The National Academy of Social Insurance is a Washington-based nonprofit, nonpartisan organization whose membership comprises the nation’s leading experts on social insurance. The Academy’s mission is to advance solutions to national social and economic challenges and to increase public understanding of how social insurance programs contribute to economic security. Social insurance encompasses broad-based systems that pool risks to help workers and their families avoid loss of income due to retirement, death, disability, or unemployment, and to provide access to healthcare. The Academy regularly convenes study panels and steering committees that are charged with conducting research, issuing findings, making recommendations, and identifying a range of alternative policy options. Members of these groups are selected for their recognized expertise and with due consideration for the balance of disciplines and perspectives appropriate to each project. The Academy has recently initiated two study panels that are expected to provide significant guidance for social insurance policy initiatives in 2020 relating to Medicare Eligibility and Economic Security.
The Medicare Eligibility Study Panel will be releasing a comprehensive report in March that will focus on three principal alternative pathways to reform, namely, reducing the eligibility age, allowing buy-in to Medicare, and creating a national healthcare system as “Medicare for All”. The Academy’s 32nd Annual Policy Conference, scheduled for March 4-5, 2020 in Washington DC, will focus primarily on the Study Panel’s work and cover other related issues. Details of the conference, Healthcare Coverage and Costs: Assessing Medicare-based Approaches are available at https://secure.nasi.org/upcoming-conferences-events/ including the agenda and registration information.
With respect to healthcare, the United States is widely considered as an outlier compared to other advanced countries, spending more on healthcare while lagging in terms of the extent of providing coverage among its population, and generating less favorable measures of health outcomes such as life expectancy. The 2010 Affordable Care Act provided the means to protect consumers and improve the quality and extent of healthcare coverage for around 20 million Americans. The Academy issued a report in 2017 on social insurance and inequality that included a set of options that can guide policymakers to improve coverage and lower the cost of health insurance. While healthcare is important in managing the health of the nation, there are also social, economic, and environmental factors that influence health and wellbeing. Medicaid is the nation’s largest public insurer of low-income and medically vulnerable individuals and families. The Medicaid program, working in combination with other programs that address determinants of health, could play a major role in future efforts to improve overall population health. It insures a greater and more sustained range of clinical services that promote health whenever the need for healthcare arises. Strengthening Medicaid and the efficiency with which it operates will serve to improve health conditions, lower healthcare costs and reduce the impact of inequality in society. In addition to Medicaid, Medicare provides critical protection to millions of older people who might otherwise be uninsured and unable to afford the costs of even the basics of healthcare. Medicare faces long-term financing problems arising from the aging of the population and continued growth in costs throughout the healthcare system; nevertheless many creative policy options are available for strengthening its finances.
The Economic Security Study Panel will identify options for how current social insurance and social assistance programs might be modified to adapt to current economic challenges, including a range of potential funding sources needed to fill coverage gaps and financial shortfalls. The Study panel expects to issue a final report by the end of 2020.
One of the policy challenges facing the Social Security system is that of enhancing its sustainability by increasing its projected level of solvency extending beyond the next twenty years. Many experts advocate an expanding role for Social Security. Economic inequality and disparities in income and opportunity have produced significant gaps in the availability of adequate resources in retirement for many Americans. In particular, women still experience challenges in achieving sustainable retirement security, despite decades of gradual economic progress. Another area for potential improvement is that of providing essential protections against disability, including addressing specific issues regarding the finances of the Social Security Disability Insurance program.
Unemployment Insurance is intended to be an automatic stabilizer during periods of recession. In order to operate effectively, stronger advance funding is necessary by collecting taxes during good times so as to build reserves to pay benefits during recessions. Another area of concern that merits attention from policymakers is that workers’ traditional relationships with their employers have been changing over recent decades. With traditional long-term employment conditions being replaced by part-time, temporary, and contract arrangements, workers are left without adequate protection against economic and other risks that would be provided by the stability, efficiency and adequacy available with pooled-risk social insurance systems.