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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

Social Security Insurance Issues

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"The new chief of the Social Security Administration criticized the way her agency's disability benefits program works after hearing tearful horror stories Wednesday from sick Houston-area residents who battled the system. One woman told Commissioner Jo Anne Barnhart it took eight years and congressional intervention for her husband, a Vietnam War veteran with multiple sclerosis, to get approval for disability benefits. Another local woman, a former department store executive, said Social Security administrative law judges have denied her benefits request for the last three years despite medical evidence that a rare liver disease robs her of the energy to work. "It's heartless, heartless," Brent Bowers of Pipefitters Local Union 211 called out from the back of the crowded room as the witnesses told their tales. Several injured union members have sought the benefits.

Barnhart, who took over the federal agency in November with promises of reform, said the testimony showed she has several problems to tackle. "The kind of stories we heard today ... is not what was intended by Congress and certainly not what was intended by the vast majority of people in the Social Security Administration," Barnhart said. Barnhart, joined at a downtown Houston hearing by five area congressmen and other officials, said she will make sure the judges follow the law. "I intend to make sure that everybody throughout the agency is doing the job the way they are supposed to, in a manner we can all be proud of," she said.

About 6 million U.S. residents get disability benefits, averaging about $750 a month. The witnesses at the hearing sold some of the congressmen on the idea that Social Security judges don't apply the law evenly. "Too many of these cases are handled with no consistency," said U.S. Rep. John Culberson, R-Houston. Democratic U.S. Reps. Gene Green, Ken Bentsen and Sheila Jackson Lee also attended.

Gisela Montano of Houston testified that the judges originally rejected the disability claim from her husband, Michael, who is afflicted by MS. "The judge refused to look at all the facts," she said, explaining that a second judge reversed the rulings with the same evidence. Donna Brown, the former department store executive, tearfully told Barnhart that without disability benefits, she had to borrow money for her cancer surgery scheduled for Friday. "I don't know what you can do about a judge ignoring medical evidence, (but) that has to be a reform," she told Barnhart." SOCIAL SECURITY CHIEF AGREES SYSTEM HAS FLAWS

ADDITIONAL ARTICLES:

Document Name & Link to Document

Description

File Size /Type

2007-Coverage through the “Doughnut Hole” Unlike most forms of insurance, the Medicare Part D prescription drug program has a hole in its middle. This coverage gap, colloquially known as the “doughnut hole,” is perhaps the most bizarre and troublesome aspect of the Part D drug program. After beneficiaries reach their initial limit of total drug expenses ($2,250 in 2006), they have no prescription drug coverage until their total drug expenses reach a catastrophic threshold for the year ($5,100 in 2006). While beneficiaries are in the doughnut hole, they must continue to pay their monthly premiums, although they do not receive any drug benefits. Only after they have spent thousands of dollars of their own money to get out of the hole ($2,850 in 2006), in addition to their monthly premiums, does their coverage resume. Pdf 534 kb
A CONSUMER’S GUIDE TO HEALTH INSURANCE This booklet, developed by the Vermont Department of Banking, Insurance, Securities and Health Care Administration, helps you understand health insurance and how it works.  It explains the different types of insurance policies available to you and what to expect once you have health insurance.  With a little knowledge, you can choose the right kind of coverage for you and your family.   
A History of the Disability Listings In order to facilitate the process, the Social Security Administration created a list of diseases and conditions which were felt to be incompatible with substantial gainful activity (gainful employment). Persons who were not engaged in substantial gainful activity, and whose conditions met the requirements of one or more of the listed conditions, were considered disabled. Called the listings, the criteria proved so useful that they were retained and revised periodically, and have been kept in continuous use ever since. Pdf 248 kb

CHILDHOOD DISABILITY CLAIMS

To provide a policy interpretation that children who have a "marked" limitation in cognitive functioning and a "marked" limitation in speech have an impairment or combination of impairments that medically equals Listing 2.09. Also, to provide guidance for determining when a child has a "marked" or an "extreme" limitation in each of these areas.

 

Compassionate Allowances Under titles II and XVI of the Social Security Act (the Act), we pay benefits to individuals who meet our rules for entitlement and have medically determinable physical or mental impairments that are severe enough to meet the definition of disability in the Act. The rules for determining disability can be very complicated, but some individuals have such serious medical conditions that their conditions obviously meet our disability standards. Pdf 53 kb

Hepatitis C and Social Security Disability Benefits

Over 50% of the initial applications for disability benefits are denied, not because the disability definition is that difficult to meet, but primarily because the applicant didn’t understand the disability determination process and didn’t give Social Security the information they needed to award benefits

445 kb pdf

Guilty until proven innocent-Dealing with a flawed SSDI Application process The Social Security Disability Insurance system, which is supposed to protect workers from suddenly losing all sources of income with an unexpected disability, is seriously flawed and becoming more so. There's a widespread national myth that people are "faking it". I understand that Connecticut spent over a million dollars to unroot all those fakers in their system, and only found 6  

Obtaining Social Security Benefits for Patients with Liver Disease

Social Security disability benefits are often the ultimate safety net for persons suffering from medical impairments that make it impossible for them to work. For most people, however, struggling through the Social Security Administration's bureaucracy is frustrating, confusing and slow. For people suffering with Hepatitis C and liver disease, the requirements of the Act can appear overwhelming.

 

SOCIAL SECURITY CHIEF AGREES SYSTEM HAS FLAWS

The new chief of the Social Security Administration criticized the way her agency's disability benefits program works after hearing tearful horror stories Wednesday from sick Houston-area residents who battled the system.

 

Health Hippo: Evaluations of Social Security Disability #1

Health Hippo: Evaluations of Social Security Disability #2

Health Hippo: Evaluations of Social Security Disability #3

 

The Social Security Administration administers two programs that provide benefits based on disability: the Social Security disability program and the supplemental security income program Title II provides benefits to individuals who are insured under the Act by virtue of their contributions to the Social Security trust fund through tax on their earnings. Title XVI provides payments to individuals who are disabled and have limited income and resources.

 

How States Can Make More Patients Eligible for Part D’s Full Low Income Subsidy/Extra Help at Little or Even No State Cost

Medicare patients with incomes (using the SSI income counting rules and disregards)  under 135% of the Federal Poverty Level, or FPL ($1103 monthly for one) and with assets (other than a home of any value; any vehicles of any value; and a separate burial fund up to $1500 per person) under $6.000 ($9,000 per couple) qualify for full Low Income Subsidy (LIS) Extra Help Medicare Part D prescription coverage: No deductible or premium; no donut hole; co-pays of only $1/$2 per generic and $3/$5 per brand name drug. Co-pays and income and asset levels will rise with inflation yearly, as will the non-Extra Help Part D premiums, deductibles and donut hole and catastrophic thresholds.  

The Language Of Disability: Problems Of Politics And Practice

"Language. . .has as much to do with the philosophical and political conditioning of a society as geography or climate. . .people do not realise the extent to which their attitudes have been conditioned since early childhood by the power of words to ennoble or condemn, augment or detract, glorify or demean. Negative language inflicts the subconscious of most people from the time they first learn to speak. Prejudice is not merely imparted or superimposed. It is metabolised in the bloodstream of society.

 

Widening State Pharmacy Assistance Programs (SPAPs) for the Aged Only to Cover the Disabled Too While state Medicaid programs appear to be prohibited by the new law in most, if not all, cases from offering secondary, "wraparound" drug coverage to "dual eligibles" [those Medicare patients who are also poor enough to be on Medicaid too] this is not so for SPAPs. They're allowed to be secondary, "wraparound" payers if they choose to do so. Given state budget problems, some may propose terminating SPAP programs to save state funds, on the [disingenuous] grounds that the new Medicare drug benefit makes the state program unnecessary. But either way, enactment of the Medicare Part D  drug benefit means enormous savings to SPAPs---in addition to the savings states will get from Part D displacing some state Medicaid drug expenses.  For example, Pennsylvania was predicted to save $150 million just from the preliminary Medicare interim $600 drug discount card program; New Jersey’s savings were to be $90 million; Connecticut’s were to be $15 million; and all SPAPs will save proportionately at least as much when the full, permanent Part D program becomes primary payer in 2006.    

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