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Monday, January 31, 2011

Disability Benefits Available Under the Social Security Disability Insurance (SSDI) and Veterans Disability Compensation (VDC) Programs

Umar Moulta-Ali
Analyst in Disability Policy

Social Security Disability Insurance (SSDI) and Veterans Disability Compensation (VDC)— administered by the Social Security Administration (SSA) and the Department of Veterans Affairs (VA) respectively—are two of the largest federal disability programs, but strongly differ along several dimensions, including the populations served, how each program defines a “disability,” as well as varying eligibility requirements.

First, SSDI is an insurance program that replaces a portion of earnings for an eligible worker whose illness or injury—while not necessarily caused by a work-related incident—results in an inability to work. SSDI is one of several federal programs funded through the Federal Insurance Contributions Act (FICA) payroll tax and the Self-Employment Contributions Act (SECA) tax to which all workers and employers in covered occupations (including military personnel) and selfemployed individuals make contributions. On the other hand, VDC is not insurance, but is a compensation program in that payments are made to veterans who develop medical conditions that are related to their service in the military. VDC is non-contributory and neither veterans nor active military personnel pay into the program, which is funded through a mandatory appropriation as part of the VA annual budget.

Second, while the purpose of both SSDI and VDC is to provide income security, SSDI provides a financial “safety-net” to eligible civilian and military workers due to their inability to work as a result of long-term or terminal injury or illness. Conversely, VDC provides veterans with tax-free, cash benefits specifically for service-connected illnesses or injuries. The ability to work is not factored into VDC disability determinations, although additional compensation is available for veterans who are unemployable as the result of a service-connected condition(s).

Third, SSDI only compensates workers that are fully disabled, whereas VDC compensates veterans for both partial and fully disabling injuries and illnesses. The VA is further guided by a principle that views disability compensation as an obligation, owed to veterans, for injuries impacting employment that were incurred or aggravated by their service to the country. SSDI benefits are granted solely on medical and economic grounds and other noneconomic factors are not considered. Eligibility requirements generally tend to be more stringent for SSDI than VDC, and most veterans will not likely meet the criteria for both programs.

Both SSA and the VA have faced challenges in the administration of benefits and have been criticized for a lack of interagency coordination, processes that are “out-of-sync” with modern conceptions of disability, and extensive processing delays for claims and appeals. These are a few issues which led, in part, to a Government Accountability Office (GAO) investigation and determination of federal disability programs as “high risk.” Both agencies have made efforts to address issues surrounding pending claims and appeals, but differ in their responses to other recommendations.

This report provides a description and comparative analysis of the SSDI and VDC programs. These issues will be of particular interest to Congress because of the expected increase in the numbers of SSDI and VDC claims. The recent economic decline and aging baby-boomers have continued to place a strain on SSA’s resources. The aging of the veteran population and expansion of presumptive conditions policies have contributed to the increase in VDC claims.



Date of Report: January 11, 2011
Number of Pages: 23
Order Number: R41289
Price: $29.95

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Health Insurance Agents and Brokers in the Reformed Health Insurance Market


Mark Newsom
Specialist in Health Care Financing

Health insurance agents and brokers, collectively called “producers” by insurance companies, assist consumers and small employers in choosing and enrolling in health insurance products. Producers are licensed and regulated by the states. Traditionally, the federal government has had no role in regulating producer activities outside of federal programs such as Medicare Advantage. The Patient Protection and Affordable Care Act (P.L. 111-148, PPACA), as amended, creates a limited federal role in developing standards for the use of producers in the health insurance exchanges, which are competitive regulated markets effective January 1, 2014. The additional regulation of producers and alternative health insurance information (e.g., the online insurance portal) and assistance services available to consumers may limit the traditional demand for producers’ services. PPACA also has a minimum medical loss ratio provision requiring plans to pay rebates to their members if a certain percentage of their premiums are not spent on medical costs. This provision may provide an incentive for health insurance companies to reduce their compensation to and/or utilization of producers as they seek to reduce their administrative costs in relation to their medical costs.


Date of Report: January 5, 2011
Number of Pages: 9
Order Number: R41439
Price: $29.95

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Neglected Tropical Diseases: Background, Responses, and Issues for Congress


Tiaji Salaam-Blyther
Specialist in Global Health

Over the past decade, global health has become a priority in U.S. foreign policy, and U.S. funding for related efforts has more than tripled. Neglected tropical diseases (NTDs), an important focus of U.S. global health assistance, may come under scrutiny as the 112th Congress debates spending levels for ongoing global health programs. NTDs are a group of 17 diseases that are found primarily among the poorest people in 149 countries and territories. Estimates indicate that some 2 billion people are at risk of contracting an NTD, of whom more than 1 billion people are afflicted with one or more. Roughly 534,000 people are believed to be killed by an NTD annually.

Although these diseases are concentrated among the world’s poor, population shifts and climate change increase the vulnerability of the United States to some of these diseases, particularly Chagas disease and dengue. While blood centers test for Chagas, some health experts believe that several cases remain undiagnosed in the United States and that Chagas stands as an undetected cause of heart disease and stroke. Some observers are concerned about scientists’ expectations that mosquitoes capable of spreading dengue fever are gradually spreading across the United States, particularly because no vaccine or treatment exists for this disease. In addition, travelers from industrialized countries are increasingly contracting NTDs such as schistosomiasis while engaged in tourism. These cases are usually identified once tourists develop severe, acute infection or other unusual problems.

Proponents support funding research on and treatment for NTDs because it is a cost-effective way of making a significant health impact. Roughly 90% of all NTDs are easy to treat with drugs that cost less than $2 per dose and need to be taken only once or twice annually. This means that all people at risk of contracting an NTD worldwide can be treated for less than $2 billion over the next five years. With consistent treatment and control, several NTDs are being eliminated in various parts of the world, especially in Latin America, and guinea worm disease is on the cusp of eradication, meaning there is no risk of contracting the disease.

Some groups argue that the United States should increase funding for NTD programs to improve global health and advance domestic capacity to detect NTD cases that may arise, particularly for diseases like dengue and Chagas. Other groups maintain that countries like Brazil, China, and India that have received support for eliminating NTDs should play a greater role in addressing the health challenge, particularly as their own economies exhibit strong growth. The 112
th Congress may debate funding much of the President’s FY2011 budget, which includes $155 million for the NTD Program, as well as upcoming FY2012 budget levels. The 112th Congress will likely weigh calls for greater spending on NTDs with other challenges, such as streamlining foreign and global health assistance to make them more effective and efficient, particularly in light of efforts to reduce federal spending.


Date of Report: January 21, 2011
Number of Pages: 59
Order Number: R41607
Price: $29.95

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Friday, January 28, 2011

The Americans with Disabilities Act (ADA) Coverage of Contagious Diseases

Nancy Lee Jones
Legislative Attorney

The Americans with Disabilities Act (ADA), 42 U.S.C. §§12101 et seq., provides broad nondiscrimination protection for individuals with disabilities in employment, public services, public accommodations and services operated by private entities, transportation, and telecommunications. As stated in the act, its purpose is “to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities.” Due to concern about the spread of highly contagious diseases such as pandemic influenza and extensively drug-resistant tuberculosis (XDR-TB), questions have been raised about the application of the ADA in such situations. Generally, individuals with serious contagious diseases would most likely be considered individuals with disabilities. However, this does not mean that an individual with a serious contagious disease would have to be hired or given access to a place of public accommodation if such an action would place other individuals at a significant risk. Such determinations are highly fact specific and the differences between the contagious diseases may give rise to differing conclusions since each contagious disease has specific patterns of transmission that affect the magnitude and duration of a potential threat to others.


Date of Report: January 10, 2011
Number of Pages: 9
Order Number: RS22219
Price: $29.95

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Health Insurance: State High Risk Pools

Bernadette Fernandez
Specialist in Health Care Financing

In an effort to expand the options for health coverage, 35 states have established high risk health insurance pools. These programs target individuals who cannot obtain or afford health insurance in the private market, primarily because of preexisting health conditions. Also, many states use their high risk pools to comply with the portability and guaranteed availability provisions of the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).

In general, state high risk pools tend to enroll a small percentage of the uninsured. In December 2008, a total of 200,358 individuals were enrolled in the 34 high risk pools in operation at that time. State-established nonprofit organizations typically run these pools, with private insurance companies handling day-to-day operations. Although benefit packages vary across states and plans, they generally reflect health benefits that are available in the private insurance market. The majority of high risk pools cap premiums between 150% to 200% of market rates, and pools are subsidized through insurer assessments and other funding mechanisms.

The Trade Act of 2002 (P.L. 107-210) appropriated a total of $100 million for FY2003-FY2004. With the expiration of authorizing legislation for federal funding of state pools, the 109
th Congress took up this issue. The House passed H.R. 4519, the State High Risk Pool Funding Extension Act of 2006, which reauthorized federal grants to state high risk pools through FY2010, and changed the funding formula used for such grants. The Act authorized $15 million for seed grants and $75 million for operational and bonus grants for FY2006. The Senate passed H.R. 4519 without amendment, and it was signed into law (P.L. 109-172) on February 10, 2006.

As part of the budget reconciliation process, the Senate passed S. 1932, the Deficit Reduction Act of 2005 (DRA) conference agreement, which provided appropriations for the grants authorized under H.R. 4519. The measure also included conforming language on enactment of H.R. 4519. The House agreed to the Senate-amended DRA bill, and it was signed it into law (P.L. 109-171) on February 8, 2006. The Centers for Medicare and Medicaid Services (CMS) awarded grants to 31 states that experienced operational losses in 2005. Of those 31 states, 25 also received bonus grants. In 2006, CMS awarded seed grants to five states, and to another five states in 2007.

The 110
th Congress took up the issue of extending the federal grant program by making funding available pursuant to the Consolidated Appropriations Act of 2008 (P.L. 110-161). The grant funding totaled $49,127,000. In July 2008, CMS announced that 30 states received operational and bonus grants totaling $49,126,500.

The 111
th Congress provided $75,000,000 in appropriations for grants to state high risk pools under the Omnibus Appropriations Act of 2009 (P.L. 111-8). On September 30, 2009, CMS awarded operational grants to 31 states and bonus grants to 28 states. Furthermore, the Consolidated Appropriations Act of 2010 (P.L. 111-117) provided $55,000,000 in additional appropriations for high risk pools.

In addition to state-established high risk pools, the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148), as amended, requires the Secretary of Health and Human Services to establish a temporary high risk pool program to provide health insurance coverage for certain uninsured individuals with preexisting health conditions.



Date of Report: January 10, 2011
Number of Pages: 16
Order Number: RL31745
Price: $29.95

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