History of SSA During the Johnson Administration 1963-1968



During the fiscal year 1966, the Social Security Administration faced the major task of processing increased workloads growing out of the changes the 1965 amendments made in the retirement, survivors, and disability insurance programs; and planning and organizing for implementation of the health insurance provisions of the Social Security Act. To help implement the amendments, the Social Security Administration was reorganized (previously discussed in this history) on July 26, 1965, to accommodate the administration of the new health insurance program and at the same tine continue its standards of service to the public.

Planning--Administrative Strategy Committee

Many of the provisions of the new social security laws were written very broadly, and needed clarification before they could be put into efficient operation. Policies had to be determined, procedures had to be detailed, and criteria established. To begin with a special committee designated as the Administrative Strategy Committee was formed at the request of the Commissioner's office to coordinate pre-amendment planning. It was composed of members of the operating bureaus and the Division of Management. The basic responsibility of the Committee was to consider and report on alternative plans on how, as well as when, to process workloads expected to be generated by the 1965 amendments; to consider the total impact of the amendment workloads; and to recommend courses which the Administration should consider in order to achieve a better workload balance. These responsibilities involved the full range of overall planning, considering the present program and requirements for today and the future, the scheduling of workloads where possible, procedural shortcuts and modified policies with respect to processing present and amendment workloads, and included planning for training of existing staff and new recruits. Work groups and subcommittees were appointed by the strategy committee to give an in-depth consideration to major areas of concern. The work groups were asked to describe how the present programs would be affected by the proposed amendment provisions, the manpower required to process the new workloads, pros and cons of adopting changed procedures from an administrative and program viewpoint. The workgroups were also expected to consider alternatives in the nature of expedients, short cuts, etc., as may occur to them during their consideration of the assigned projects.

The Committee prepared and submitted reports regularly to the Commissioner's office. The Committee, in its reports, attempted to describe the broad general outlines of a proposal pertaining to regular program activities, or to any activity that may grow out of the proposed amendments detailing only those aspects required for conceptual understanding. Reported items were sometimes submitted for information but more often for concurrence and/or decision by the Office of the Commissioner.

Administrative Planning Binder

In view of the magnitude of the administrative job of implementing the amendments, it was decided that a single standard binder containing plans for administering the 1965 amendments should be prepared. The Administrative Planning Binder, as it was titled, was designed primarily for use by the Commissioner and top staff as a ready reference to the Administration's plans for implementing the 1965 amendments. The source of the information in the binder was the reports submitted to the Commissioner by each component having "lead responsibility" for each individual provision. Lead responsibility involves:

1. Assessment of workloads and needs (number of claims, manpower and equipment, etc.).

2. Planning and taking steps necessary for implementation.

3. Identification of significant problems. Resolution of those within assigned area of responsibility; submittal of those requiring high level decisions or resolution.

4. Coordination of all related activities including establishing and directing inter-component work teams.

5. Preparation of periodic status reports.

The binder contained appropriate planning statements for each of the anticipated provisions as well as sections setting forth the overall administrative scheme for administering the amendments (strategy), staffing, and budget plans, training, information plans, deferred policy issues, administrative problems, etc. The binder was updated on a regular basis (approximately every other week) and served as a very useful instrument for informing key Administration officials of the Social Security Administration's current state of readiness for implementing the 1965 amendments.

Brief Summary on Implementing the 1965 Amendments

An extensive public information program way undertaken to inform the public in meaningful and understandable terms about the complex provisions of the new health insurance program. Pamphlets, notices, posters, instruction booklets, and explanations of the need for action by potential beneficiaries were prepared and printed. Over 120 million booklets about the new programs of health insurance for the aged were printed and distributed; when material on other parts of the law were added, the total for the year was 230 million printed informational items.

To insure that the 19 million potential beneficiaries of the Medicare program were informed of the voluntary part of the program, direct mailings were used where names and addresses of aged people could be secured. Practically all the media of mass communication were used. The mass efforts were supplemented by many other projects, including door-to-door visits in certain areas.

Arrangements were made with State health agencies to determine whether hospitals and home health agencies met the quality standards for participation in the Medicare program. In addition, the Public Health Service made contacts with these institutions to determine whether they were in compliance with Title VI of the Civil Rights Act. Contractual and administrative arrangements were made with the Blue Cross-Blue Shield plans and the private insurance companies chosen to serve as intermediaries (or carriers) in dealing with health institutions, physicians and beneficiaries. In addition, policies and procedures were developed for cost reimbursement, payment of physicians, safeguards against unnecessary or excessive use of services, and many other important aspects of the Medicare program.

Automatic data processing systems were designed and put into operation to process the enrollment of individuals for health insurance coverage; to handle the notices of hospital admissions; to process requests for
information on eligibility, bills, and payments; and to prepare premium notices and handle premium collections. To facilitate health insurance operations at the local level, each social security district office was provided with a microfilm locator record, which in a high proportion of cases enabled it to provide health insurance claim numbers and to verify entitlement to hospital insurance and enrollment for medical insurance when a beneficiary was unable to present his health insurance card to a provider of service.

In the retirement and survivors insurance area, extensive planning and preparation was made for the automatic recalculation of benefits of those persons whose total earnings record might support a benefit
increase on the basis of additional work. Programs were completed so that eligible individuals could be identified and their benefits automatically recalculated by computer.

In addition, service to the public was expanded through the opening of nine additional district offices, 74 branch offices, 12 resident stations, and 21 temporary service centers. At year end, there were 725 district offices, 82 branch offices, 37 resident stations, 16 service centers, and 3,361 contact stations to serve the public.