,712 children in 2010,30 and it is the most important source of income for the 232,968 children living in North Carolina’s grandfamilies, which are households headed by a grandparent or other relative.31

Social Security Works for North Carolina’s African Americans
• In North Carolina, Social Security provided benefits to 340,933 African Americans in 2009, 1 out of 6 (16.8 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 North Carolina’s Latinos
• In North Carolina, Social Security provided benefits to 1 out of 16 (6.2 percent) Latino households in 2010, 11,995 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 Works for North Carolina’s American Indians and Alaska Natives
• In North Carolina, Social Security provided benefits to (27.8 percent) American Indian and Alaska Native households in 2010, 16,597 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

Social Security, Medicare and Medicaid Work for north carolina

5

• 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

• 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 North Carolina’s Rural Communities44
• Social Security is more important to rural North Carolinians than to other North Carolinians. Over 1 out of 5 (22.4 percent) rural North Carolinians received Social Security compared with 1 out of 6 (16.7 percent) non-rural North Carolinians in 2010.45 • Social Security is more important to the local economies of North Carolina’s rural counties than to its non-rural counties. Total personal income in North Carolina’s 60 rural counties was $85.7 billion in 2010 of which $7.8 billion, or 9.1 percent, was from Social Security. By comparison, total personal income in the state’s 40 non-rural counties was $249 billion, of which $14.8 billion, or 5.9 percent, was from Social Security.46

Social Security Works for North Carolina’s Asian Americans
• In North Carolina, Social Security provided benefits to 1 out of 10 (10 percent) Asian American households in 2010, 6,724 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

Social Security, Medicare and Medicaid Work for north carolina

6

Social Security Works for North Carolina’s Working Families
• Through their hard work and payroll tax contributions, nearly all North Carolina 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 North Carolina 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.

Social Security, Medicare and Medicaid Work for north carolina

7

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 benefit 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 north carolina 8

and out-of-pocket costs for those low-income beneficiaries who are enrolled in Medicaid.) Medicare Part C, also known as the Medicare Advantage program, allows beneficiaries to enroll in a private insurance plan, in lieu of Medicare Parts A and B. These private plans receive payments from Medicare to cover physician and hospital service, and in most cases, prescription drug benefits. Medicare Advantage Plans cost more for the same services as provided under Parts A and B.57 According to the White House, “Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than traditional Medicare.”58 These extra costs result not only in higher government outlays but also higher Part B premiums for those enrolled in traditional Medicare. The Patient Protection and Affordable Care Act (ACA) of 2010 includes provisions which seek to make the costs of Part C closer to those of Part A and Part B.59 About 11.5 million Medicare beneficiaries were enrolled in Medicare Advantage as of April 2010— one-quarter (24.5 percent) of all beneficiaries.60 Medicare Part D, the prescription drug benefit, covers most outpatient prescription drugs. Part D

benefits are provided by private plans that contract with Medicare and are purchased voluntarily by Medicare beneficiaries. They exist independently, or as part of a Medicare Advantage plan. Part D is funded by beneficiary premiums, generally deducted from beneficiaries’ Social Security checks, and from general revenue. In addition, states are required to pay premiums for low-income beneficiaries who are enrolled in Part D programs. 27.6 million beneficiaries were enrolled in a Part D plan in 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

FIGuRE 4

average annual increase in Spending on common Benefits,* 1999–2009
6.9%

4.7%

Medicare

Private Health Insurance *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 9

*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 north carolina

were less than 2 percent of its total expenditures in 2011.64 Private health insurance’s administrative 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 North Carolina Residents
• Medicare insured 1,421,348 North Carolinians in 2009—1 out of 7 (14.9 percent) state residents.70

Medicare Works for North Carolina’s Seniors
• 1,149,372 of North Carolina’s 1,421,348 Medicare beneficiaries were aged 65 or older in 2009— 8 out of 10 (80.9 percent) beneficiaries.71

Medicare Works for North Carolina’s People with Disabilities
• 284,574 of North Carolina’s 1,421,348 Medicare beneficiaries were people with disabilities in 2009—1 out of 5 (20 percent) beneficiaries.72

Medicare Works for North Carolina’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 North Carolina’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 North Carolina residents with ALS would impoverish themselves or their families without the help of Medicare. Seniors and people with disabilities cannot be economically secure if they are one illness away from bankruptcy. Medicare should be strengthened, not cut. As private sector health insurance continues to rise in cost, Medicare is more important than ever.

Medicare Works for North Carolina’s Economy
• Medicare provided $14.1 billion in benefits in 2009—23.4 percent of all health care spending in the state.68 The average expenditure per Medicare beneficiary was $9,924.69

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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 north carolina 11

afford it. More troubling still, it may make life-saving medical care inaccessible for those who need it.

Medicaid Works for North Carolina’s Economy
• Medicaid provided $11.5 billion in benefits in 2009—19.1 percent of all health care spending in the state.82 The average expenditure per Medicaid beneficiary was $6,345.83

Medicaid Works for North Carolina Residents
• Medicaid insured 1,813,298 North Carolinians in 2009—1 out of 5 (19.3 percent) state residents.84

Medicaid Works for North Carolina’s Children
• Medicaid insured 960,827 children in 2009— 4 out of 10 (42.7 percent) children in the state.85

o $1.3 billion to nursing home facilities (37.7 percent) o $88 million to mental health facilities (2.6 percent) o o $549 million to intermediate care facilities for the intellectually disabled (16.1 percent).88 • Medicaid insured the vast majority of North Carolina residents who opt for nursing home care. 24,750 of North Carolina’s 37,190 nursing home residents were Medicaid beneficiaries in 2010— 2 out of 3 (66.6 percent) residents.89 The average annual cost of nursing home care for a semi– private room in North Carolina was $66,400 in 2010.90 Given the high cost of nursing home care, many North Carolina residents would not be able to afford it without Medicaid.

Medicaid Works for North Carolina During Economic Recessions
Because Medicaid eligibility is contingent upon having low income, the program expands to accommodate those who have lost jobs or earnings during a recession. Nationwide, between June 2008 and June 2009, the height of the Great Recession, monthly Medicaid enrollment rose by 3.3 million. That amounts to a 79 percent increase from the average annual enrollment rate between 2000 and 2007. While there are several factors that fuel Medicaid enrollment, experts believe that job losses and resulting losses of employer-based insurance and declining income, cause more people to qualify for Medicaid.91 As financially strapped states cut Medicaid, the last thing the 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.

Medicaid Works for North Carolina’s Seniors
• 182,522 of North Carolina’s 1,813,298 Medicaid beneficiaries were aged 65 or older in 2009— 1 out of 10 (10.1 percent) beneficiaries.86

Medicaid Works for North Carolina’s People with Disabilities
• 309,097 of North Carolina’s 1,813,298 Medicaid beneficiaries were people with disabilities in 2009—1 out of 6 (17 percent) beneficiaries.87

Medicaid Works for North Carolina’s LongTerm Care Residents
• Medicaid provided $3.4 billion in long-term care benefits for North Carolina residents in 2009. That includes: o $1.5 billion in home health care services (43.7 percent)

Social Security, Medicare and Medicaid Work for north carolina

12

concluSion
The large run-up in federal deficits in recent years resulted primarily from huge tax cuts in 2001 and 2003; the unpaid costs of the Iraq and Afghanistan wars; the Great Recession, which dramatically reduced tax collections and increased unemployment compensation and other spending; the economic stimulus and recovery spending; and the Wall Street bank bailout.92 [Figure 5] By law, Social Security can only pay benefits if it has the income to cover its costs. Its income is primarily the result of insurance contributions paid by hardworking Americans and their employers. It does not have borrowing authority which is why it never has and never will contribute to federal budget deficits. Likewise, large anticipated yearly increases in health care expenditures, public and private, reflect longterm structural problems in the nation’s health care
FIGuRE 5

system. Compared to other industrial democracies, the united States expends roughly twice as much per person on health care generally without providing coverage for all our citizens. While the 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 To reduce the federal debt, Congress should be looking at its causes. It should not cut Social Security, Medicare, and Medicaid, which were built to protect working persons and their families against lost wages and the high cost of health care, and which are so vital to the economic security of our nation. Social Security, Medicare and Medicaid represent the best of America’s values, including caring for aging parents and neighbors, reward for hard work, personal responsibility and dignity. In North Carolina, these programs spend about $48.2 billion a year, providing benefits to an average of 1 out of 6 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.
13

causes of recent run-up in federal deficits
1600 1400 1200 1000
Billions of dollars

ACTuAL DEFICITS

800 600 400 200 0 -200 -400 2001 DEFICITS WITHOuT THESE FACTORS 2003 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 north carolina

appendix 1: Social Security Works for north carolina’s congressional districts
State total 1 2 3 4 5 6 7 8 9 10 11 12 13
$22,579M $1,663M $1,494M $1,635M $1,474M $1,922M $2,074M $1,971M $1,461M $1,729M $1,919M $2,279M $1,433M $1,525M

CongreSSional DiStriCtS

total annual benefits ($ in millions)*
9,535,483

number of residents in state/congressional district
1,757,135

635,936 741,576 735,979 826,878 693,414 714,412 742,938 709,449 852,377 689,468 703,606 736,346 753,104

number of residents receiving Social Security benefits
18.4% 22.7% 16.6% 17.7% 12.5% 21.4% 21.4% 21.2% 16.5% 14.3% 21.6%

144,664 122,864 130,303 103,185 148,249 153,098 157,255 117,154 121,973 148,991 178,859 113,477 117,063

Percent of residents receiving Social Security benefits
917,261 N/A 82,526 31,649 12,120 4,146 14,223 12,038 10,095 7,731 3,209 4,715 3,568 4,641 10,503 9,072 10,048 6,761 10,313 9,583 4,515 10,290 25,606 21,143 14,053 23,750 22,665 30,140 12,054 5,098 13,564 72,939 84,302 71,072 99,042 106,045 96,399 N/A N/A N/A N/A N/A N/A N/A 70,195 24,241 8,150 3,041 11,527 1,125,816 310,399 125,013 53,195 142,712 N/A 82,972 17,244 8,522 4,090 9,145

25.4%

15.4%

15.5%

Women

N/A 97,389 26,915 9,491 3,591 11,605

N/A 119,666 28,233 13,315 6,919 10,726

N/A 69,290 23,272 7,658 2,515 10,742

N/A 73,979 21,488 7,926 3,147 10,523

SOCIAl SeCurIty BeNeFICIArIeS By CAtegOry

Social Security, Medicare and Medicaid Work for north carolina

Retired workers

Disabled workers

Widow(er)s

Spouses

Children

Sources: uS Census Bureau, Profile of General Population and Housing Characteristics: 2010, 2011. SSA, “Nevada,” 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.

14

appendix 2: Social Security, Medicare, and Medicaid data by county, in north carolina’s counties (Page 1/3)
sOCIAL seCuRITy BeNefITs, 2010 sOCIAL seCuRITy BeNefICIARIes By CHARACTeRIsTIC, 2010* meDICARe & meDICAID

NORTH CAROLINA COuNTy DemOgRApHICs, 2010

Social Security, Medicare and Medicaid Work for north carolina

County

population

Rural-urban median Continuum Household Code (2003) Income % in poverty Children Annual Total Benefits Total Beneficiaries Retired Workers Disabled Widow(er)s spouses Workers

population over Age 65

% of population Over Age 65

% of population Receiving Benefits

% Receiving % Receiving medicare, medicaid 2010 2011

15

Total (100 Counties) Alamance Alexander Alleghany Anson Ashe Avery Beaufort Bertie Bladen Brunswick Buncombe Burke Cabarrus Caldwell Camden Carteret Caswell Catawba Chatham Cherokee Chowan Clay Cleveland Columbus Craven Cumberland Currituck Dare Davidson Davie Duplin Durham edgecombe Forsyth Franklin

9,535,483 151,131 37,198 11,155 26,948 27,281 17,797 47,759 21,282 35,190 107,431 238,318 90,912 178,011 83,029 9,980 66,469 23,719 154,358 63,505 27,444 14,793 10,587 98,078 58,098 103,505 319,431 23,547 33,920 162,878 41,240 58,505 267,587 56,552 350,670 60,619

N/A 3 2 9 1 9 8 6 9 6 2 2 2 1 2 8 4 8 2 2 9 7 9 4 6 5 2 1 5 4 2 6 2 3 2 2

$43,417 $41,519 $40,441 $32,210 $32,268 $31,965 $35,568 $38,194 $30,586 $31,637 $44,186 $42,846 $38,541 $49,355 $36,860 $59,522 $43,356 $37,115 $41,782 $53,958 $32,963 $36,176 $35,314 $38,392 $32,518 $41,791 $43,356 $53,939 $50,203 $40,618 $46,957 $34,672 $48,023 $33,146 $44,443 $45,592

17.4% 18.5% 16.9% 23.0% 22.6% 20.0% 23.5% 20.7% 27.0% 22.3% 16.5% 17.1% 18.7% 12.5% 18.4% 9.7% 14.1% 20.8% 14.5% 14.2% 18.1% 21.1% 18.8% 20.9% 26.9% 17.5% 18.2% 11.1% 12.3% 17.3% 14.0% 23.7% 18.4% 24.5% 16.7% 16.0%

1,234,079 22,081 5,627 2,304 3,866 5,501 3,097 8,782 3,656 5,481 23,026 38,096 14,673 20,085 12,816 1,283 12,659 3,755 21,773 11,631 6,284 2,908 2,498 14,677 8,830 15,810 30,200 3,041 5,167 23,388 6,829 8,295 26,117 8,104 45,511 7,678

12.9% 14.6% 15.1% 20.7% 14.3% 20.2% 17.4% 18.4% 17.2% 15.6% 21.4% 16.0% 16.1% 11.3% 15.4% 12.9% 19.0% 15.8% 14.1% 18.3% 22.9% 19.7% 23.6% 15.0% 15.2% 15.3% 9.5% 12.9% 15.2% 14.4% 16.6% 14.2% 9.8% 14.3% 13.0% 12.7%

18.4% 20.2% 20.9% 29.3% 20.8% 26.7% 22.8% 27.2% 26.5% 22.8% 29.3% 21.5% 22.6% 16.2% 22.9% 18.6% 24.5% 24.7% 21.7% 21.9% 31.5% 26.4% 31.5% 24.6% 24.4% 20.6% 15.0% 17.7% 20.4% 21.0% 22.4% 17.7% 13.4% 21.7% 18.1% 17.4%

$22,613,990,000 $403,475,000 $97,951,000 $37,883,000 $66,259,000 $84,802,000 $48,844,000 $162,611,000 $60,657,000 $91,966,000 $436,825,000 $663,110,000 $258,615,000 $389,364,000 $238,291,000 $22,367,000 $206,311,000 $70,296,000 $447,199,000 $195,937,000 $104,597,000 $46,704,000 $41,163,000 $306,135,000 $163,104,000 $266,415,000 $566,999,000 $52,568,000 $93,517,000 $446,176,000 $124,692,000 $116,916,000 $486,932,000 $142,780,000 $874,984,000 $131,278,000

1,757,135 1,125,816 310,399 125,013 30,590 20,735 4,945 1,965 7,770 5,130 1,360 485 3,265 2,175 555 220 5,600 3,220 1,235 460 7,280 4,855 1,125 570 4,055 2,750 585 330 13,005 8,210 2,290 1,095 5,630 3,020 1,345 490 8,040 4,280 1,940 700 31,435 22,760 4,095 1,905 51,330 33,780 8,610 3,840 20,580 13,150 3,890 1,230 28,905 19,540 4,665 1,715 19,005 12,160 3,640 1,255 1,860 1,210 270 155 16,280 11,310 2,300 1,240 5,855 3,465 1,245 450 33,455 23,065 5,310 2,125 13,905 10,240 1,555 890 8,640 5,625 1,470 670 3,910 2,550 570 355 3,330 2,295 495 245 24,100 14,995 4,980 1,515 14,160 7,450 3,465 1,260 21,295 14,295 3,300 1,550 47,960 26,025 10,375 4,225 4,160 2,745 610 340 6,925 5,055 750 475 34,205 22,395 6,245 2,245 9,245 6,385 1,295 595 10,340 6,190 2,030 900 35,800 23,190 6,425 2,280 12,295 6,810 2,975 920 63,440 42,965 9,715 4,385 10,555 6,415 2,245 715

53,195 142,712 725 2,220 185 610 105 210 115 570 265 465 140 250 475 935 170 605 245 875 1,065 1,610 1,720 3,380 410 1,900 660 2,325 465 1,485 95 135 615 810 175 520 705 2,250 485 735 315 555 155 280 125 170 545 2,065 455 1,530 765 1,385 1880 5,455 140 330 250 400 830 2,490 325 645 330 890 835 3,070 265 1,325 1950 4,425 260 920

15.5% 17.6% 16.7% 25.2% 17.2% 22.2% 22.3% 23.0% 21.5% 17.1% 23.3% 18.9% 17.8% 14.2% 18.4% 14.2% 19.4% 17.3% 18.3% 13.6% 26.2% 22.3% 26.0% 20.8% 20.4% 19.0% 12.7% 14.9% 16.8% 14.9% 18.2% 14.2% 11.9% 14.9% 16.5% 13.3%

13.0% 12.1% 12.5% 14.4% 16.8% 12.1% 12.0% 16.4% 20.3% 19.3% 11.4% 12.1% 13.8% 12.1% 14.5% 7.4% 10.4% 12.8% 13.0% 9.0% 13.5% 17.2% 14.0% 17.0% 21.7% 11.5% 15.2% 7.8% 7.8% 14.0% 10.9% 17.2% 12.8% 24.5% 13.7% 13.3%

*State totals do not equal the sum of county figures, because individual county figures provided by SSA are rounded.

appendix 2: Social Security, Medicare, and Medicaid data by county, in north carolina’s counties (Page 2/3)
sOCIAL seCuRITy BeNefITs, 2010 sOCIAL seCuRITy BeNefICIARIes By CHARACTeRIsTIC, 2010* meDICARe & meDICAID

NORTH CAROLINA COuNTy DemOgRApHICs, 2010

Social Security, Medicare and Medicaid Work for north carolina

County
$40,332 $43,010 $31,863 $45,828 $38,428 $42,415 $30,861 $40,956 $39,987 $43,589 $32,410 $43,679 $35,206 $46,576 $36,741 $46,922 $38,578 $41,999 $36,455 $45,332 $34,383 $36,229 $36,158 $34,814 $52,363 $35,032 $34,608 $47,705 $42,315 $46,129 $32,168 $41,969 $51,434 $41,442 $39,381 $43,573 19.9% 17.5% 22.5% 15.5% 23.7% 17.9% 26.2% 16.7% 14.6% 15.8% 26.1% 19.0% 21.9% 13.3% 19.3% 16.1% 18.4% 18.6% 23.2% 15.0% 19.9% 19.3% 19.7% 23.4% 15.6% 18.5% 24.6% 16.6% 15.6% 18.1% 22.5% 15.8% 17.4% 15.2% 22.9% 16.7% 27,294 1,831 1,742 7,441 2,665 60,123 8,836 11,947 12,416 23,865 3,898 3,483 875 20,445 6,084 17,259 1,756 7,937 9,514 10,361 7,377 8,069 3,666 4,297 81,113 3,260 4,364 19,986 13,393 28,092 4,336 13,262 12,889 2,857 5,513 7,886 13.2% 15.0% 19.7% 12.4% 12.5% 12.3% 16.2% 10.4% 21.0% 22.4% 15.8% 7.4% 15.1% 12.8% 15.1% 10.2% 17.3% 13.7% 16.0% 13.2% 16.4% 23.8% 17.7% 17.5% 8.8% 20.9% 15.7% 22.6% 14.0% 13.9% 19.6% 7.5% 9.6% 21.7% 13.6% 15.1% 20.6% 20.9% 26.1% 18.0% 16.8% 17.1% 27.0% 15.6% 28.9% 27.7% 21.6% 12.7% 18.4% 18.6% 19.2% 16.3% 24.7% 20.0% 24.6% 18.5% 24.8% 31.3% 25.7% 24.2% 12.2% 28.3% 20.8% 27.2% 20.6% 18.5% 26.4% 11.4% 12.7% 28.1% 19.0% 21.2% $556,411,000 $30,251,000 $25,840,000 $131,267,000 $41,283,000 $1,139,452,000 $169,089,000 $213,306,000 $218,569,000 $398,282,000 $61,090,000 $67,172,000 $11,286,000 $394,917,000 $96,400,000 $339,127,000 $27,990,000 $148,765,000 $172,058,000 $191,984,000 $136,447,000 $133,190,000 $60,681,000 $69,985,000 $1,552,542,000 $51,223,000 $71,018,000 $327,131,000 $243,471,000 $512,735,000 $67,136,000 $234,253,000 $242,486,000 $46,344,000 $90,812,000 $141,145,000 42,545 2,550 2,315 10,805 3,585 83,335 14,785 17,880 17,075 29,550 5,320 5,970 1,070 29,680 7,715 27,505 2,505 11,570 14,635 14,490 11,165 10,615 5,345 5,925 112,260 4,405 5,780 23,975 19,765 37,560 5,840 20,315 16,960 3,695 7,745 11,045 26,560 1,490 1,375 6,435 2,115 56,210 7,950 10,400 11,155 21,020 2,955 3,005 640 19,760 5,310 16,195 1,495 7,295 8,655 9,570 6,895 7,555 3,270 3,505 73,495 2,720 3,630 17,490 11,955 25,065 3,385 11,970 11,705 2,535 4,935 6,995 8,790 475 445 2,100 770 13,075 3,525 3,865 2,680 3,705 1,230 1,605 160 4,765 1,135 5,870 500 2,100 2,865 2,615 2,385 1,305 1,055 1,265 17,515 845 1,195 2,645 3,905 5,650 1,210 3,805 2,365 505 1,215 2,025 2,780 240 210 720 285 5,380 1,345 1,320 1,395 2,110 465 395 135 1,910 575 2,000 210 890 1,100 880 700 770 435 505 8,095 345 350 1,580 1,610 2,845 540 1,720 1,040 280 685 810 925 120 95 190 95 2,310 430 500 820 1,355 175 145 45 790 270 690 95 305 400 355 310 470 215 170 3,600 175 135 1,050 485 1,385 190 845 535 140 275 380 3,490 225 190 1,360 325 6,360 1,535 1,795 1,025 1,360 490 820 90 2,455 420 2,750 205 980 1,615 1,070 875 515 370 480 9,555 325 470 1,210 1,810 2,615 515 1,975 1,315 235 635 835 17.3% 17.0% 21.4% 13.7% 11.9% 14.8% 23.4% 10.6% 23.4% 24.9% 19.1% 7.7% 15.5% 15.3% 15.4% 11.7% 21.3% 19.7% 21.8% 15.8% 20.7% 27.8% 21.2% 22.0% 10.7% 24.0% 17.4% 24.3% 19.9% 16.2% 22.4% 9.2% 12.2% 21.4% 17.0% 17.4%

population

Rural-urban median Continuum Household Code (2003) Income % in poverty Children Annual Total Benefits Total Beneficiaries Retired Workers Disabled Widow(er)s spouses Workers

population over Age 65

% of population Over Age 65

% of population Receiving Benefits

% Receiving % Receiving medicare, medicaid 2010 2011
15.5% 10.7% 16.5% 11.6% 17.4% 11.3% 23.6% 13.4% 14.1% 10.9% 18.7% 16.0% 12.1% 10.3% 9.3% 13.7% 14.8% 15.7% 20.0% 11.2% 9.8% 8.9% 21.3% 29.8% 12.2% 13.8% 18.2% 10.8% 15.5% 10.6% 19.2% 8.7% 6.4% 12.4% 14.2% 13.3%

gaston gates graham granville greene guilford Halifax Harnett Haywood Henderson Hertford Hoke Hyde Iredell Jackson Johnston Jones lee lenoir lincoln McDowell Macon Madison Martin Mecklenburg Mitchell Montgomery Moore Nash New Hanover Northampton Onslow Orange Pamlico Pasquotank Pender

206,086 12,197 8,861 59,916 21,362 488,406 54,691 114,678 59,036 106,740 24,669 46,952 5,810 159,437 40,271 168,878 10,153 57,866 59,495 78,265 44,996 33,922 20,764 24,505 919,628 15,579 27,798 88,247 95,840 202,667 22,099 177,772 133,801 13,144 40,661 52,217

1 8 9 6 3 2 4 4 2 2 7 2 9 4 6 2 8 4 4 4 6 7 2 6 1 9 6 4 3 2 9 3 2 9 7 2

16

*State totals do not equal the sum of county figures, because individual county figures provided by SSA are rounded.

appendix 2: Social Security, Medicare, and Medicaid data by county, in north carolina’s counties (Page 3/3)
sOCIAL seCuRITy BeNefITs, 2010 sOCIAL seCuRITy BeNefICIARIes By CHARACTeRIsTIC, 2010* meDICARe & meDICAID

NORTH CAROLINA COuNTy DemOgRApHICs, 2010

Social Security, Medicare and Medicaid Work for north carolina

County
$40,772 $42,621 $39,519 $44,756 $39,648 $31,568 $30,627 $38,063 $38,658 $35,057 $37,047 $31,805 $42,854 $43,178 $36,622 $36,109 $40,652 $31,732 $64,486 $34,000 $61,594 $32,574 $33,293 $38,923 $40,274 $34,886 $36,645 $41,095 $36,934 16.4% 16.4% 21.6% 14.4% 18.1% 28.1% 31.5% 18.5% 20.1% 25.0% 21.4% 27.2% 15.4% 14.3% 19.3% 18.5% 15.9% 28.7% 9.2% 24.3% 12.0% 27.1% 22.4% 24.8% 19.7% 19.9% 22.9% 15.1% 20.3% 2,887 5,993 16,619 4,993 19,949 6,691 15,078 15,171 19,993 11,726 9,044 4,914 9,507 7,575 12,250 2,321 8,539 742 19,466 6,421 76,549 3,961 2,414 6,329 16,078 11,778 11,517 6,241 3,672 21.5% 15.2% 9.9% 24.3% 14.1% 14.3% 11.2% 16.2% 14.4% 17.3% 14.3% 13.6% 15.7% 16.0% 16.6% 16.6% 25.8% 16.8% 9.7% 14.1% 8.5% 18.9% 18.2% 12.4% 13.1% 17.0% 14.2% 16.3% 20.6% 27.5% 22.8% 15.3% 28.6% 20.6% 23.8% 18.8% 25.0% 21.5% 24.8% 21.0% 25.1% 22.4% 21.4% 24.2% 27.4% 29.0% 19.2% 13.4% 23.4% 11.8% 22.3% 26.0% 15.8% 19.3% 25.8% 22.3% 23.0% 29.9% $45,948,000 $112,362,000 $315,655,000 $79,623,000 $373,572,000 $130,185,000 $276,402,000 $295,571,000 $383,223,000 $211,970,000 $154,786,000 $109,273,000 $174,029,000 $129,524,000 $213,930,000 $42,354,000 $130,533,000 $9,434,000 $370,939,000 $125,390,000 $1,483,232,000 $52,689,000 $42,931,000 $103,756,000 $278,553,000 $211,105,000 $222,715,000 $110,343,000 $61,102,000 3,700 9,005 25,760 5,875 29,175 11,085 25,245 23,390 29,735 16,850 13,335 9,090 13,590 10,125 17,830 3,835 9,610 845 27,070 10,610 105,880 4,680 3,445 8,065 23,685 17,870 18,090 8,850 5,325 2,555 5,585 14,935 4,210 19,390 5,910 12,845 14,445 18,850 10,775 7,825 4,670 9,070 6,480 11,185 2,390 6,870 530 18,290 5,890 70,835 2,705 1,950 5,795 13,655 11,020 10,925 5,745 3,350 480 1,840 5,620 670 5,185 3,000 6,550 4,810 5,825 3,350 2,875 2,500 2,380 1,855 3,470 720 1,165 140 3,785 2,570 15,410 1,005 610 950 4,780 3,525 3,775 1,530 955 290 630 1,955 445 1,690 765 1,995 1,585 1,875 1,100 1,075 610 820 720 1,270 290 705 80 1,820 810 7,140 365 365 555 1,880 1,335 1,345 630 420 155 225 705 240 635 245 630 580 705 415 360 195 290 300 520 115 460 40 860 225 3,695 140 190 325 685 535 505 245 260 220 725 2,545 310 2,275 1,170 3,225 1,975 2,475 1,210 1,200 1,115 1,030 770 1,385 320 410 55 2,315 1,115 8,800 465 325 440 2,685 1,455 1,540 700 335 23.0% 16.1% 12.9% 24.7% 17.2% 20.4% 16.3% 20.4% 16.7% 19.6% 15.7% 18.0% 19.5% 17.0% 22.0% 21.8% 25.7% 16.1% 9.4% 20.2% 10.6% 18.5% 21.6% 12.4% 16.5% 19.9% 17.5% 19.2% 24.9%

population

Rural-urban median Continuum Household Code (2003) Income % in poverty Children Annual Total Benefits Total Beneficiaries Retired Workers Disabled Widow(er)s spouses Workers

population over Age 65

% of population Over Age 65

% of population Receiving Benefits

% Receiving % Receiving medicare, medicaid 2010 2011
12.6% 13.5% 13.3% 9.0% 13.8% 22.3% 25.7% 14.3% 15.4% 15.5% 19.8% 23.6% 13.6% 11.1% 16.2% 11.1% 11.1% 15.7% 8.9% 24.5% 7.5% 16.5% 22.2% 4.8% 16.4% 15.9% 17.6% 12.8% 14.6%

Perquimans Person Pitt Polk randolph richmond robeson rockingham rowan rutherford Sampson Scotland Stanly Stokes Surry Swain transylvania tyrrell union Vance Wake Warren Washington Watauga Wayne Wilkes Wilson yadkin yancey

13,453 39,464 168,148 20,510 141,752 46,639 134,168 93,643 138,428 67,810 63,431 36,157 60,585 47,401 73,673 13,981 33,090 4,407 201,292 45,422 900,993 20,972 13,228 51,079 122,623 69,340 81,234 38,406 17,818

9 2 3 8 2 4 4 2 4 4 6 6 6 2 4 8 6 9 1 4 2 8 7 6 3 6 4 2 8

17

*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-continuumcodes ERS designates counties as rural or urban based on population density, grading them on a scale of 1 to 9, with 1 being the most urban and 9 being the most rural. Counties are considered rural if they are designated 4 or higher. Median Household income: uS Census Bureau, Table 1: 2010 Poverty and Median Income Estimates - Counties, November 2011. http://www.census.gov/did/www/saipe/data/statecounty/data/2010.html Percentage of Households in Poverty: uS Census Bureau, Table 1: 2010 Poverty and Median Income Estimates - Counties, November 2011. http://www.census.gov/did/www/saipe/data/statecounty/data/2010.html Population aged 65 or older: uS Census Bureau, “Age Groups and Sex: 2010,” 2010 Census Summary File 1, 2011. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_SF1_QTP1&prodType=table total annual Social Security Benefits: Bureau of Economic Analysis (BEA), Regional Economic Accounts: Local Area Personal Income, “Old-Age, Survivors and Disability Insurance (OASDI) benefits,” CA 35 Personal current transfer receipts. http://bea.gov/regional/reis/ BEA data were used for total annual Social Security benefits rather than the figures available from the SSA in order to be consistent with the denominator of “Personal income,” which came from BEA. For other purposes in the report, such as calculating the average benefit and average retirement benefit in rural counties, SSA data were used. Social Security Beneficiaries by Characteristic: Social Security Administration (SSA), “Table 4. Number of beneficiaries in current-payment status, by county, type of benefit, and sex of beneficiaries aged 65 or older, December 2010,” OASDI Beneficiaries by State and County, 2010, June 2011. http://www.ssa.gov/policy/docs/statcomps/oasdi_sc/2010/index.html Percentage of Population receiving Medicare: Center for Medicare and Medicaid Services (CMS), “Beneficiaries Receiving Medicare: Total Beneficiaries by State and County,” 2010. http://www.cms.gov/Research-Statistics-Data-andSystems/Statistics-Trends-and-Reports/MedicareEnrpts/Downloads/County2010.pdf Percentage of Population receiving Medicaid: North Carolina Department of Health and Human Services, 2011. “Medicaid Monthly Enrollment Report 2011”. http://www.ncdhhs.gov/dma/ca/enroll/index.htm

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 relating to Medicare date to 2009, and nearly all numbers relating 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 Annual 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 Annual 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.B1, 2012 Annual 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.

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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, 2011. 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 31 Association of American Retired Persons (AARP), “Grandfacts: State fact sheets for grandparents and other relatives raising children,” 2011. http://www.aarp.org/relationships/friends-family/grandfacts-sheets/ 32 SSA, “Table 5.J5.1—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
20

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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 Trustees Report, p. 201, May 13, 2011. 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-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2012.pdf 54 Average expenditure per beneficiary is “average benefit per enrollee.” Medicare Trustees, “Table II.B1—Medicare Data for Calendar Year 2011,” 2012 Trustees Report, April 2012, 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 Trustees Report, April 2012, p. 10. http://www.cms.gov/ResearchStatistics-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 69 Average benefit found by dividing total spending by total beneficiaries. KFF, “Medicare Spending Estimates by State of Residence (in millions), 2009,” December 2011. http://www.statehealthfacts.org/comparemaptable.jsp?ind=620&cat=6 KFF, “Total Number of Medicare Beneficiaries, 2009,” 2010. http://www.statehealthfacts.org/comparemaptable.jsp?yr=92&typ=1&ind=290&cat=6&sub=74 70 KFF, “Total Number of Medicare Beneficiaries, 2009,” 2010. http://www.statehealthfacts.org/comparemaptable.jsp?yr=92&typ=1&ind=290&cat=6 &sub=74 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.

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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 86 KFF, “Distribution of Medicaid Enrollees by Enrollment Group, FY2009,” 2012. http://www.statehealthfacts.org/comparemaptable. jsp?typ=1&ind=200&cat=4&sub=52 87 KFF, “Distribution of Medicaid Enrollees by Enrollment Group, FY2009,” 2012. http://www.statehealthfacts.org/comparemaptable. jsp?typ=1&ind=200&cat=4&sub=52 88 KFF, “Medicaid Long-Term Care Funding by Category, FY2009,” 2012, unpublished; Data provided to Social Security Works by Lindsay Donaldson, Research Associate at the Kaiser Family Foundation. 89 Data on 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, 2012 Medicare Trustees Report, “Table II.B1—Medicare Data for Calendar Year 2011,” p. 10. 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 are individually sourced in the report. Average ratio of residents receiving benefits from either Social Security, Medicare or Medicaid, is an average of the percentages of residents receiving benefits from each of the three programs.
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Social Security, Medicare and Medicaid Work for north carolina

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key factS aBout Social Security, Medicare & Medicaid in north carolina
Social Security, Medicare and Medicaid work for North Carolina residents of all ages and backgrounds. This report, Social Security, Medicare & Medicaid Work for North Carolina shows that:

Social Security Works for North Carolina’s Residents and Economy
• Social Security provided benefits to 1,757,135 North Carolinians in 2010, 1 out of 5 residents, including 1,125,816 retired workers, 310,399 disabled workers, 125,013 widow(er)s, 53,195 spouses, and 142,712 children. [Figure 3] • Social Security provided benefits totaling over $22.6 billion in 2010, an amount equivalent to 5.3 percent of the state’s annual GDP (the total value of all goods and services produced). • The average Social Security benefit in 2010 was $12,864. • Social Security lifted 671,000 North Carolina residents out of poverty in 2008.

Social Security Works for North Carolina’s Women
• Social Security provided benefits to 917,261 women residents in 2010, 1 out of 5 women. • Without Social Security, the poverty rate of elderly women would increase from 13.2 percent to 51.7 percent.

Social Security Works for North Carolina’s People of Color
• Social Security provided benefits to 340,933 African Americans in North Carolina in 2009, 1 out of 6 African American residents. • It provided benefits to 1 out of 16 Latino households in North Carolina in 2010, 11,995 households.

Medicare Works for North Carolina’s Residents and Economy
• 1,421,348 North Carolinians received Medicare benefits in 2009—1 out of 7 state residents. • Medicare provided $14.1 billion in benefits in 2009—23.4 percent of all health care spending in the state. The average expenditure per Medicare beneficiary was $9,924.

Medicare Works for North Carolina’s Seniors and People with Disabilities
• 1,149,372 of North Carolina’s 1,421,348 Medicare beneficiaries were aged 65 or older in 2009— 8 out of 10 beneficiaries. • 284,574 of North Carolina’s 1,421,348 Medicare beneficiaries were people with disabilities in 2009— 1 out of 5 beneficiaries.

Medicaid Works for North Carolina’s Residents and Economy
• 1,813,298 North Carolinians received Medicaid benefits in 2009—1 out of 5 state residents. • A total of $14.1 billion in Medicaid benefits were paid in 2009—19.1 percent of all health care spending in the state. The average expenditure per Medicaid beneficiary was $6,345.

Medicaid Works for North Carolina’s Seniors, People with Disabilities and Long-Term Care Residents
• 182,522 of North Carolina’s 1,813,298 Medicaid beneficiaries were aged 65 or older in 2009— 1 out of 10 beneficiaries. • 309,097 of North Carolina’s 1,813,298 Medicaid beneficiaries were people with disabilities in 2009— 1 out of 6 beneficiaries. • Medicaid provided $3.4 billion in long-term care benefits for North Carolina residents in 2009, including providing nursing home care for 24,750 nursing home residents, 2 out of 3 of state residents enrolled in nursing homes.

http://strengthensocialsecurity.org/statereports2012

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