Recently there seems to be some confusion about the meaning of the word entitlements as used regarding certain government programs and anger about politicians and pundits who use the word to refer to Medicare and Social Security in particular.
I first noticed this a couple of weeks ago in a comment by a poster who was angry that the President used the word and who seemed to believe that the use of the word indicated that the President was not going to protect these programs. Since then I have seen a number of comments along that line. Then yesterday there was a diarist who was very angry that Donna Brazile had used the word entitlement.
While in everyday language, the word entitlement is often used to convey its opposite, as in a sense of entitlement, it is important that we do not fall into the trap that an entitlement is actually something you are not entitled to.
So, what are entitlements, what does it mean for a program to be an entitlement, and why should we be glad they are entitlements?
An entitlement is a benefit provided to a person or entity that is guaranteed by legislation.
From the Free Dictionary's Legal Dictionary: "An individual's right to receive a value or benefit provided by law."
From the Merriam Webster online Dictionary: " a right to benefits specified especially by law or contract" and " a government program providing benefits to members of a specified group; also : funds supporting or distributed by such a program"
From wikipedia: "An entitlement is a guarantee of access to benefits based on established rights or by legislation."
The Medicare statute itself uses the term "persons entitled to benefits" or similar phrases over 100 times and beneficiaries are specifically granted access to federal courts to seek protection of their entitlement to benefits. One becomes entitled to Part A benefits by reaching the age of 65 and having paid FICA Medicare taxes for at least 40 quarters. For Part B benefits, the recipient must also pay premiums or qualify as a dual Medicare-Medicaid beneficiary.
The Social Security Act of 1935 says
"SEC. 202. (a) Every qualified individual (as defined in section 210) shall be entitled to receive, with respect to the period beginning on the date he attains the age of sixty-five, or on January 1, 1942, whichever is the later, and ending on the date of his death, an old-age benefit (payable as nearly as practicable in equal monthly installments) as follows:...
The language is important because it is that language which gives individuals the legal right to receive such payments.
To see why this is important, one needs only to look at Medicaid. While Medicaid is generally thought of as an entitlement, there is no language of entitlement or enforcement in the bill and therefore Medicaid is a much weaker entitlement. Dr. Timothy Jost's article in Health Affairs points out the tenuous nature of the Medicaid entitlement. Due to Medicaid being a program which is jointly funded by the federal and state governments and administered by the states, the states have leeway in deciding who is entitled to benefits and can change the parameters of the categories of people. In fact, the states can opt out of Medicaid and the penalty is only that their federal funding for the program will be cut off. Of course, all states do participate in Medicaid, but they do not have to.
To show how easy it is for a state to change eligibility for Medicaid, one can look at my state of Tennessee. Our Medicaid program is called TennCare and for a number of years, people who were uninsurable due to pre-exising conditions qualified regardless of income. These people paid premiums for their insurance unless they also qualified due to low income. I was one of those people. But around 2005, the governor cut me and over a quarter of a million people from the TennCare rolls. I believe he had to get permission from the legislature, but that was an easy thing to do. Of course, he still had to follow federal guidelines for low income people and keep them on TennCare in order not to lose federal funds, but these guidelines do not cover all poor people.
From the Centers for Medicare and Medicaid Services website
Medicaid does not provide medical assistance for all poor persons. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services, even for very poor persons, unless they are in one of the designated eligibility groups. Low income is only one test for Medicaid eligibility; assets and resources are also tested against established thresholds.
It has been suggested that instead of the word entitlement, we should use social safety net. I suggest this would be wrong for several reasons. First, it is not true. While Medicare and SS do provide a safety net for many people and while Medicare, in particular, has been instrumental in keeping many beneficiaries from poverty, eligibility is not based on needing a safety net. Warren Buffet needs no safety net, yet he is eligible to receive both Medicare and SS. Secondly, social safety net programs are means tested and generally are non-contributory programs. SS and Medicare are contributory programs and are not means tested. And thirdly, this framing of Medicare and SS as social safety net programs would indicate that they are welfare programs, which has an even worse connotation than entitlements. (I am not trying to say that welfare programs are not deserved or necessary, just that exchanging one word that right wingers have given a wrong connotation to to another one which has no better connotation is not good framing.)
So, in conclusion, yes, Medicare and SS are entitlements, as is Medicaid in a weaker sense, and it is a good thing they are. That is what gives beneficiaries the legal right to these benefits. Do not let Limbaugh and Hannity and their ilk define your reality. If your neighbor sneers when he says "entitlements" to you, don't deny it. Say "hell, yes, they are entitlements and here is why. I paid into the system and lived long enough, therefore, yes I am legally and morally entitled to those benefits." (Or my grandma did.)
There are many fronts on which to battle those who would take away or diminish these programs but the technical word entitlements is not one of them except in the area of reclaiming what the word means and the implications thereof.