Beyond the Looking Glass

Transcription

1 Beyond the Looking Glass Can our Nation Reform its way to Financial Security? Carma Matti-Jackson, MBA (TIM)

2 Section 1: The Status of our Nation s Finances To see beyond the looking glass, you must first look squarely into it. 2

3 Annual Federal Expenditures Exceeded Revenue by $600 billion in 2016 Source: The Federal Budget in U.S. Congressional Budget Office, February 8,

4 Federal Debt is the Highest Its Been Since World War II Debt* Year % GDP % % % % % % % *Actual through 2012 Source: 2017 Long-term Budget Outlook. Congressional Budget Office, March 30, 2017: Figure 2, Page

5 Why is Debt Growing so Much? 5

6 Forecasted Federal Expenditures Source: The Budget Outlook for 2017 to 2027 in 20 Slides. January Central Budget Office 6

7 CBO s Forecasted Federal Revenues Percent of GDP Individual income taxes 8 6 Payroll taxes Other Corporate income taxes By 2027 revenues from all sources are expected to decline with the exception of income taxes. Although the labor force participation rates are expected to drop by 1.8%, underlying assumption project that income tax revenues will increase because of workers moving into higher paying tax brackets. It also assumes lower levels of unemployment. NOTE: Revenue projections assume that all tax provisions expire according to current law and are not extended. Chart Data Source: Supplemental Data to, CBO s The Budget and Economic Outlook: 2017 to January

8 The Proportion of Revenue to Expenditures Under Current Law As a Percentage of GDP Revenue 17.8% 18.4% Expenditure 20.9% 23.9% Shortfall (3.1)% (5.5)% Chart Data Source: Supplemental Data to, CBO s The Budget and Economic Outlook: 2017 to January

9 The Focus of the Federal Government: Low Interest Rates A lower portion of the total budget is needed to maintain higher levels of debt. In 2000, our public debt was $3.4 trillion and 12.5% of our budget was spent on interest. Today, the public debt is $14.3 trillion, but only 6% of our budget is spent on interest. 9

10 What Has the Federal Government Been Looking At? AS A PERCENTAGE OF TOTAL BUDGET 14.3% 13.9% 15.4% 11.4% 12.5% 6.5% 7.2% 7.1% 8.5% 5.3% 6.2% Data Source: Data Supplemental Information. CBO s January 2017 report The Budget and Economic Outlook: 2017 to

11 Dollars in Billions It s All About Perspective Total Federal Budget $4,000 $3,500 Other Expenditures Interest Total Budget $3.9 Trillion $3,000 $2,500 $2,000 $1,500 Total Budget $1.8 Trillion Year Interest Total Budget (Trillion) % $ % $1.8 $1,000 $500 $0 Total Budget $157.5 Billion $222.9 $240.7 Data Source: Data Supplemental Information. CBO s January 2017 report The Budget and Economic Outlook: 2017 to

12 Where Do We Go From Here? If lawmakers want to maintain our nation s debt at it s current 77% of GDP: Beginning in 2018, they need to change the budget by $380 Billion. Increase revenues by 10% Decrease spending by 9% If, by 2047, the goal is to reduce our nation s debt to its 50-year average of 40% of GDP: Beginning in 2018, lawmakers need to change the budget by $620 Billion. Increase revenues by 17% Decrease spending by 15% If lawmakers do nothing in 2018: Debt continues to accumulate which either: Grows the magnitude of changes needed to bring debt down; or Extends the timeline for decreasing the debt (beyond 2047). Rising interest rates + increased debt means a larger portion of the budget must be allocated to pay interest. In order to maintain programs at current levels, additional revenue is needed. A higher debt-to-gdp ratio weakens the dollar. The USA credit ratings are at risk. In 2011, the USA credit rating was downgraded by the S&P from AAA (outstanding) to AA+ (excellent) because, Budget savings fell short of what was necessary to tame the nation s debt over time. 12

13 Section 2: A Peek at the Details The Domestic Trio - Social Security, Medicare, & Medicaid 13

14 The Domestic Trio: Social Security, Medicare, & Medicaid All Other Programs $563 Billion Mandatory Programs $164 Fed Civilian & Military Retirement Benefits $107 Veteran s Benefits $73 SNAP (Supplemental Nutrition Assist.) $51 Health Subsidies (ACA) $33 Unemployment Compensation $600 Billion Discretionary Programs $92 Education $68 Veteran s Benefits $59 SSI (Supplemental Security Income) $50 Housing Programs 52% of $3.6 Trillion* Spent on The Domestic Trio (Dollars in Billions) BUT 81% of the $2.4 Trillion Spent on Mandatory Programs *2016 Expenditures. Excludes $241 Billion spent on interest 14

15 Elderly Individuals, Providers, and the Economy Rely Heavily on These Programs 48.2 Million Beneficiaries Age 65 & Older 3 $26,466 = Median Annual Income 4 91% have Savings: Median = $75, % have home equity: Median = $86,300 4 Spending per aged enrollee: 5 $9,870 = age $17,267 = age 85+ Medicare Beneficiary Costs 3 Part B premiums range between $1,608 - $5,136 Part D Out-of-pocket max = $4,950 Part A Hospital Deductible =$1,316 Without Medicare, many seniors could not afford health insurance. A mid-tier or silver health care plan for a 60-year-old: Premium = $8,940 per year Out-of-pocket medical max ~ $12,000 Deductible for two people = $6,500 Typically does not pay for Room & Board 44 Million Beneficiaries Age 65 & older 1 Average monthly benefit = $1,300* 5.3 Million Age Average monthly benefit = $1,120* 31.6 Million Senior rely on SS for half or more of their annual income. 2 Total Income ~ $32,640 - $51,600 or less per year 15.5 Million Seniors rely on SS for 90% of Total Income. 2 Total Income ~ $18,133 - $28,666 per year Benefit $$$ used for: Medicare Part B & D Premiums & Out-of-Pocket Costs; Shelter & Food. 5.7 Million Beneficiaries Age 65 & Older 3 Provides Medical, Personal Care, and Long Term Care for Low Income Spending per aged enrollee: 6 $11,433 = age $27,470 = age 85+ Does not pay for Room & Board. These are typically paid for with the client s social security benefit. *SSA Data: December Weighted Average Includes Spouses, Survivors, & Disabilities. 15

16 The Mechanics of Funding the Domestic Trio Social Security Fund Source: Payroll Taxes Fund Reserves: Trust Funds OASI: Old Age and Survivors Insurance Benefits are paid directly to individuals age 62 or older with sufficient work credits, their spouses, & survivors. Medicare Fund Sources: See Below Fund Reserves: Trust Funds HI: Hospital Insurance Part A Fund Source: Payroll Taxes Medicaid Fund Sources: Federal & State General Funds No Federal Reserves Federal Medical Assistance Percentage (FMAP) varies by State and by Eligibility Populations. SSDI: Social Security Disability Insurance Benefits are paid directly to disabled workers with sufficient work credits,* spouses, & children. (Age 54 is average for disabled workers). SMI: Supplementary Medical Insurance Trust Fund Part B & D Fund Sources: General Funds (income taxes) & Premiums In 2014, the ACA expanded Medicaid to low income adults w/o children. WA State s FMAP is ~ 50/50, except for the expansion population. Expansion FMAP: Currently 95/5 and will phase-down to 90/10 in *You must meet work history criteria to qualify for SSDI. Another program called, Supplemental Security Insurance (SSI) provides benefits to disabled with insufficient work credits. This program is also administered by Social Security Administration, but it is funded with general funds, not payroll taxes. SSI does not utilize reserve funding held by the Trust. 16

17 The Impacts of The Domestic Trio on Washington State Program Federal Expenditures Amount Spent on 65 and older SS Old Age & Survivor 10 $ 17.3 Billion $ 15.5 Billion SS Disability 10 $ 3.1 Billion Medicare 11 $ 6.3 Billion $ 5.3 Billion $ Medicaid12, Billion $ 10.9 Total Funds $ 1.2 Billion (LTC) $ 2.3 Total Funds Total Federal Spend in WA $ 33.4 Billion $ 22 Billion 17

18 Domestic Programs With Reserves TRUST FUND OPERATIONS 7 (dollars in billions) Fund Sources >>> Old Age/ Survivor OASI 85% Payroll Taxes 11% Interest Earned 3% Tax on SS Benefits Social Security Disabled SSDI 95% Payroll Taxes 3% Interest Earned 1% Tax on of SS Benefits Part A HI 87% Payroll Taxes 7% Tax on SS Benefits Medicare Part B&D SMI 20% Premiums 74% General Fund 5% Interest & Other Reserves (end of 2014) $2,729.2 $60.2 $197.3 $69.1 Income during Expenditures during 2015 (750.5) (146.6) (278.9) (368.8) Net change in Reserves Reserves (end of 2015) 2, The Actuaries recommend maintaining reserves equal to or greater than one full year of the program s expenditures. Social Security Old Age & Survivors has reserves 3 ½ times its current annual costs. Worker s Disability has reserves equal to about 1/5 its current annual costs. To postpone full depletion of DI trust funds in 2016, the Bipartisan Act of 2015 temporarily transferred a portion of the payroll tax rates from OASI to DI. Medicare Medicare Part A has reserves equal to about 2/3 its current annual costs. Supplemental Medicaid Insurance (Medicare Part B & D) is not expected to exceed revenues because most of it s funding comes from the general fund and premiums. Raising premiums is an option to increase revenue, however, this contributes to inflationary adjustments to social security benefits paid to help the beneficiaries cover these increased costs. 18

19 2016 Medicare & Social Security Trust Report: Revenue & Cost Growth ADA Amendment Act (ADAAA) New Definition for Disability 2011 Baby Boomers aging into 65 and Older 19

20 Revenue & Expenditure Forecast 7 Under Current Law: Social Security- OASI & SSDI (Dollars in Billions) $1,450 $1,350 $1,250 $1,150 $1,050 $950 $850 $750 OASI Actuarial Intermediate Forecast $826 $813 Revenue w/interest Expenditures $1,395 $1,283 Old Age/Survivor Exceeds Revenue by 2022 If Interest is excluded, expenditures exceed revenue beginning in Board of Trustees Predicts Depletion of Reserves by CBO Predicts depletion of Reserves by $220 $200 $180 $160 $140 $120 $100 SSDI Actuarial Intermediate Forecast $170 $153 $214 $189 Disability Began Exceeding Revenue in 2010 Received a one-time transfer from OASI in 2015 Board of Trustees predicts depletion of Reserves in 6 years (2023). 8 Revenue w/interest Expenditures Charts- Data Source: 2016 Annual Report of the Board of Trustees of OASI and DI Trust Funds. 20

21 Two Revenue & Expenditure Forecasts Under Current Law: Medicare Part A (Dollars in Billions) HI 10-Year Actuarial Analysis $287 $275 $500 $470 Medicare Part A Began Exceeding Revenue in 2015 Board of Trustees released its Report in June It predicts depletion of reserves by Revenue (w/ interest) Expenditures Chart Data Source: 2016 Annual Report of the Board of Trustees of OASI and DI Trust Funds HI Congressional Budget Office 10-Year Analysis Revenue (w/ interest) $488 $407 Expenditures $560 $457 March 2017, CBO predicted depletion of Part A reserves by Uses data from 2016 instead of 2015 Projected lower revenues from interest Reduced the ratio of workers paying payroll taxes to those receiving benefits Chart Data Source: Supplemental Data to, CBO s The Budget and Economic Outlook: 2017 to

22 Medicaid: Traditionally, Expenditures Tend to Follow the Economy Unlike the other two programs in the Domestic Trio, Medicaid has no dedicated fund source or Federal Trust Reserves. Data Source: Congressional Budget Office. Supplement information to the January 2017 report, The Budget and Economic Outlook: 2017 to 2027 Data Sets Selected: Mandatory Outlays Projected in CBO's Baseline and Mandatory Outlays Since

23 Federal Expenditure Forecast 7 Under Current Law: Medicaid $700 $600 $500 $400 $300 $200 $100 $0 $181 (Dollars in Billions) Congressional Budget Office 10-Year Analysis $389 $650 Medicaid is projected to become a $1 Trillion Program in the next decade January 2014: The ACA provided states the authority to expand Medicaid coverage to low income adults (138% of FPL). 31 States and DC are participating in the Expansion Including Washington State million newly expansion enrollees todate. This is projected to become 13.2 million by 2025.* Federal participation on expansion population is currently 95%. This becomes 90% in $315 Federal Expenditures on the expansion population were $58.1 billion in 2015 and are projected to reach $103.4 billion by 2025.* 23

24 Dollars in Billions Washington State s Medicaid Program $10.9 Billion in 2015 Medicaid Expansion Began January Expansion expenditures are 100% Federal through December $12 $10 $8 $6 $4 $2 51% Federal WA State Total Medicaid Expenditures $7.4 Billion Annual Average 65% Federal $ State Federal Source: CMS 64 Reports. 24

25 In Thousands IN THOUSANDS Medicaid Expansion Population in Washington State WA State predicted they would enroll 328,000 additional people by As of February 2017, enrollment is 62% higher per month than it was prior to expansion. Total newly expansion adult enrolled is over 600,000 (about 690,000 including CHIP). 2,000 1,700 1,400 1, Total Medicaid Population (In Thousands) 500 JAN 2013 JAN 2015 JAN 2017 JAN 2019 Non Expansion Population 1,400 1,300 1,200 1,100 1, JUL 2009 JUL 2011 JUL 2013 JUL 2015 JUL 2017 JUN Expansion Population JAN 2014 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 Data Source: February 2017 Caseload Forecast. Actuals through January Washington State Caseload Forecast Council 25

26 Preliminary Medicaid Expansion Costs in Washington State Federal Fiscal Year 2014 (Jan. Sept. 2014): $1.4 Billion Averages out to about $150,000 per month for the first 9 months 100% Federal Funds Federal Fiscal Year 2015 (Oct Sept. 2015): $3 Billion Averages out to about $247,000 per month 100% Federal Funds Unofficial Estimates of State Cost based on an estimated per capita of $5,557: Federal Fiscal Year Oct 1 Sep 30 Expansion Caseload* Estimated Total Cost Estimated WA State Share ,060 $1.4 Billion $ ,800 $3.0 Billion $ ,267 $3.3 Billion $ ,868 $3.4 Billion $128 Million (95/5) ,183 $3.4 Billion $171 Million (95/5) ,362 $3.5 Billion $173 Million (95/5) ,362 $3.5 Billion $346 Million (90/10) Uses FFY15 preliminary costs from the 2015 CMS 64 Report and Washington State CFC data to estimate the expansion caseload by federal fiscal year. Using this methodology, estimated per capita for the newly eligible group is around $5,557. CFC Caseloads for years 2014, 2015, and 2016 are an Actual taken from September of each year. All other years are the average for the forecasted months of October September. Cost Data Source: New Adult Group Expenditure Reports. CMS 64 Reports. Population Data Source: February 2017 Caseload Forecast. Washington State Caseload Forecast Council 26

27 Section 3: Zeroing In On Health Care Reform Government Actions to Address the Growing Deficit & the Focus on Health Care Reform. 27

28 Why Focus on Health Care? Unlike Social Security where benefits are paid to individuals, Medicare and Medicaid make payments to the providers of services. Federal Health Care Expenditures Continue to Grow. According to the CBO this is due to: Rising Enrollment of the Adult Population Expansion of Programs Number of enrollees in Medicaid expansion are more than twice of what was expected Subsidies for health insurance totaled $51 Billion Rising Health Care Costs per Enrollee Medicare 20.2% of the nations total health expenditures Projected 10-year cost increase: $771 Billion. Cost per beneficiary averaged 1.4% between 2010 and 2015, down from 7.4% between 2000 and This is projected to rise to 4.3% annually from Medicaid 17% of the nations total health expenditures Projected 10-year cost increase: $73 Billion. Costs per beneficiary increased by 1.3% in This is Projected to rise annually to 4.4% from National Private Health Insurance cost per beneficiary was 3.0% between 2010 and I is expected to be 4.8% between Drug costs are the biggest contributing factor to cost per beneficiary increases. 28

29 Health Care is a Key Driver in the Federal Deficit Expenditures of $3.8 Trillion in 2016 Grow to $6.5 Trillion by 2027 Revenue of $3.3 Trillion in 2016 Grow to $5.1 Trillion by 2027 Total Increase in Outlays $2.7 Trillion Health Programs are 31% of the costs* Social Security: Old Age & Survivors= 29% Disability = 3% Expenditures Interest, 20% Medicaid, 10% Medicare, 21% Social Security, 31% All Other, 17% Total Increase in Revenue $1.8 Trillion Revenue Payroll taxes, 28% Individ ual income taxes, 62% Other, 2% Corporate taxes, 7% Expenditure Chart includes cost offsets such as premiums paid for Part B and D. Chart Data Source: Supplemental Data to, CBO s The Budget and Economic Outlook: 2017 to January

30 To Date - The Key Area of Cost Containment for Federal Government has Been Health Care My NOTES: Major Health Care is adjusted upward in the out years for excessive health costs. Social Security cost adjustments have been flat. See Appendix A. Growth in health care projections does not include the cost offsets for things like premiums paid for Medicare Part B & D. 30

31 Government Actions to Address the Growing Annual Deficit (Approaching $3.8 Trillion) A. $900 Million 17 over 3 years Recovered in Medicare/Medicaid Audits. ($3 Billion in reduced cost over 10 years).* B. HHS projected that Medicare Spent about $ Billion less between By 2027, this could reduce outlays by $933 Million). C. Medicare/Medicaid Initiatives Currently Cost $1.6 Billion Per Year. 19 This annual expenditure is likely to grow since the program is authorized to distribute $10 Billion in Grants and so far have only distributed about $4.2 Billion. Long term savings is the ultimate goal. D. Cap Growth A. Waste Fraud Abuse Do Not Pass Go Do Not Collect $200 B. Reform D. Social security benefits remain flat despite rising out-of-pocket medical expenses for beneficiaries. (See Appendix A) C. Initiatives *Audit collections are already included in the budget projections as offsetting receipts. This would only help reduce the deficit over the next 10 years extend collections exceed current levels. 31

32 There are Many Good Reasons to Reform Health Care But it will Not Bring Our Nation to Financial Security A. Audit Collections* Possible +/- Budget Change by 2027 B. Health Care Reforms C. Health Care Initiatives D. Caps on Cost Growth Approximate Amount - $3 Billion - $946 Billion + $16 Billion $0 - $933 Billion The Budget Shortfall in 2016 was $600 Billion The Current Debt Held By the Public is about $13 Trillion (less financial assets). Under Current Law, this is projected to become $22 Trillion by The CBO projects an annual policy change of $380 Billion is needed beginning in 2018 to maintain the current level of debt level which is about $13.8 Trillion. The CBO projects an annual policy change of $620 Billion is needed beginning in 2018 to reduce the current level of debt to the 40 year average by *Audit collections are already included in the budget projections as offsetting receipts. This would only help reduce the deficit over the next 10 years extend collections exceed current levels. 32

33 Percent Change in Population We Have a GROWING problem In Millions % 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% U.S.A. Growth in Total Population The Number of Workers to Beneficiaries is Falling Every day between now and 2030, 10,000 baby boomers are turning age 65. Leaving the Workforce (payroll & income taxes decline) Joining Medicare Social Security Beneficiary Ratio of workers to beneficiaries: = 4.6 to = 3.1 to = 2.4 to 1 Ages 20 to 64 Age 65 or Older Data Source: Congressional Budget Office. Supplement information to the March 2017 report, The 2017 Long-Term Budget Outlook 33

34 Population in Millions Population in Millions Washington State s Aging Populations WA State Total Population In 2001, there was a ratio of 2.9 working age adults for every 1 person age 65 or older. Today = 2.1 to Population Forecast by Age Cohort In 2040 = 1.4 to 1 65 & Older Data Source: November 2016 Forecast of the State Population by Age & Sex. Washington State Office of Financial Management, Forecasting Division. 34

35 A Growing Demand for LTC in Washington State CHANGE IN WA AGE COHORTS Year Total 65 & Older or Older Million 42% 36% 23% Million 27% 36% 37% 800,000 WA State Population Changes Within the Age 65 & Older Cohort 700, , , , , , , & Older Data Source: November 2016 Forecast of the State Population by Age & Sex. Washington State Office of Financial Management, Forecasting Division. 35

36 Big Change is inevitable. It s Time For Courage 36

37 This is EVERYBODY S Problem There will be no riding off into the sunset. Potential revenue changes If Federal income taxes are raised it impacts you and many individuals you know. If Payroll Taxes are raised, it impacts you and your employees. If Corporate Taxes are raised, it impacts your community and unfortunately (but likely) the prices you pay for goods or services. Potential spending changes to the Domestic Trio (currently 52% of federal outlays) Reductions to Social Security benefits: Providers have fewer dollars to pay for room and board Seniors and Disabled have less to pay for food, housing, and out-of-pocket medical. Medicaid caseloads and the need for low income housing likely increase. Without Medicare, most Seniors cannot afford health care. Many would become Medicaid beneficiaries. Drastic changes to federal Medicaid matching funds will put pressure on state budgets, impacting WA state s economy 37

38 A Few Options Under Discussion Projected Savings (Dollars in Billions) Impose Caps on Federal Spending for Medicaid $370 - $680 Limit State's Taxes on Health Care Providers $16 to $14 Repeal all Insurance Coverage Provisions of the Affordable Care Act $1,236 Repeal the individual Health Insurance Mandate $416 Change the Cost-sharing for Medicare $18 to $66 Increase Premiums for Medicare Parts B & D $22 to $331 Raise the Eligibility of Medicare to 67 $18 Require Manufacturers to Pay a Minimum Rebate on Drugs Covered under Part D $145 Reduce Tax Preferences for Employment-Based Health Insurance $174-$429 Repeal the Low-Income Housing Tax Credit $34 Increase the Max Earnings for Social Security Payroll Taxes $633 to $1,008 Increase Payroll Tax Rate for Medicare Part A by 1% $823 Increase Taxes that Fund Unemployment Insurance $13 to $15 Increase Corporate Income taxes by 1% $100 Change the Tax rates on Social Security Benefits $423 Increase Individual Income Tax rates $93 to $734 Raise Capital Gains Tax by 2% $57 Curtail the Deduction for Charitable Giving $229 Limit the Deduction for State and Local Sales Taxes $955 Limit the Value of Itemized Tax Deductions $119 to $2,232 Reduce the Number of Housing Choice Vouchers or Eliminate the Program $16 to $111 Reduce Social Security Benefits for New Beneficiaries $105 to $190 Raise the Full Retirement Age for Social Security $8 Use an Alternate Measure of Inflation to Adjust Social Security and Other programs $182 Eliminate Eligibility for Starting Social Security Disability Benefits at Age 62 or Later $17 To Learn More: 38

39 Conclusions Don t Forget About the Big Picture This is not just about health care reform or improving client services. Know Your Local Environment & Talk About What s Coming Data is essential. How much does your local economy rely on the Domestic Trio? What is the upcoming demand for services? (Local demographics & impacts can be forecasted). Where are the current service gaps in your community & where they will be in the future? Organization Readiness Traditional will have a difficult time. Be Nimble: Build an organizational climate that can change when needed. It starts with a conversation: Arm your Board, your staff, and your stakeholders with the data & information they need to help you create organizational readiness. 39

40 What Does the Domestic Trio Mean to Your Local Economy? (Excludes Medicaid) County Population of 65 and Older Annual Dollars In Millions Medicare Social Security Combined 65 & Older Annual 65 & Older Annually On 65 & Older ADAMS 2,044 $11 $9 $35 $28 $47 $37 ASOTIN 4,879 $37 $31 $94 $71 $130 $102 BENTON 24,797 $227 $193 $536 $418 $763 $611 CHELAN 12,803 $71 $60 $249 $202 $319 $262 CLALLAM 18,600 $164 $140 $378 $310 $542 $450 CLARK 60,822 $256 $217 $1,275 $1,002 $1,531 $1,220 COLUMBIA 1,095 $9 $8 $18 $15 $28 $23 COWLITZ 18,591 $93 $79 $412 $309 $506 $388 DOUGLAS 6,519 $70 $60 $115 $94 $185 $154 FERRY 1,746 $12 $10 $31 $23 $44 $34 FRANKLIN 7,077 $62 $53 $142 $107 $204 $160 GARFIELD 533 $7 $6 $10 $8 $16 $13 GRANT 12,406 $94 $80 $222 $173 $316 $253 GRAYS HARBOR 13,680 $131 $111 $287 $212 $417 $323 ISLAND 16,951 $98 $83 $337 $283 $434 $366 JEFFERSON 9,428 $71 $60 $179 $153 $250 $213 KING 252,100 $1,448 $1,231 $4,735 $3,949 $6,183 $5,180 KITSAP 42,450 $274 $233 $726 $574 $1,000 $807 KITTITAS 6,034 $49 $42 $126 $102 $175 $143 KLICKITAT 4,584 $38 $33 $87 $68 $126 $101 Continued Next Slide 40

41 What Does the Domestic Trio Mean to Your Local Economy? (Excludes Medicaid) County Population of 65 and Older Annual Dollars in Millions Medicare Social Security Combined 65 & Older Annual 65 & Older Annually On 65 & Older LEWIS 14,558 $103 $87 $307 $232 $409 $319 LINCOLN 2,495 $27 $23 $44 $36 $71 $59 MASON 13,013 $89 $76 $253 $196 $342 $271 OKANOGAN 8,761 $65 $55 $148 $115 $212 $170 PACIFIC 5,826 $57 $49 $115 $91 $173 $139 PEND OREILLE 3,169 $23 $20 $57 $43 $80 $63 PIERCE 103,731 $714 $607 $2,208 $1,670 $2,922 $2,277 SAN JUAN 4,693 $26 $22 $81 $72 $107 $94 SKAGIT 22,548 $154 $131 $447 $364 $602 $495 SKAMANIA 1,990 $11 $9 $36 $28 $47 $37 SNOHOMISH 90,203 $418 $355 $1,856 $1,464 $2,274 $1,819 SPOKANE 71,611 $499 $424 $1,452 $1,111 $1,951 $1,535 STEVENS 9,388 $62 $53 $174 $131 $236 $184 THURSTON 39,940 $224 $191 $867 $675 $1,091 $865 WAHKIAKUM 1,302 $7 $6 $22 $18 $29 $24 WALLA WALLA 9,485 $78 $67 $183 $149 $261 $215 WHATCOM 32,426 $187 $159 $633 $512 $820 $671 WHITMAN 4,691 $49 $42 $88 $72 $137 $113 YAKIMA 32,155 $248 $211 $600 $461 $848 $672 LEWIS 14,558 $103 $87 $307 $232 $409 $319 41

42 Questions? Web: 42

43 Notes 1 Data Source: U.S. Social Security Administration Office of Retirement and Disability Policy Office of Research, Evaluation, and Statistics Annual Statistical Supplement, Fast Facts & Figures About Social Security, SSA Publication No , p 6. 3 CMS Fast Fact March Data Sources: CMS/Office of Enterprise Data & Analytics/Office of the Actuary 4 Income and Assets of Medicare Beneficiaries Kaiser Family Foundation. April Table 26 Medicare Per-enrollee Spending by Gender and Age Group. Source: Centers for Medicare and Medicaid Services, Office of the Actuary, & National Health Statistics Group. Data from Table 25 Medicaid Per-enrollee Spending by Gender and Age Group. Source: Centers for Medicare and Medicaid Services, Office of the Actuary, & National Health Statistics Group. Data from A SUMMARY OF THE 2016 ANNUAL REPORTS. Social Security and Medicare Boards of Trustees 2016 Annual Social Security & Medicare Trust Fund Report 8 The 2016 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds. June 22, The2017 Long Term Budget Outlook. March Congressional Budget Office. 10 OASDI Beneficiaries by State and County, U.S. Social Security Administration, Office of Research, Evaluation, and Statistics Center for Medicare and Medicaid. Public Use Files. Reports/Medicare-Geographic-Variation/GV_PUF.html 12 FFY 2016 Data Federal and State Share of Medicaid Spending The Henry J. Kaiser Family Foundation Urban Institute estimates based on data from CMS (Form 64), as of January Excludes administrative costs 13 Data Source for Washington State Medicaid: Operating Budget Legislative reports. Legislative Evaluation and Accountability Program (LEAP). 14 Healthcare spending and the Medicare program. June 2016 Data Book. MedPac Actuarial Report on the Financial Outlook for Medicaid. Center for Medicare and Medicaid Services. 16 Facts On Medicare Spending And Financing. July 20, Juliette Cubanski & Tricia Neuman. The Henry J. Kaiser Family Foundation FFS Medicare RAC Report to Congress. Center for Medicare and Medicaid Services. 18 Issue Brief - Healthcare Spending Growth and Federal Policy. March 22, Assistant Secretary of Planning and Evaluation, Health & Human Services. 19 Health and Human Services FY2017 Budget Brief - CMS Center for Innovations Programs Obligations and Outlays. 43

44 Appendix A Cap Growth on SSA Cost of Living Increases for Social Security Recipients Year COLA Year COLA Year COLA a