Restated
As of September 30, 2002
|
Accounts Receivable Principal |
Interest Receivable |
Accounts Receivable, Gross |
Allowance |
Net OPDIV Receivables Combined |
Intra-OPDIV Eliminations |
Net OPDIV Receivables Consolidated |
Inter-OPDIV Eliminations |
Net HHS Receivables Consol. |
Intragovernmental |
|
|
|
|
|
|
|
|
|
Entity |
$ 2,844 |
$ - |
$ 2,844 |
$ - |
$ 2,844 |
$ (1,876) |
$ 968 |
$ (125) |
$ 843 |
Non-Entity |
3 |
- |
3 |
- |
3 |
- |
3 |
- |
3 |
Total, Intragovernmental |
$ 2,847 |
$ - |
$ 2,847 |
$ - |
$ 2,847 |
$ (1,876) |
$ 971 |
$ (125) |
$ 846 |
With the Public |
|||||||||
Entity |
|
|
|
|
|
|
|
|
|
Medicare |
$ 6,335 |
$ - |
$ 6,335 |
$ (3,667) |
$ 2,668 |
$ - |
$ 2,668 |
$ - |
$ 2,668 |
Other |
1,642 |
- |
1,642 |
(592) |
1,050 |
- |
1,050 |
- |
1,050 |
Non-Entity |
388 |
630 |
1,018 |
(590) |
428 |
- |
428 |
- |
428 |
Total, |
$ 8,365 |
$ 630 |
$ 8,995 |
$ (4,849) |
$ 4,146 |
$ - |
$ 4,146 |
$ - |
$ 4,146 |
CMS's Medicare receivables are primarily due to overpayments to providers, beneficiaries, physicians and suppliers, and to claims where Medicare should be the secondary payer.
HHS's non-entity receivable balances represent amounts that cannot be used by HHS once collected. Such receipts are transferred to the General Fund of the Department of the Treasury.
HHS bases the allowance for loss on accounts receivable on analytical procedures on both individual and group bases. Individual analysis considers the debtor's ability and willingness.to pay, payment record, and probable recovery of amounts from secondary sources (i.e., liens, garnishments, etc). To estimate allowance for loss by groups, HHS stratifies receivables into groups exhibiting similar characteristics. Estimated losses are projected based upon statistical sampling or historical loss experience. The allowance is periodically reviewed and adjusted.
Note 7. Anticipated Congressional Appropriation
The CMS has recorded $11,830 million in anticipated Congressional appropriations ($10,399 in FY 2002) to cover liabilities incurred as of September 30 by the Medicaid program and the Payments to the Health Care Trust Funds appropriation, as discussed below:
Medicaid
Beginning in FY 1996, CMS has accrued an expense and liability for Medicaid claims incurred but not reported (IBNR) as of September 30. In FY 2003, the IBNR expense exceeded the available unexpended Medicaid appropriations in the amount of $8,449 million ($10,399 in FY 2002). A review of appropriation language by CMS's Office of General Counsel (OGC) has resulted in a determination that the Medicaid appropriation's indefinite authority provision allows for the entire IBNR amount to be reported as a funded liability.
Payments to the Health Care Trust Funds
The SMI program is financed primarily by the general fund appropriation, Payments to the Health Care Trust Funds, and by monthly premiums paid by beneficiaries. Section 1844 of the Social Security Act authorizes funds to be appropriated from the general fund to match premiums payable and deposited in the Trust Fund . . . Section 1844 also outlines the ratio for the match and the method to make the trust funds whole if insufficient funds are available in the appropriation to match all SMI premiums received in the fiscal year. The appropriated amount is an estimate calculated annually by CMS's Office of the Actuary (OACT) and can be insufficient in any particular fiscal year. In FY 2003, the estimate was insufficient and the matching ceased prior to the close of the fiscal year. Subsequently, OACT has valued the unmatched amount as $3,381 million (which includes $46.4 million in interest). When this occurs, Section 1844 allows for a reimbursement to be made to the SMI Trust Fund from the Payments to the Health Care Trust Funds appropriation enacted for the following year. Consequently, CMS has recorded a $3,381 million anticipated appropriation in FY 2003 for the amount of the unmatched SMI premiums. Although the actual transfer of funds will occur in FY 2004, CMS has reported the $3,381 million as revenues earned in FY 2003.
Note 8. Direct Loans and Loan Guarantee Programs
HRSA operates guaranteed loan programs for the Health Center and Health Education Assistance Loans (HEAL) programs. For HEAL, the administration guarantees payment of principal and interest made by private lenders to medical students (who are enrolled in various approved fields of practice) in the event of default, death or permanent disability. Health Center Program (Post-1991) guarantees the loans to HRSA grantees, made by non-federal lenders.
Total loans guaranteed under these programs, as of September 30, 2003 and 2002 are summarized as follows.
|
2003 |
Restated |
||
HEAL Loan Guarantees: |
No. of Loans |
Amount |
No. of Loans |
Amount |
Pre-1992 loans |
54,026 |
$ 436 |
63,403 |
$ 483 |
Post-1991 loans |
82,944 |
1,880 |
94,238 |
2,254 |
Health Centers Loan Guarantees |
7 |
14 |
6 |
10 |
Total |
136,977 |
$ 2,330 |
157,647 |
2,747 |
The receivable amount reported in the Balance Sheet represents defaulted loans, which have been paid to lenders under the guarantee. The lenders are required to perform certain procedures in an effort to collect amounts due prior to submitting the loan for payment under the guarantee. An allowance for loss has been established for estimated uncollectible amounts on the loans. The allowance is based on management's assessment of the future collectibility analysis of these aged loans based on the last date of collection.
HHS's loans receivable at September 30, 2003 and 2002 are summarized below.
September 30, 2003: Defaulted Guaranteed Loans: |
Loans, Receivable, Principal |
Interest Receivable |
Loans Receivable, Gross |
Allowance |
Loans, Receivable, Net |
HEAL Loans (HRSA) |
|
|
|
|
|
Pre-1992 Loans |
$ 490 |
$ 12 |
$ 502 |
$ (203) |
$ 299 |
Post-1991 Loans |
112 |
3 |
115 |
(27) |
88 |
Subtotal |
$ 602 |
$ 15 |
$ 617 |
$ (230) |
$ 387 |
Other |
|
|
|
|
|
Pre-1992 Loans |
- |
- |
- |
- |
- |
Post-1991 Loans |
4 |
- |
4 |
(4) |
- |
Total |
$ 606 |
$ 15 |
$ 621 |
$ (234) |
$ 387 |
September 30, 2002: Defaulted Guaranteed Loans: |
Loans, Receivable, Principal |
Interest Receivable |
Loans Receivable, Gross |
Allowance |
Loans, Receivable, Net |
HEAL Loans (HRSA) |
|
|
|
|
|
Pre-1992 Loans |
$ 492 |
$ 12 |
$ 504 |
$ (201) |
$ 303 |
Post-1991 Loans |
87 |
2 |
89 |
(22) |
67 |
Subtotal |
$ 579 |
$ 14 |
$ 593 |
$ (223) |
$ 370 |
Other |
|
|
|
|
|
Post-1991 Loans |
4 |
- |
4 |
(4) |
- |
Total |
$ 583 |
$ 14 |
$ 597 |
$ (227) |
$ 370 |
The liability amount reported in the Balance Sheet represents future estimated payouts on defaulted loans under the loan guarantee program. The post-1991 loan guarantee liability is established based on criteria set forth in accordance to the Credit Reform Act of 1990. This Act requires that the present value of cash outflows, associated with the estimated amount to be paid out under loan guarantees for each fiscal year, be calculated to determine the liability. The calculation is performed using a computer model established by OMB, utilizing assumptions made by the HEAL program based on historical data, such as default rates and interest rates. The liability is adjusted and accounted for independently each year based on loans issued annually under the guarantee. The pre-1992 loan guarantee liability for losses is established based upon an average default rate of approximately 3.76 percent in 2003 and 3.95 percent in 2002. The liability is adjusted each year for the change in default rates.
The loan guarantee liability is summarized as follows:
|
2003 |
2002 |
Loan Guarantee Liabilities: |
|
|
HEAL Loans (HRSA) |
|
|
Pre-1992 Loans |
$ 15 |
$ 17 |
Post-1991 Loans |
344 |
256 |
Subtotal |
$ 359 |
$ 273 |
Other |
|
|
Post-1991 Loans |
3 |
3 |
Total Loan Guarantee Liabilities |
$ 362 |
$ 276 |
Loan guarantee subsidy expense:
Loan guarantee subsidy expense is required for new loans or new loan guarantee obligations. The HEAL program's existing borrowers are allowed to refinance loans to achieve better terms of their existing loans. OMB ruled that although the HEAL program does not have authority to make loans to new borrowers, it is completely authorized (see Public Health Service Act, Section 701-709) to refinance existing loans to existing borrowers. This includes extending new loan terms to existing borrowers for up to 25 years.
Loan guarantee subsidy expense for the years ended September 2003 and 2002 is summarized as follows:
2003 |
Restated |
|
Loan Defaults (Net of Recoveries) |
$ (5) |
$ 9 |
Interest cohort |
(23) |
(24) |
Other write-offs |
(138) |
(20) |
Other |
62 |
(32) |
Total current year subsidy |
$ (104) |
$ (67) |
Re-estimates |
(68) |
- |
Total Loan Guarantee Subsidy Expense |
$ (172) |
$ (67) |
Note 9. Inventory and Related Property, Net
HHS's inventory and related property, net at September 30, 2003 and 2002 are summarized below.
|
2003 |
2002 |
Inventory Held for Sale: |
|
|
Inventory Held for Current Sale |
$ 33 |
$ 29 |
Total Inventory Held for Sale |
$ 33 |
$ 29 |
Operating Materials and Supplies: |
|
|
Operating Materials and Supplies Held for Use |
$ 7 |
$ 10 |
Operating Materials and Supplies Reserved for Future Use |
- |
- |
Total Operating Materials and Supplies |
$ 7 |
$ 10 |
Stockpile Materials: |
|
|
Stockpile Materials Held for Emergency or Contingency |
$ 53 |
$ 126 |
Total Stockpile Materials |
$ 53 |
$ 126 |
Inventory and Related Property, Gross |
$ 93 |
$ 165 |
Less: Allowance for Loss/Obsolescence/Spoilage |
- |
- |
Inventory and Related Property, Net |
$ 93 |
$ 165 |
HHS inventories are comprised of inventory held for sale, operating materials and supplies used in general operations, and stockpile materials. Inventories are valued at historical cost, with the exception of the NIH inventory valued at cost.
NIH has an inventory of materials to support their day-to-day activities. The NIH inventory is valued using the moving average cost method.
The PSC, through its Perry Point Supply Services Center, maintains an inventory of pharmaceutical items for sale to HHS components and other federal agencies.
During FY 2003 OS transferred Stockpile Materials held for emergencies to the Department of Homeland Security, a federal agency outside of HHS, in the amount of $648 million.
Note 10. General Property, Plant and Equipment, Net
Major categories of HHS General Property, Plant and Equipment (PP&E) at September 30, 2003 and 2002 are listed below.
2003 |
Restated |
|||||
|
Depreciation |
Estimated Useful Lives |
Acquisition Cost |
Accumulated Depreciation |
Net Book Value |
Net Book Value |
Land & Land Rights |
|
|
$ 48 |
$ - |
$ 48 |
$ 48 |
Construction in Progress |
|
|
1,025 |
- |
1,025 |
773 |
Buildings, Facilities & Other Structures |
Straight Line |
5-50 Yrs |
2,196 |
(770) |
1,426 |
1,430 |
Equipment |
Straight Line |
3-20 Yrs |
941 |
(419) |
522 |
453 |
Internal Use Software |
Straight Line |
Various |
109 |
(15) |
94 |
45 |
Assets Under Capital Lease |
Straight Line |
Life of Lease |
107 |
(15) |
92 |
98 |
Leasehold Improvements |
Straight Line |
*Life of Lease |
42 |
- |
42 |
- |
Totals |
|
|
$ 4,468 |
$ (1,219) |
$3,249 |
$ 2,847 |
*7 to 15 years or life of lease.
See Note 1. "Summary of Significant Accounting Policies" for capitalization criteria and thresholds.
Note 11. Other Assets
Other Assets at September 30, 2003 and 2002 are comprised of the following, all of which are considered entity assets.
|
2003 |
Restated |
Intragovernmental |
|
|
Advances to Other Federal Entities |
$ 654 |
$ 429 |
Other |
23 |
(3) |
OPDIV Combined, Intragovernmental |
677 |
426 |
Less: Intra-OPDIV Eliminations |
(326) |
(277) |
OPDIV Consolidated, Intragovernmental |
351 |
149 |
Less: Inter-OPDIV Eliminations |
(1) |
- |
HHS Consolidated, Intragovernmental |
$ 350 |
$ 149 |
With the Public |
|
|
Prepayments and Deferred Charges |
$ - |
$ 1 |
Travel Advances & Emergency Employee Salary Advances |
6 |
4 |
Other |
79 |
54 |
HHS Consolidated, With the Public |
$ 85 |
$ 59 |
A major portion of the Other Assets is the advance balance with PMS related activity of $72 million reported by CMS.
Note 12. Liabilities Not Covered by Budgetary Resources
|
2003 |
Restated |
Intragovernmental |
|
|
Accounts Payable |
$ - |
$ - |
Accrued Payroll and Benefits |
20 |
16 |
Other |
151 |
748 |
Total Intragovernmental |
$ 171 |
$ 764 |
Entitlement Benefits Due and Payable |
$ 39,326 |
$ 39,526 |
Environmental and Disposal Costs |
37 |
37 |
Federal Employees and Veterans' Benefits |
6,903 |
8,174 |
Accrued Payroll and Benefits |
418 |
370 |
Other |
705 |
395 |
Total Liabilities Not Covered by Budgetary Resources |
$ 47,560 |
$ 49,266 |
Total Liabilities Covered by Budgetary Resources |
15,499 |
11,189 |
Total Liabilities |
$ 63,059 |
$ 60,455 |
Note 13. Entitlement Benefits Due and Payable
Entitlement Benefits Due and Payable represents benefits due and payable to the public at year-end from entitlement programs enacted by law. In HHS the largest entitlement programs are the CMS managed Medicare and Medicaid programs which comprise all of HHS entitlement benefits due and payable.
Entitlement Benefits Due and Payable at September 30, 2003 and 2002 are summarized below.
|
2003 |
Restated |
||||
|
Liabilities Covered by Budgetary Resources |
Liabilities Not Covered by Budgetary Resources |
Total |
Liabilities Covered by Budgetary Resources |
Liabilities Not Covered by Budgetary Resources |
Total |
Medicare |
$ - |
$ 30,339 |
$ 30,339 |
$ - |
$ 28,236 |
$ 28,236 |
Medicaid |
8,797 |
8,987 |
17,784 |
5,050 |
11,290 |
16,340 |
Other |
- |
- |
- |
- |
- |
- |
Totals |
$ 8,797 |
$ 39,326 |
$ 48,123 |
$ 5,050 |
$ 39,526 |
$ 44,576 |
Note 14. Federal Employee and Veterans' Benefits
HHS's Federal Employee and Veterans' Benefits at September 30, 2003 and 2002 are summarized below. These liabilities are not covered by budgetary resources.
|
2003 |
2002 |
With the Public |
|
|
Liabilities Not Covered by Budgetary Resources |
|
|
PHS Commissioned Corp Pension Liability |
$ 6,107 |
$ 5,913 |
PHS Commissioned Corp Post-retirement Health Benefits |
495 |
1,984 |
Workers' Compensation Benefits (Actuarial FECA Liability) |
301 |
277 |
Total, Federal Employee and Veterans' Benefits |
$ 6,903 |
$ 8,174 |
PHS Commissioned Corps: HHS administers the Public Health Service (PHS) Commissioned Corps Retirement System for approximately 5,882 active duty officers and 4,739 retiree annuitants or survivors. Authorized by Public Law 78-410, it is a defined noncontributory benefit plan. The plan does not have accumulated assets; funding is provided entirely on a pay as you go basis by Congressional appropriations. Administrative costs are borne by the plan. The plan provides pension payments and medical benefits to eligible retirees. At September 30, 2003, the actuarial present value of accumulated plan pension benefits was $ 6,107 million of which $ 577 million was not vested, and the liability for medical benefits was actuarially determined to be $ 495 million.
Significant assumptions used by the actuary in its reports on the pension and medical programs as of September 30, 2003, were as follows: interest on Federal securities of 6.25 percent, annual basic pay scale increase of 3.5 percent, and annual inflation of 3.0 percent. Withdrawal and retirement rates are based on the historical trends of officers in the PHS retirement system. HHS bases aggregate entry age normal actuarial cost method to both programs to determine their liabilities.
The following shows key valuation results as of September 30, 2002, in conformance with the actuarial reporting standards set forth in the Statement of Federal Financial Accounting Standards No. 5 (SFFAS 5):
SSFAS 5 Expense |
2003 |
2002 |
(a) Normal Cost |
$176 |
$173 |
(b) Interest Cost |
485 |
425 |
(c) Ongoing Cost (a & b) |
661 |
598 |
(d) Prior Service Cost & (Gains)/Losses |
(340) |
284 |
(e) Total Expense |
$321 |
$882 |
Workers' Compensation Benefits: The actuarial liability for future workers' compensation benefits includes the expected liability for death, disability, medical and miscellaneous costs for approved compensation cases.
Note 14. Federal Employee and Veterans' Benefits (continued)
The liability utilizes historical benefit payment patterns related to a specific incurred period to predict the ultimate payment related to that period. Consistent with past practice, these projected annual benefit payments have been discounted to present value using the OMB's economic assumptions for 10-year Treasury notes and bonds. Interest rate assumptions utilized for discounting in FY 2003 and 2002 appear below.
FY 2003 |
FY 2002 |
3.84% in Year 1 |
5.20% in Year 1 |
4.85% in Year 2 and thereafter |
5.20% in Year 2 and thereafter |
To provide more specifically for the effects of inflation on the liability for future workers' compensation benefits, wage inflation factors (cost of living adjustments or COLAs) and medical inflation factors (consumer price index medical or CPIMs) are applied to the calculations projected future benefits. These factors are also used to adjust historical payments to current year dollars. The compensation COLAs and CPIMs used in projections are as follows:
FY |
COLA |
CPIM |
2004 |
2.30% |
3.21% |
2005 |
2.00% |
3.54% |
2006 |
1.83% |
3.64% |
2007 |
1.97% |
3.80% |
2008+ |
2.17% |
3.92% |
Note 15. Environmental and Disposal Costs
Environmental and Disposal Costs are the costs of removing, containing, and/or disposing of (1) hazardous waste from property, or (2) material and or property that consists of hazardous waste at a permanent or temporary closure or shutdown of associated PP&E.
Following is a summary of HHS's Environmental and Disposal Costs at September 30, 2003 and 2002.
|
With The Public |
||
At September 30, 2003: |
Liabilities Covered by Budgetary Resources |
Liabilities Not Covered by Budgetary Resources |
Total |
CDC |
$ - |
$ 3 |
$ 3 |
FDA |
2 |
3 |
5 |
IHS |
- |
23 |
23 |
NIH |
- |
8 |
8 |
Consolidated HHS Totals |
$ 2 |
$ 37 |
$ 39 |
With The Public |
|||||
Restated |
Liabilities Covered by Budgetary Resources |
Liabilities Not Covered by Budgetary Resources |
Total |
||
CDC |
$ - |
$ 3 |
$ 3 |
||
FDA |
1 |
3 |
4 |
||
IHS |
- |
23 |
23 |
||
NIH |
- |
8 |
8 |
||
Consolidated HHS Totals |
$ 1 |
$ 37 |
$ 38 |
Note 16. Accrued Grant Liability
Grant advances are liquidated upon the grantee's reporting of expenditures on the quarterly SF-272 Report (Federal Cash Transaction Report). In many cases, HHS receives these reports several months after the grantee actually incurs the expense, resulting in an understated grant expense in the financial statements. To mitigate this, HHS developed Department wide procedures to estimate and accrue amounts due grantees for their expenses, both realized and accrued, through September 30, 2003 and 2002.
At fiscal year-end, the OPDIVs record the estimated accrual for amounts due to grantees for their unreported grantee expenses. If the amount of the collective OPDIV advances outstanding exceeds the amount of the collective OPDIV accrual, HHS reports an asset for "Advances to Grantees." Otherwise, HHS reports a liability called "Accrued Grant Liability", equal to the amount that the accrual exceeds the outstanding advances. For additional information on this subject see Note 1 under "Advances to Grantees/Accrued Grant Liability".
|
2003 |
Restated |
Grant Advances Outstanding (before year-end grant accrual) |
$ 14,699 |
$ 14,861 |
Less: Estimated Accrual for Amounts Due to Grantees |
(18,451) |
(18,363) |
Net Grant Advances (Liability) |
$ (3,752) |
(3,502) |
All advances other than grant advances are reported in Note 11, "Other Assets."
Note 17. Other Liabilities
|
Intragovernmental |
With the Public |
||||
At September 30, 2003: |
Liabilities Covered by Budgetary Resources |
Liabilities Not Covered by Budgetary Resources |
Total |
Liabilities Covered by Budgetary Resources |
Liabilities Not Covered by Budgetary Resources |
Total |
Advances from Others |
$ - |
$ - |
$ - |
$ - |
$ - |
$ - |
Deferred Revenue |
558 |
- |
558 |
547 |
- |
547 |
Liabilities for Deposit Funds, Clearing Accounts and Undeposited Collections |
- |
- |
- |
3 |
- |
3 |
Contingent Liabilities |
- |
- |
- |
- |
320 |
320 |
Capital Lease Liability |
- |
91 |
91 |
- |
6 |
6 |
Custodial Liabilities |
- |
60 |
60 |
- |
- |
- |
Vaccine Injury Compensation Program |
- |
- |
- |
- |
365 |
365 |
Other |
250 |
- |
250 |
84 |
14 |
98 |
Combined OPDIV Totals |
$ 808 |
$ 151 |
$ 959 |
$ 634 |
$ 705 |
$ 1,339 |
Less: Intra-OPDIV Eliminations |
(326) |
- |
(326) |
- |
- |
- |
Consolidated OPDIV Totals |
$ 482 |
$ 151 |
$ 633 |
$ 634 |
$ 705 |
$ 1,339 |
Less: Inter-OPDIV Eliminations |
(39) |
- |
(39) |
- |
- |
- |
Consolidated HHS Totals |
$ 443 |
$ 151 |
$ 594 |
$ 634 |
$ 705 |
$ 1,339 |
|
Intragovernmental |
With the Public |
||||
Restated |
Liabilities Covered by Budgetary Resources |
Liabilities Not Covered by Budgetary Resources |
Total |
Liabilities Covered by Budgetary Resources |
Liabilities Not Covered by Budgetary Resources |
Total |
Advances from Others | $ - |
$ - |
$ - |
$ - |
$ - |
$ - |
Deferred Revenue |
535 |
- |
535 |
384 |
- |
384 |
Liabilities for Deposit Funds, Clearing Accounts and Undeposited Collections |
2 |
- |
2 |
67 |
- |
67 |
Contingent Liabilities |
- |
269 |
269 |
- |
134 |
134 |
Capital Lease Liability |
- |
96 |
96 |
- |
6 |
6 |
Custodial Liabilities |
- |
383 |
383 |
- |
- |
- |
Vaccine Injury Compensation Program |
- |
- |
- |
- |
251 |
251 |
Other |
59 |
- |
59 |
43 |
4 |
47 |
Combined OPDIV Totals |
$ 596 |
$ 748 |
$ 1,344 |
$ 494 |
$ 395 |
$ 889 |
Less: Intra-OPDIV Eliminations |
(277) |
- |
(277) |
- |
- |
- |
Consolidated OPDIV Totals |
$ 319 |
$ 748 |
$ 1,067 |
$ 494 |
$ 395 |
$ 889 |
Less: Inter-OPDIV Eliminations |
(54) |
- |
(54) |
- |
- |
- |
Consolidated HHS Totals |
$ 265 |
$ 748 |
$ 1,013 |
$ 494 |
$ 395 |
$ 889 |
Note 17. Other Liabilities (continued)
Deferred Revenue of $558 million is for the provision of goods and services. The Vaccine Injury Compensation Program (VICP), administered by HRSA, provides compensation for vaccine-related injury or death. The $365 million VICP liability represents the estimated future payment value of injury claims outstanding for VICP as of September 30, 2003.
Most of the other liabilities are made up of amounts due to Treasury from CMS. The amount CMS owes to Treasury is $233 million.
Through the issuance of grants, HRSA supports the operation of certain health centers under the Health Centers Consolidation Act of 1996. These grantees, and many of their health professionals, are provided malpractice insurance under the Federally Supported Health Centers Assistance Act. Settlements and awards are paid from a separate Fund in the Treasury (Appropriation 75x0365). Accordingly, there are numerous malpractice legal actions pending against these grantees, which, if settled, will be paid by HRSA. For FY 2003, HRSA's actuarial contractor estimated the preliminary contingent liability to be $318 million ($132 million in FY 2002 restated). This increase of $186 million is an actuarial estimate for ultimate liabilities as of FY 2003, including the incurred but not reported (IBNR) of $147 million and expected payouts for fiscal years 2003 to 2005 for the Community Health Center program.
Note 18. Leases
Capital Leases: HHS and its OPDIVS have entered into various capital leases with Indian tribes and the General Services Administrations (GSA) for office and warehouse space. Lease terms vary from one to twenty years. Capitalized assets acquired under capital lease agreements and the related liabilities are reported at the present value of the minimum lease payments.
Operating Leases: HHS and its components also have commitments under various operating leases with private entities and GSA for office, laboratory spaces, and land. Leases with private entities have initial or remaining noncancelable lease terms from one to twenty years. GSA leases in general are cancelable within 120 days notice.
A Summary of Net Assets under Capital Lease and Future Minimum Lease Payments at September 30, 2003 and 2002 follows.
Table 1. Summary of Assets Under Capital Lease |
2003 |
Restated |
Land and Building |
$ 105 |
$ 105 |
Machinery and Equipment |
1 |
1 |
Other |
1 |
- |
Subtotal |
$ 107 |
$ 106 |
less: Accumulated Amortization |
(15) |
(9) |
Assets Under Capital Lease |
$ 92 |
$ 97 |
Table 2. Future Minimum Lease Payments |
2003 |
2002 |
|||
Capital Leases |
Operating |
Capital Leases |
Operating Lease |
||
Year 1 |
$ 9 |
$ 253 |
$ 9 |
$ 214 |
|
Year 2 |
9 |
264 |
9 |
231 |
|
Year 3 |
9 |
271 |
9 |
244 |
|
Year 4 |
9 |
287 |
9 |
256 |
|
Year 5 |
9 |
300 |
9 |
270 |
|
Later Years |
128 |
665 |
145 |
629 |
|
Total Minimum Lease Payments |
$ 173 |
$ 2,040 |
$ 190 |
$ 1,844 |
|
Less: Imputed Interest |
(76) |
|
(88) |
|
|
Total Capital Lease Liability |
$ 97 |
|
$ 102 |
|
Note 19. Consolidated Gross Cost and Exchange Revenue by Budget Functional Classification
HHS's consolidated gross cost and exchange revenue by budget functional classification for the fiscal year ended September 30, 2003 and 2002 are summarized below.
|
2003 |
Restated |
||||||||
|
Education Training and Social Services |
Health |
Medicare |
Income Security |
Admin. of Justice |
Natural Resources/ |
OPDIV Combined Totals |
Intra-HHS Eliminations |
HHS Consolidated |
HHS |
Intragovernmental |
|
|
|
|
|
|
|
|
|
|
Gross Cost |
$113 |
$ 3,521 |
$ 443 |
$ 34 |
$ - |
$ 1 |
$ 4,112 |
$ (1,119) |
$ 2,993 |
$ 3,623 |
Less: Exchange Revenue |
(9) |
(1,609) |
(6) |
(4) |
- |
- |
(1,628) |
977 |
(651) |
(481) |
Net Cost, Intragovernmental |
$ 104 |
$ 1,912 |
$437 |
$30 |
$ - |
$ 1 |
$ 2,484 |
$ (142) |
$ 2,342 |
$ 3,142 |
With the Public |
|
|
|
|
|
|
|
|
|
|
Gross Cost |
$ 11,808 |
$210,525 |
$278,071 |
$36,991 |
$ (1) |
$ - |
$ 537,394 |
$ - |
$ 537,394 |
$ 493,224 |
Less: Exchange Revenue |
- |
(1,140) |
(28,434) |
- |
- |
- |
(29,574) |
- |
(29,574) |
(24,224) |
Net Cost, |
$ 11,808 |
$209,385 |
$249,637 |
$36,991 |
$ (1) |
$ - |
$ 507,820 |
$ - |
$ 507,820 |
$ 469,000 |
Totals |
|
|
|
|
|
|
|
|
|
|
Gross Cost |
$ 11,921 |
$214,046 |
$278,514 |
$37,025 |
$ (1) |
$ 1 |
$ 541,506 |
$ (1,119) |
$ 540,387 |
$ 496,847 |
Less: Exchange Revenue |
(9) |
(2,749) |
(28,440) |
(4) |
- |
- |
(31,202) |
977 |
(30,225) |
(24,705) |
Net Cost of Operations |
$ 11,912 |
$211,297 |
$250,074 |
$37,021 |
$ (1) |
$ 1 |
$ 510,304 |
$ (142) |
$ 510,162 |
$ 472,142 |
Note 20. Prior Period Adjustments
HHS included prior period adjustments in the calculation of the net change in cumulative results of operations to correct errors and accounting changes with retroactive effect. Following is a summary of the prior period adjustments as of September 30, 2003 and 2002.
Increases (Decreases) to Equity |
2003 |
Restated |
Correction of Errors |
$383 |
$6 |
Change in Accounting Principles |
- |
(37) |
Departmental Adjustments to Beginning Net Position |
(17) |
(72) |
Total |
$366 |
$(103) |
Departmental Adjustments to Beginning Net Position represent audit adjustments booked by OPDIVs after the HHS audit deadlines, as well as an additional net position adjustment related to prior year intra-HHS eliminations. These adjustments are not included in the OPDIVs' statement figures used to compile the department-wide statement figures. Therefore, the Department must enter an adjustment to Beginning Net Position to reflect the Department's true beginning net position balance, on a consolidated basis.
OS transferred Stockpile Material to DHS, as noted in Note 9 Inventory and Related Property, Net. The value of the inventory, which OS transferred, was understated as of the end of FY 2002. After a reevaluation, using historical cost, the inventory stated as $93 million in the FY 2002 HHS statement had a value of $469 million (an increase of $376). This is shown as a prior period correction for FY 2003.
Note 21. Custodial Activity
ACF receives monies from the Internal Revenue Service for outlay to the states for Child Support. These monies represent delinquent child support payments withheld from Internal Revenue tax refunds. Receipts are transferred to appropriation 75X6234 to cover outlays. During FY 2003, receipts amounted to $1,532 million ($1,466 million for FY 2002) and outlays amounted to $1,516 million ($1,494 million for FY 2002).
FDA's custodial activity involves collections for civil monetary penalties (CMP) assessed by the Department of Justice on behalf of FDA. Penalties are assessed for violations in areas such as illegally manufactured, marketed, and distributed animal feeds and drug products. Total CMP collections in FY 2003 were $398.5 million ($373.7 million for FY 2002). CMP collections are immediately forwarded to the Department of the Treasury and cannot be used for FDA operations.
Note 22. Federal Matching Contribution
Supplemental Medical Insurance program (SMI) benefits and administrative expenses are financed by monthly premiums paid by Medicare beneficiaries and are matched by the federal government through the general fund appropriation, Payments to the Health Care Trust Funds. Section 1844 of the Social Security Act authorizes appropriated funds to match SMI premiums collected, and outlines the ratio for the match as well as the method to make the trust funds whole if insufficient funds are available in the appropriation to match all premiums received in the fiscal year. The monthly SMI premium per beneficiary was $54.00 from October 2002 through December 2002 and $58.70 from January 2003 through September 2003. Premiums collected from beneficiaries totaled $26.80 billion in FY 2003 ($24.4 billion in FY 2002) and were matched by an $84.3 billion ($76.7 billion in FY 2002) contribution from the Federal government.
Note 23. Contingencies
The Department and its components are parties to various administrative proceedings, legal actions, and claims brought by or against it. These contingencies arise in the normal course of operations and their ultimate disposition is unknown. Management, in consultation with legal counsel, has determined that it is reasonably possible that certain claims may result in an adverse outcome to the Department. However, an estimate of the range of possible liability cannot be determined. Based on information currently available, it is management's opinion that the expected outcome of these matters, individually or in the aggregate, will not have a material adverse effect on the financial statements of the Department.
Obligations Related to Cancelled Appropriations Payments may be required of up to one percent of current year appropriations for valid obligations incurred against prior year appropriations that have been cancelled. The total payments related to cancelled appropriations are estimated at $ 1,477 million and $ 2,156 million as of September 30, 2003 and 2002, respectively.
Note 24. Apportionment Categories of Obligations Incurred
Obligations incurred by apportionment categories are as follows:
September 30, 2003 |
Direct |
Reimbursable |
Totals |
Category A |
$ 103,721 |
$ 4,909 |
$ 108,630 |
Category B |
533,545 |
245 |
533,790 |
Exempt from apportionment |
3,997 |
- |
3,997 |
Total Obligations Incurred |
$ 641,263 |
$ 5,154 |
$ 646,417 |
Restated |
Direct |
Reimbursable |
Totals |
Category A |
$ 99,457 |
$ 3,614 |
$ 103,071 |
Category B |
495,318 |
310 |
495,628 |
Exempt from apportionment |
3,895 |
- |
3,895 |
Total Obligations Incurred |
$ 598,670 |
$ 3,924 |
$ 602,594 |
Note 25. Legal Arrangements Affecting Use of Unobligated Balances
Unobligated balances consist of appropriated funds, revolving funds, management funds, trust
funds, NIH’s Cooperative Research and Development Agreement (CRADA) funds and royalty
funds. Annual appropriations are available for new obligations in the year of appropriation and
for adjustments to valid obligations for five subsequent years. Revolving funds are no year funds
without any time limit. The NIH Management fund is available for two fiscal years. The trust
funds are also no year funds without time limits. NIH’s CRADA funds are available for the
performance of the contractual agreement.
FDA has a Contingency Fund that was established in FY 1983 whereby funds are to be used for unusual direct costs of product emergencies (i.e., Tylenol incident, Breast Implant Hotline, etc.). Two rules were set for this fund: (1) only for emergency costs exceeding $100 thousand over the normal budget and (2) any use has to be specifically apportioned and approved by OMB. During FY 2003, FDA requested and was approved by OMB to utilize the balance of this account ($1.2 million) in support of food safety and security activities, including testing methodologies, reagents and chemical supplies. FDA is not requesting additional resources for this account. FDA received $151.1 million in funding in FY 2002, to remain available until expended, to support counter-terrorism projects. FDA’s focus is in three key areas: food safety, safe and effective medical products, and physical security. The amount obligated for counter terrorism projects through FY 2003 was approximately $150 million.
Note 26. Exchange Revenue
The pricing policy for exchange revenue at HHS is to establish prices at full cost and to incur no
profit or loss. Most OPDIVs either charge full cost, or are implementing procedures to do so.
Several Operating Divisions at HHS collect revenue related to reimbursable agreements and
recognize the revenue when expenses are incurred. In addition to reimbursable agreements,
OPDIVs recognize exchange revenue related to collection of various user fees and recognize the
exchange revenue when expenses are incurred.
Note 27. Explanation of Differences Between the Statement of Budgetary Resources (SBR)
and the Budget of the United States Government
Statement of Federal Financial Accounting Standard (SFFAS) No. 7, "Accounting for Revenue
and Other Financing Sources" calls for explanations of any material differences between the
information required by paragraph 77 [of SFFAS 7] and the amounts described as 'actual' in the
"Budget of the United States Government" (also called the "President’s Budget"). Paragraph 77
of SFFAS 7 calls for presentation of total budgetary resources available to a reporting entity, the
status of those resources, and outlays of the reporting entity. This information is provided in the
Department’s SBR (see page III.4).
Chapter 11, Title 31, U.S. Code requires: "On or after the first Monday in January but not later than the first Monday in February of each year, the President shall submit a budget of the United States Government for the following fiscal year." The FY 2005 President’s Budget, with actual numbers for FY 2003, has not yet been published, and therefore no comparisons can be made between FY 2003 amounts presented in the SBR with amounts reported in the �actual’ column of the President’s Budget. The FY 2005 President’s Budget is expected to be released on February 3, 2004, and may be obtained from the Office of Management and Budget or the U.S. Government Printing Office at that time.
Differences between the SBR and President’s Budget for FY 2002 are disclosed in the following table:
FY 2002 |
|||
|
Budgetary |
Net Outlays (Less |
|
Statement of Budgetary Resources |
613,370 |
583,651 |
|
Adjustments for Expired Accounts |
(5,252) |
- |
|
Other Adjustments |
417 |
- |
|
Budget of the U.S. Government |
608,535 |
583,651 |
Note 28. Explanation of Differences Between Liabilities Not Covered by Budgetary
Resources and Components Requiring or Generating Resources in Future Periods
Components requiring budgetary resources in the future are increases in certain liability accounts
also included in the category "not covered by budgetary resources" such as accrued annual leave.
In this instance the expense is recorded for the period when the leave is earned and is included as
a current period cost on the Statement of Net Cost.
The Balance Sheet uses proprietary accounts to present the balances for "liabilities not covered by budgetary resources". An increase in the annual leave liability increases the unfunded liability on the Balance Sheet and the expenses on the Statement of Net Cost. The increase is not included in the Statement of Budgetary Resources since the liability will be paid from future resources. As a result, the Statement of Financing includes "components requiring resources in future periods" such as accrued annual leave to reconcile budgetary resources to net cost.
Note 29. Permanent and Indefinite Appropriations
The HHS permanent and indefinite appropriations have both budget authority available without
current action by Congress and indefinite authority, meaning there is no specific amount at the
time the authority is granted. The list below includes the Treasury Fund Symbols, the period of
availability (fiscal year or no year), and the titles of the accounts.
75 0340 - (fiscal year) Health Education Assistance Loans Program
75X0513 - (no year) Payments for Credits Against Health Care Contributions
75X0585 - (no year) Taxation on OASDI Benefits
75 1552 - (fiscal year) Temporary Assistance for Needy Families
75X1553 - (no year) Children’s Research and Technical Assistance
75X4305 - (no year) Health Professions Graduate Student Loan Insurance Fund,
Liquidating Account
75X8250 - (no year) Gifts and Donations
7520X8004 - (no year) Federal Supplementary Medical Insurance Trust Fund
7520X8005 - (no year) Federal Hospital Insurance Trust Fund
Note 30. Adjustments to Beginning Balance of Budgetary Resources
FDA accelerated the FY 2003 billing and collection of advanced fees from the drug industry
during FY 2002. The fees collected in advance were unavailable in FY 2002 and did not become
available until the beginning of FY 2003 after the passage of the FDA appropriation. The
authorization for these advances is The Prescription Drug User Fee Act of 1992 (PDUFA) reauthorized
by the Prescription Drug User Fee Amendments of 2002 (Title 5 of the Public Health
Security and Bioterrorism Preparedness and Response Act of 2002, P.L. 107-188).
As a result of collecting the fees in advance, FDA adjusted the beginning of the year budgetary resources available balance in their Statement of Budgetary Resources for FY 2003, resulting in a $127 million difference in the ending balance for FY 2002 and the beginning balance for FY 2003.
HHS has two types of property, plant, and equipment (PP&E) for stewardship reporting: Heritage Assets and Indian Trust Lands. The Indian Health Service (IHS) reports both types.
Heritage Assets are PP&E of historical, natural, cultural, educational, or artistic significance. Heritage Assets which are generally expected to be preserved indefinitely. This category includes buildings on the National Historic Register, cemetery sites, etc.
Stewardship Land includes land and land rights other than that acquired for or in connection with general PP&E. "Land" is defined as the solid part of the surface of the earth, excluding natural resources related to land. Examples of Stewardship Land include land used as forests and parks, and land used for wildlife and grazing.
Indian Trust lands are those lands that do not meet the definition of Stewardship Land, but are held by IHS as separate and distinct, because of the Federal government’s long-term trust responsibility. All Indian Trust lands, when no longer needed by IHS in connection with its General PP&E, must be returned to the Department of the Interior’s Bureau of Indian Affairs for continuing trust responsibility and oversight. IHS separately reports Indian Trust land parcels by site and installation numbers, and Indian Trust lands from General PP&E situated thereon.
IHS Stewardship Classes
Asset Descriptions |
Number |
Total Square |
Federal |
Total |
Heritage Assets |
2 |
2,295 |
1 (4+/- acres) |
1 (4+/- acres) |
Indian Trust Lands |
81 |
N/A |
432.7 (1,069 acres) |
432.7 |
|
|
|
|
(1,069acres) |
Distribution of Stewardship Assets by Type and Area
Heritage Assets |
Indian Trust Lands |
||||
|
Number |
Square |
Total |
Number |
Total |
Aberdeen |
9 |
75 |
|||
Alaska |
1 |
< 1.82 |
|||
Albuquerque |
4 |
4 |
|||
Bemidjp |
2 |
9 |
|||
Billings |
7 |
48 |
|||
Navajo |
34 |
254 |
|||
Oklahoma City |
2 |
10 |
|||
Phoenix |
1 |
2,295 |
13 |
19 |
|
Portland |
5 |
2 |
|||
Tucson |
5 |
12 |
|||
Total-IHS |
2 |
2,295 |
< 1.82 |
81 |
433 |
|
|||||
RESPONSIBILITY SEGMENT |
2003 |
2002 |
2001 |
2000 |
1999 |
ACF |
|
|
|
|
|
Administration on |
$10 |
$6 |
$6 |
$8 |
$6 |
NIH |
|
|
|
|
|
Research Training |
1,405 |
1,248 |
1,118 |
871 |
820 |
Totals |
$1,415 |
$1,254 |
$1,124 |
$879 |
$826 |
"Investments in Human Capital" are expenses incurred by federal education and training programs for the public, which are intended to maintain or increase national productive capacity. Two operating divisions of the Department conduct education and training programs under this category: Administration for Children and Families, and the National Institutes of Health.
Administration for Children and Families (ACF)
ACF is able to estimate investment in human capital for the Administration for Developmental Disabilities (ADD) using existing data collection activities. Under ADD, 55 grants were awarded for Projects of National Significance (PNS). PNS grants are awarded to public or private, non-profit institutions to enhance the independence, productivity, integration and inclusion into the community of people with developmental disabilities. Monies also support the development of national and state policy to serve this community. Grants awarded totaled $10 million in FY 2003 and $6 million in FY 2002.
National Institutes of Health (NIH)
The NIH Research Training and Career Development Program addresses the need for trained personnel to conduct medical research. The primary goal of the support that NIH provides for graduate training and career development is to produce new, highly trained investigators who are likely to perform research that will benefit the Nation's health. Our ability to maintain the momentum of recent scientific progress and our international leadership in medical research depends upon the continued development of new, highly trained investigators.
U.S. Department of Health and Human Services
|
|||||||||
Responsibility |
2003 |
2003 |
2003 |
2003 |
2002 |
2001 |
2000 |
1999 |
Grand |
ACF |
|
$24 |
$24 |
$29 |
$32 |
$30 |
$19 |
$134 |
|
AHRQ |
|
163 |
|
163 |
150 |
127 |
95 |
97 |
632 |
CDC |
|
557 |
|
557 |
533 |
557 |
505 |
433 |
2,585 |
FDA |
|
25 |
6 |
31 |
29 |
26 |
26 |
19 |
131 |
HRSA |
|
16 |
|
16 |
16 |
16 |
15 |
18 |
81 |
NIH |
12,815 |
8,544 |
|
21,359 |
19,058 |
16,007 |
14,690 |
13,580 |
84,694 |
Totals |
$12,815 |
$9,329 |
$6 |
$22,150 |
$19,815 |
$16,765 |
$15,361 |
$14,166 |
$88,257 |
The many research and development programs in HHS include the following:
FDA has two programs that meet the requirements of research and development investments: Orphan Products Development (OPD) Program and FDA Research Grants Program. While FDA's center components conduct scientific studies, FDA does not consider this type of research as "research and development" because it is used to support FDA's regulatory policy and decision-making processes.
The OPD Program was established by the Orphan Drug Act (PL 97-414, as amended) with the purpose of identifying orphan products and facilitating their development. An orphan product is a drug, biological product, medical device, or medical food that is intended to treat a rare disease or condition (i.e., one with a prevalence of fewer than 200,000 people in the United States.)
The FDA Research Grants Program is a grants program which is listed as No. 93-103 under the Catalog of Federal Domestic Assistance, whose purpose is to assist public and non-public institutions and for-profit organizations to establish, expand, and improve research, demonstration, education, and information dissemination activities concerned with a wide variety of FDA areas.
HIV/AIDS prevention, Infectious Diseases, and Environmental and Occupational Health were the primary areas where CDC's research and development was invested.
The NIH Research Program includes all aspects of the medical research continuum, including basic and disease-oriented research, observational and population-based research, behavioral research, and clinical research, including research to understand both health and disease states, to move laboratory findings into medical applications, to assess new treatments or compare different treatment approaches; and health services research. NIH regards the expeditious transfer of the results of its medical research for further development and commercialization of products of immediate benefit to improved health as an important mandate.
ACF, HRSA and AHRQ oversee research and development programs that contribute to a better understanding of how to improve the economic and social well being of families and children so that they lead more healthy and productive lives.
Medicare, the largest health insurance program in the country, has helped fund medical care for the nation's aged and disabled for almost four decades. The required supplementary stewardship information (RSSI) contained in this section is presented in accordance with the requirements of the Federal Accounting Standards Advisory Board (FASAB). Included are a description of the long-term sustainability and financial condition of the program and a discussion of trends revealed in the data.
RSSI material is generally drawn from the 2003 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, which represents the official government evaluation of the financial and actuarial status of the Medicare trust funds. Unless otherwise noted, all data are for calendar years, and all projections are based on the Trustees' intermediate set of assumptions.
Printed copies of the Trustees Report may be obtained from CMS' Office of the Actuary (410-786-6386). The report is also available online at www.cms.hhs.gov/publications/trusteesreport/default.asp.
Please note that the 2003 Trustees Report for Medicare (issued March 17, 2003) was used as the source document for this report. We anticipate that the Government-wide financial statement report for FY 2003 (expected to be issued March 31, 2004) will contain updated information from the 2004 Trustees Report (which is expected to be issued on or near March 15, 2004). Thus, some data related to the Medicare trust funds contained in this report may differ from that contained in the FY 2003 Financial Report of the United States Government. |
Cashflow in Nominal Dollars
Using nominal dollars1 for short-term projections paints a reasonably clear picture of expected performance with particular attention on cashflow and trust fund balances. Over longer periods, however, the changing value of the dollar can complicate efforts to compare dollar amounts in different periods and can create severe barriers to interpretation, since projections must be linked to something that the mind can comprehend in today's experience.
For this reason, long-range (75-year) Medicare projections in nominal dollars are seldom used and are not presented here. Instead, nominal-dollar estimates for the HI trust fund are displayed only through the projected date of depletion, currently the year 2026. Estimates for SMI are presented only for the next 10 years, primarily due to the fact that under present law, the SMI trust fund is automatically in financial balance every year.
Chart 1 shows the actuarial estimates of HI income, expenditures, and assets for each of the next 24 years, in nominal dollars. Income includes payroll taxes, income from the taxation of Social Security benefits, interest earned on the U.S. Treasury securities held by the trust fund, and other miscellaneous revenue. Expenditures include benefit payments and administrative expenses. The estimates are for the "open group" population-all persons who will participate during the period as either taxpayers or beneficiaries, or both-and consist of payments from, and on behalf of, employees now in the workforce, as well as those who will enter the workforce over the next 24 years. The estimates also include expenditures attributable to these current and future workers, in addition to current beneficiaries.
As chart 1 shows, under the intermediate assumptions HI expenditures would begin to exceed income including interest in 2018 and income excluding interest in 2013. This situation is due in part to the attainment of Medicare eligibility, starting in 2011, of those born during the 1946-1964 baby boom. It also arises as a result of health cost increases that are expected to continue to grow faster than workers’ earnings. Beginning in 2018, the trust fund would start redeeming trust fund assets; in 2026, the assets would be depleted.
The projected year of depletion of the trust fund is very sensitive to assumed future economic and other trends. Under less favorable conditions the cash flow could turn negative much earlier and thereby accelerate asset exhaustion.
By law, Medicare trust fund assets are invested in special U.S. Treasury Securities, which earn interest while Treasury uses those cash resources for other Federal purposes. During times of Federal "on-budget" surpluses, this process reduces the Federal debt held by the public. In times of Federal budget deficits, Medicare surpluses reduce the amount that must be borrowed from the public to finance those deficits. The trust fund assets are claims on the Treasury that, when redeemed, will have to be financed by raising taxes, borrowing from the public, or reducing other Federal expenditures. (When the assets are financed by borrowing, the effect is to defer today's costs to later generations who will ultimately repay the funds being borrowed for today's Medicare beneficiaries.) The existence of large trust fund balances, therefore, represents an important obligation of the Government to pay future Medicare benefits but does not necessarily make it easier for the Government to pay those benefits. |
Chart 2 shows the actuarial estimates of SMI income, expenditures, and assets for each of the next 10years, in nominal dollars. Whereas HI estimates are displayed through the year 2026, SMI estimates cover only the next 10years, as SMI differs fundamentally from HI in regard to the way it is financed. In particular, SMI financing is not at all based on payroll taxes but instead on monthly beneficiary premiums and income from the general fund of the U.S. Treasury—both of which are established annually to cover the following year’s expenditures. Estimates of SMI income and expenditures, therefore, are virtually the same, as illustrated in chart 2, and so are not shown in nominal dollars separately beyond 10 years.
Income includes monthly premiums paid by, or on behalf of, beneficiaries, transfers from the general fund of the U.S. Treasury, and interest earned on the U.S. Treasury securities held by the trust fund.2 Chart 2 displays only total income; it does not represent income excluding interest. The difference between the two is not visible graphically since interest is not a significant source of income.3 Expenditures include benefit payments as well as administrative expenses.
As chart 2 indicates, SMI income is very close to expenditures. As noted earlier, this is due to SMI's financing mechanism. Under present law, SMI is automatically in financial balance every year, regardless of future economic and other conditions.
HI Cashflow as a Percentage of Taxable Payroll
Each year, estimates of the financial and actuarial status of the HI trust fund are prepared for the next 75 years. Because of the difficulty in comparing dollar values for different periods without some type of relative scale, income and expenditure amounts are shown relative to the earnings in covered employment that are taxable under HI (referred to as "taxable payroll").
Chart 3 illustrates income excluding interest and expenditures as a percentage of taxable payroll over the next 75 years. As it was in the 2001 and 2002 reports, the per beneficiary long-range growth in the 2003 report is assumed to be the level of per capita gross domestic product (GDP) growth plus 1 percentage point-reflecting an expectation that the impact of advances in medical technology on health care costs will continue, both in Medicare and in the health sector as a whole.
Since HI payroll tax rates are not scheduled to change in the future under present law, payroll tax income as a percentage of taxable payroll will remain constant at 2.90 percent. Income from taxation of benefits will increase only gradually as a greater proportion of Social Security beneficiaries become subject to such taxation over time. Thus, as chart 3 shows, the income rate is not expected to increase significantly over current levels. On the other hand, expenditures as a percentage of taxable payroll sharply escalate-in part due to health care cost increases that exceed wage growth, but also due to the attainment of Medicare eligibility of those born during the 1946-1964 baby boom.
HI and SMI Cashflow as a Percentage of GDP
Expressing Medicare incurred expenditures as a percentage of the GDP gives a relative measure of the size of the Medicare program compared to the general economy. The GDP represents the total value of goods and services produced in the United States. This measure provides an idea of the relative financial resources that will be necessary to pay for Medicare services.
Chart 4 shows HI income excluding interest and expenditures over the next 75 years expressed as a percentage of GDP. In 2002, the expenditures were $152.5 billion, which was 1.5 percent of GDP. Following slight reductions over the next 5 years, this percentage is projected to increase steadily throughout the remainder of the 75-year period.
Because of the SMI financing mechanism in which income mirrors expenditures, it is not necessary to test for long-range imbalances between income and expenditures. Rather, it is more important to examine the projected rise in expenditures and the implications for beneficiary premiums and Federal general revenue payments.
Chart 5 shows SMI expenditures over the next 75 years expressed as a percentage of GDP. In 2002, SMI expenditures were $113.2 billion, which was 1.1 percent of GDP. After 2005, this percentage is projected to increase steadily, reflecting growth in the volume and intensity of services provided per beneficiary throughout the projection period, together with the effects of the baby boom eligibility for retirement.
In the SMI expenditure projections, as in those for HI, the per beneficiary long-range growth rate is assumed to equal per capita GDP growth plus 1 percentage point. The growth rates are estimated year by year for the next 12 years, reflecting the impact of specific statutory provisions. Expenditure growth for years 13 to 25 is assumed to grade smoothly into the long-range assumptions.
Also shown in chart 5 are SMI general revenue transfers and premium income expressed as a percentage of GDP4. Under present law, premiums will cover roughly 25 percent of total expenditures. As indicated, both sources of revenue would increase more rapidly than the GDP over time, to match the faster growth rates for SMI expenditures.
Worker-to-Beneficiary Ratio
Another way to evaluate the long-range outlook of the HI trust fund is to examine the projected number of workers per HI beneficiary. Chart 6 illustrates this ratio over the next 75 years. For the most part, current benefits are paid for by current workers. The retirement of the baby boom generation will therefore be financed by the relatively smaller number of persons born after the baby boom. In 2002, every beneficiary had almost 4.0 workers to pay for his or her benefit. In 2030, however, after the last baby boomer turns 65, there will be only about 2.4 workers per beneficiary. The projected ratio continues to decline until there are just 2.0 workers per beneficiary in 2077.
Actuarial Present Values
Projected future expenditures can be summarized by computing an "actuarial present value." This value represents the lump-sum amount that, if invested today in trust fund securities, would be just sufficient to pay each year's expenditures over the next 75 years, with the fund being drawn down to zero at the end of the period. Similarly, future revenues (excluding interest) can be summarized as a single, equivalent amount as of the current year.
Actuarial present values are calculated by discounting the future annual amounts of non-interest income and expenditures at the assumed rates of interest credited to the HI and SMI trust funds. Present values are computed as of the beginning of the 75-year projection period for three different groups of participants: current workers and other individuals who have not yet attained eligibility age; current beneficiaries who have attained eligibility age; and new entrants, or those who are expected to become participants in the future.
Table 1 sets forth, for each of these three groups, the actuarial present values of all future HI and SMI expenditures and all future non-interest income for the next 75 years. Also shown is the net present value of cashflow, which is calculated by subtracting the actuarial present value of future expenditures from the actuarial present value of future income.
Table 1-Actuarial Present Values of |
||||||||
HI |
SMI2 |
|||||||
|
2003 |
2002 |
2001 |
2000 |
2003 |
2002 |
2001 |
2000 |
Actuarial present value1 of estimated future income (excluding interest) received from or on behalf of: |
||||||||
Current participants3 who, at start of projection period: |
||||||||
Have not yet attained eligibility age (ages 15-64) |
$4,510 |
$4,408 |
$4,136 |
$3,757 |
$8,796 |
$7,423 |
$7,378 |
$6,109 |
Have attained eligibility age (age 65 and over) |
128 |
125 |
113 |
97 |
1,160 |
1,008 |
1,032 |
934 |
Those expected to become participants (under age 15) |
3,773 |
3,753 |
3,507 |
3,179 |
2,817 |
2,402 |
2,370 |
1,616 |
All current and future participants |
8,411 |
8,286 |
7,757 |
7,033 |
12,773 |
10,833 |
10,780 |
8,659 |
Actuarial present value1 of estimated future expenditures4 paid to or on behalf of: |
||||||||
Current participants3 who, at start of projection period: |
||||||||
Have not yet attained eligibility age (ages 15-64) |
10,028 |
9,195 |
8,568 |
6,702 |
8,845 |
7,463 |
7,415 |
6,094 |
Have attained eligibility age (age 65 and over) |
1,897 |
1,747 |
1,693 |
1,681 |
1,306 |
1,132 |
1,159 |
1,051 |
Those expected to become participants (under age 15) |
2,653 |
2,470 |
2,225 |
1,349 |
2,622 |
2,238 |
2,206 |
1,514 |
All current and future participants |
14,577 |
13,412 |
12,487 |
9,732 |
12,773 |
10,833 |
10,780 |
8,659 |
Actuarial present value1 of estimated future income (excluding interest) less expenditures |
-6,166 |
-5,126 |
-4,730 |
-2,700 |
- |
- |
- |
- |
Trust fund assets at start of period |
235 |
209 |
177 |
141 |
34 |
41 |
44 |
45 |
Assets at start of period plus actuarial present value1 of estimated future income (excluding interest) less expenditures |
-5,931 |
-4,917 |
-4,553 |
-2,558 |
34 |
41 |
44 |
45 |
2 SMI income includes premiums paid by beneficiaries and general revenue contributions made on behalf of beneficiaries. See footnote 2 of CMS’s FY 2003 CFO financial report concerning treatment of SMI general revenues in the consolidated financial statement of the U.S. Government. 3Current participants are the “closed group” of individuals age 15 and over at the start of the period. The projection period for these current participants would theoretically cover all of their working and retirement years, a period that could be greater than 75 years in some instances. As a practical matter, the present values of future income and expenditures from/for current participants beyond 75 years are not material. The projection period for new entrants covers the next 75 years. 4Expenditures include benefit payments and administrative expenses. Note: Totals do not necessarily equal the sums of rounded components. |
As shown in table 1, the HI trust fund has an actuarial deficit of more than $5.9 trillion over the 75-year projection period, as compared to more than $4.9 trillion in the 2002 financial report. SMI, on the other hand, does not have similar problems because it is automatically in financial balance every year due to its financing mechanism.5
The existence of a large actuarial deficit for the HI trust fund indicates that, under reasonable assumptions as to economic, demographic, and health cost trends for the future, HI income is expected to fall substantially short of expenditures in the long range. Although the deficits are not anticipated in the immediate future, as indicated by the preceding cashflow projections, they nonetheless pose a serious financial problem for the HI trust fund.
A figure as large as $5.9 trillion can be difficult to interpret without some relative basis of comparison. To put this number in perspective, it is helpful to consider that the present value of future taxable payroll over the same 75?year period is estimated to be $256 trillion in the 2003 Trustees Report. Thus, the $5.9?trillion deficit represents approximately 2.3 percent of future taxable payroll.
It is important to note that no liability has been recognized on the balance sheet for future payments to be made to current and future program participants beyond the existing "incurred but not reported" Medicare claim amounts as of September 30, 2003. This is because Medicare is accounted for as a social insurance program rather than a pension program. Accounting for a social insurance program recognizes the expense of benefits when they are actually paid, or are due to be paid, because benefit payments are primarily nonexchange transactions and, unlike employer-sponsored pension benefits for employees, are not considered deferred compensation. Accrual accounting for a pension program, by contrast, recognizes retirement benefit expenses as they are earned so that the full actuarial present value of the worker's expected retirement benefits has been recognized by the time the worker retires.
Actuarial Assumptions and Sensitivity Analysis
In order to make projections regarding the future financial status of the HI and SMI trust funds, various assumptions have to be made. First and foremost, the estimates presented here are based on the assumption that the trust funds will continue under present law. In addition, the estimates depend on many economic and demographic assumptions, including changes in wages and the consumer price index (CPI), fertility rates, immigration rates, and interest rates. In most cases, these assumptions vary from year to year during the first 5 to 30 years before reaching their ultimate values for the remainder of the 75?year projection period.
Table 2 shows some of the underlying assumptions used in the projections of Medicare spending displayed in this section. Further details on these assumptions are available in the Social Security and Medicare Trustees Reports for 2003. In practice, a number of specific assumptions are made for each of the different types of service provided by the Medicare program (for example, hospital care and physician services). These assumptions include changes in the utilization, volume, and intensity of each type of service. The per beneficiary cost increases displayed in table 2 reflect the overall impact of these more detailed assumptions.
Table 2—Medicare Assumption |
||||||||||
Fertility |
Net |
Real‑wage |
Annual percentage change in: |
Real‑ interest rate4 |
||||||
Wages |
CPI |
Real |
Per beneficiary cost3 |
|||||||
HI |
SMI |
|||||||||
2003 |
2.04 |
1,200,000 |
1.6 |
3.9 |
2.3 |
2.9 |
2.0 |
5.5 |
2.8 |
|
2005 |
2.03 |
1,150,000 |
1.6 |
4.3 |
2.7 |
3.5 |
3.3 |
4.2 |
3.5 |
|
2010 |
2.01 |
1,025,000 |
1.2 |
4.2 |
3.0 |
2.5 |
4.2 |
5.7 |
2.9 |
|
2020 |
1.98 |
950,000 |
1.1 |
4.1 |
3.0 |
1.9 |
4.3 |
5.4 |
2.9 |
|
2030 |
1.95 |
900,000 |
1.1 |
4.1 |
3.0 |
1.9 |
5.9 |
5.5 |
2.9 |
|
2040 |
1.95 |
900,000 |
1.1 |
4.1 |
3.0 |
1.9 |
5.9 |
5.2 |
2.9 |
|
2050 |
1.95 |
900,000 |
1.1 |
4.1 |
3.0 |
1.8 |
5.2 |
4.9 |
2.9 |
|
2060 |
1.95 |
900,000 |
1.1 |
4.1 |
3.0 |
1.8 |
5.4 |
5.4 |
2.9 |
|
2070 |
1.95 |
900,000 |
1.1 |
4.1 |
3.0 |
1.8 |
5.5 |
5.2 |
2.9 |
|
2077 |
1.95 |
900,000 |
1.1 |
4.1 |
3.0 |
1.8 |
5.3 |
5.1 |
2.9 |
|
Estimates made in prior years have sometimes changed substantially because of revisions to the assumptions, which are due either to changed conditions or to more recent experience. Furthermore, it is important to recognize that actual conditions are very likely to differ from the projections presented here, since the future cannot be anticipated with certainty. In order to illustrate the magnitude of the sensitivity of the long‑range projections, six of the key assumptions were varied individually to determine the impact on the HI actuarial present values and net cashflows.6 The assumptions varied are the fertility rate, net immigration, real‑wage differential, CPI, real‑interest rate, and health care cost factors.7
For this analysis, the intermediate economic and demographic assumptions in the 2003 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds are used as the reference point. Each selected assumption is varied individually to produce three scenarios. All present values are calculated as of January 1, 2003 and are based on estimates of income and expenditures during the 75‑year projection period.
Charts 7 through 12 show the net annual HI cashflow in nominal dollars and the present value of this net cashflow for each assumption varied. In most instances, the charts depicting the estimated net cashflow indicate that, after increasing in the early years, net cashflow decreases steadily through 2026 under all three scenarios displayed. On the present value charts, the same pattern is evident, though the magnitudes are lower because of the discounting process used for computing present values.
Fertility Rate
Table 3 shows the net present value of cashflow during the 75‑year projection period under three alternative ultimate fertility rate assumptions: 1.7, 1.95, and 2.2 children per woman.
Table 3—Present Value of Estimated HI Income Less
Expenditures under |
|||
Ultimate fertility rate1 |
1.7 |
1.95 |
2.2 |
Income minus expenditures (in billions) |
-$6,323 |
-$6,166 |
-$6,014 |
As table 3 demonstrates, for every increase of 0.25 in the assumed ultimate fertility rate, the projected deficit of income over expenditures decreases by approximately $150 billion.
Charts 7 and 7A show projections of the net cashflow under the three alternative fertility rate assumptions presented in table 3.
As charts 7 and 7A indicate, the fertility rate assumption has only a negligible impact on projected HI cashflows over the next 30 years. This is because higher fertility in the first year does not affect the labor force until roughly 20 years have passed (increasing HI payroll taxes slightly) and has virtually no impact on the number of beneficiaries within this period. Over the full 75‑year period, the changes are somewhat greater, as illustrated by the present values in table 3.
Net Immigration
Table 4 shows the net present value of cashflow during the 75‑year projection period under three alternative net immigration assumptions: 672,500 persons, 900,000 persons, and 1,300,000 persons per year.
Table 4—Present Value of Estimated HI Income Less Expenditures under |
||||||||
Ultimate net immigration |
672,500 |
900,000 |
1,300,000 |
|||||
Income minus expenditures (in billions) |
-$6,379 |
-$6,166 |
-$5,849 |
As shown in table 4, for every increase of 100,000 persons on the ultimate net immigration assumption, the deficit of income over expenditures decreases by nearly $100 billion.
Charts 8 and 8A show projections of the net cashflow under the three alternative net immigration assumptions presented in table 4.
As charts 8 and 8A indicate, this assumption has an impact on projected HI cashflow starting almost immediately. Because immigration tends to occur among younger individuals, the number of covered workers is affected immediately, while the number of beneficiaries is affected much less quickly. Nonetheless, variations in net immigration result in fairly small differences in cashflow.
Real-Wage Differential
Table 5 shows the net present value of cashflow during the 75‑year projection period under three alternative ultimate real‑wage differential assumptions: 0.6, 1.1, and 1.6 percentage points. In each case, the CPI is assumed to be 3.0 percent, yielding ultimate percentage increases in average annual wages in covered employment of 3.6, 4.1, and 4.6 percent, respectively.
Table 5—Present Value of Estimated HI Income Less
Expenditures under Various |
|||
Ultimate percentage increase in wages ‑ CPI |
3.6 - 3.0 |
4.1 - 3.0 |
4.6 - 3.0 |
Ultimate percentage increase in real-wage differential |
0.6 |
1.1 |
1.6 |
Income minus expenditures (in billions) |
-$6,538 |
-$6,166 |
-$5,816 |
As indicated in table 5, for every half‑point increase in the ultimate real‑wage differential assumption, the deficit of income over expenditures decreases by approximately $360 billion.
Charts 9 and 9A show projections of the net cashflow under the three alternative real‑wage differential assumptions presented in table 5.
As charts 9 and 9A indicate, this assumption has a fairly large impact on projected HI cashflow very early in the projection period. Higher real‑wage differential assumptions immediately increase both HI expenditures for health care and wages for all workers. Though there is a full effect on wages and payroll taxes, the effect on benefits is only partial, since not all health care costs are wage‑related.
Consumer Price Index
Table 6 shows the net present value of cashflow during the 75‑year projection period under three alternative ultimate CPI rate-of-increase assumptions: 2.0, 3.0, and 4.0 percent. In each case, the ultimate real‑wage differential is assumed to be 1.1 percent, yielding ultimate percentage increases in average annual wages in covered employment of 3.1, 4.1, and 5.1 percent, respectively.
Table 6—Present Value of Estimated HI Income Less
Expenditures under |
||||||||
Ultimate percentage increase in wages - CPI |
3.1 - 2.0 |
4.1 - 3.0 |
5.1 - 4.0 |
|||||
Income minus expenditures (in billions) |
-$6,189 |
-$6,166 |
-$6,182 |
Table 6 demonstrates that for every 1‑point change in the ultimate CPI‑increase assumption, the deficit of income over expenditures changes by approximately $20 billion.
Charts 10 and 10A show projections of the net cashflow under the three alternative CPI rate-of-increase assumptions presented in table 6.
As charts 10 and 10A indicate, this assumption has a large impact on projected HI cashflow in nominal dollars but only a negligible impact when the cashflow is expressed as present values. The relative insensitivity of the projected present values of HI cashflow to different levels of general inflation occurs because inflation tends to affect both income and costs equally. In nominal dollars, however, a given deficit “looks bigger” under high‑inflation conditions but is not significantly different when it is expressed as a present value or relative to taxable payroll. This sensitivity test serves as a useful example of the limitations of nominal‑dollar projections over long periods.
Table 7—Present Value of Estimated HI Income Less
Expenditures under |
|||
Ultimate real-interest rate |
2.1 percent |
2.9 percent |
3.6 percent |
Income minus expenditures (in billions) |
-$8,962 |
-$6,166 |
-$4,501 |
As illustrated in table 7, for every increase of 0.1 in the ultimate real‑interest rate percentage, the deficit of income over expenditures decreases by approximately $300 billion.
Charts 11 and 11A show projections of the net cashflow under the three alternative real‑interest assumptions presented in table 7.
As shown in charts 11 and 11A, the present values of the net cashflow are more sensitive to the interest assumption than is the nominal net cashflow. This is not an indication of the actual role that interest plays in HI financing. In actuality, interest finances very little of the cost of the HI trust fund because, under the intermediate assumptions, the fund is projected to be relatively low and exhausted by 2026. These results illustrate the substantial sensitivity of present value measures to different interest rate assumptions. With higher assumed interest, the very large deficits in the more distant future are discounted more heavily (that is, are given less weight), and the overall net present value is smaller.
Health Care Cost Factors
Table 8 shows the net present value of cashflow during the 75‑year projection period under three alternative assumptions of the annual growth rate in the aggregate cost of providing covered health care services to beneficiaries. These assumptions are that the ultimate annual growth rate in such costs, relative to taxable payroll, will be 1 percent slower than the intermediate assumptions, the same as the intermediate assumptions, and 1 percent faster than the intermediate assumptions. In each case, the taxable payroll will be the same as that which was assumed for the intermediate assumptions.
Table 8—Present Value of Estimated HI Income Less
Expenditures under |
|||
Annual cost/payroll relative growth rate |
-1 percentage point |
Intermediate assumptions |
+1 percentage point |
Income minus expenditures (in billions) |
‑$1,583 |
‑$6,166 |
‑$13,684 |
Table 8 demonstrates that if the ultimate growth rate assumption is 1 percentage point lower than the intermediate assumptions, the deficit of income over expenditures decreases by $4,583 billion. On the other hand, if the ultimate growth rate assumption is 1 percentage point higher than the intermediate assumptions, the deficit increases more substantially, by $7,518 billion.
Charts 12 and 12A show projections of the net cashflow under the three alternative annual growth rate assumptions presented in table 8.
This assumption has a dramatic impact on projected HI cashflow. The assumptions analyzed thus far have affected HI income and costs simultaneously. However, several factors, such as the utilization of services by beneficiaries or the relative complexity of services provided, can affect costs without affecting tax income. As charts 12 and 12A indicate, the financial status of the HI trust fund is extremely sensitive to the relative growth rates for health care service costs versus taxable payroll.
Trust Fund Finances and Sustainability
The HI trust fund is substantially out of financial balance in the long range. Under the Medicare Trustees’ intermediate assumptions, income from all sources is projected to continue to exceed expenditures for the next 15 years but to fall short by steadily increasing amounts in 2018 and later. These shortfalls can be met by increasingly drawing on interest payments on invested assets and the redemption of those assets, but only until 2026 when assets would be exhausted. In the absence of corrective legislation, a depleted trust fund would intitially produce payment delays, but very quickly lead to a curtailment of health care services to beneficiaries.
Bringing the HI trust fund into actuarial balance over the next 75 years under the intermediate assumptions would require very substantial increases in revenues and/or reductions in benefits. These changes are needed in part as a result of the impending retirement of the baby boom generation.
The financing established for the SMI trust fund for calendar year 2003, along with a portion of trust fund assets, is estimated to be sufficient to cover expenditures for that year and to still preserve an adequate contingency reserve in the fund. Moreover, for all future years, trust fund income is projected to equal expenditures—but only because beneficiary premiums and government general revenue contributions are set to meet expected costs each year. However, a critical issue for the SMI trust fund is the impact of the past and expected rapid growth of SMI costs, which place steadily increasing demands on beneficiaries and society at large.
The SMI trust fund’s automatic financing provisions prevent crises such as those faced in the mid‑1990s by the HI trust fund, the assets of which were projected to be exhausted in the near future. As a result, there has been substantially less attention directed toward the financial status of the SMI trust fund than to the HI trust fund—even though SMI expenditures have increased faster than HI expenditures in most years and are expected to continue to do so for a number of years in the future.
Medicare Overall
The projections shown in this section continue to demonstrate the need for the Administration and the Congress to address the financial challenges facing Medicare—both the long-range financial imbalance facing the HI trust fund and the continuing problem of rapid growth in SMI expenditures. In their 2003 annual report to Congress, the Medicare Boards of Trustees emphasize the seriousness of these concerns and urge the nation’s policy makers to take "effective and decisive action…to build upon the strong steps taken in recent reforms." They also state: "Consideration of further reforms should occur in the relatively near future."
1Dollar amounts that are not adjusted for inflation or other factors are referred to as "nominal."
2In the financial statements for CMS, Medicare income and expenditures are shown from a "trust fund perspective." All sources of income to the trust funds are reflected, and the actuarial projections can be used to assess the financial status of each trust fund. Corresponding estimates for Medicare and other Federal social insurance programs are also shown in the annual Financial Report of the United States Government, also known as the consolidated financial statement. On a consolidated basis, the estimates are shown from a "Federal budget perspective." In particular, certain categories of trust fund income-primarily interest payments and SMI general revenues-are excluded because they represent intragovernmental transfers, rather than revenues received from the public. Thus, the consolidated financial statement focuses not on the financial status of individual trust funds, but on the overall balance between revenues and outlays for the Federal budget. Each perspective is appropriate and useful for its intended purpose.
3Interest income is generally about 3 percent of total SMI income.
4See footnote 2 regarding the treatment of SMI general revenue income in the consolidated financial statement of the U.S. Government.
5As noted in footnote 2 of CMS's FY 2003 CFO financial report, the actuarial deficit is calculated from a trust fund perspective, reflecting all sources of income and expenditures to or from the HI and SMI trust funds. If, instead, a budget perspective is considered, as used in the consolidated financial statement, one would compare Medicare outlays to the public with revenues received directly from the public. On this basis, transfers to the SMI trust fund from the general fund of the Treasury would be excluded, with the result that the present value of projected SMI expenditures through 2077 would exceed the present value of projected SMI premium revenue alone by $9.6 trillion. When added to the corresponding differential for HI, the present value of expenditures for the Medicare program overall is projected to exceed receipts from the public by $15.8 trillion. This budget impact reflects both (i) the cost to the Federal budget of SMI general revenues provided under current law and (ii) the amount that HI revenues would have to be increased to enable HI benefits to be paid at their currently scheduled level-for which there is no provision in current law.
6Sensitivity analysis is not done for the SMI trust fund due to its financing mechanism. Any change in assumptions would have no impact on the net cashflow, since the change would affect income and expenditures equally.
7The sensitivity of the projected HI net cash flow to variations in future mortality rates is also of interest. At this time, however, relatively little is known about the relationship between improvements in life expectancy and the associated changes in health status and per beneficiary health expenditures. As a result, it is not possible at present to prepare meaningful estimates of the HI mortality sensitivity.
|
|||||||
|
|
CMS |
Other |
|
|||
|
|
Medicare HI |
Medicare SMI |
Medicaid |
OPDIV Budgetary Accounts1 |
OPDIV Combined Totals |
|
Budgetary Resources: |
|
|
|
|
|
|
|
1. Budget Authority |
|
$ 174,752 |
$110,180 |
$ 164,731 |
$ 195,195 |
$ 644,858 |
|
2. Unobligated Balances – Beginning of Period |
|
- |
- |
- |
10,898 |
10,898 |
|
3. Spending Authority from Offsetting Collections |
|
- |
- |
112 |
8,281 |
8,393 |
|
4. Recoveries of prior year obligations |
|
- |
- |
4,445 |
3,231 |
7,676 |
|
5. Temporarily not available pursuant to Public Law |
|
(21,699) |
14,025 |
- |
(270) |
(7,944) |
|
6. Permanently not available (-) |
|
- |
- |
(1,347) |
(8,127) |
(9,474) |
|
7. Total Budgetary Resources |
|
$ 153,053 |
$ 124,205 |
$ 167,941 |
$ 209,208 |
$ 654,407 |
|
|
|
|
|
|
|
|
|
Status of Budgetary Resources: |
|
|
|
|
|
|
|
8. Obligations Incurred |
|
$ 153,053 |
$ 124,205 |
$ 167,941 |
$ 201,218 |
$ 646,417 |
|
9. Unobligated Balances - Available |
|
- |
- |
- |
2,864 |
2,864 |
|
10. Unobligated Balances - Not Available |
|
- |
- |
- |
5,126 |
5,126 |
|
11. Total Status of Budgetary Resources |
|
$ 153,053 |
$ 124,205 |
$ 167,941 |
$ 209,208 |
$ 654,407 |
|
|
|
|
|
|
|
|
|
Relationship of Obligations to Outlays: |
|
|
|
|
|
|
|
12. Obligated Balance, Net – Beginning of Period |
|
$ 968 |
$ 922 |
$ 5,049 |
$ 69,467 |
$ 76,406 |
|
13. Obligated Balance Transferred, Net (+/-) |
|
- |
- |
- |
- |
- |
|
14. Obligated Balance, Net – End of Period |
|
1,228 |
1,072 |
8,797 |
70,749 |
81,846 |
|
|
|
|
|
|
|
|
|
15. Outlays |
|
152,793 |
124,055 |
159,636 |
188,424 |
624,908 |
|
16. Less: Offsetting receipts |
|
1,598 |
26,834 |
- |
11 |
28,443 |
|
17. Net Outlays |
|
$ 151,195 |
$ 97,221 |
$ 159,636 |
$ 188,413 |
$ 596,465 |
|
|
|
|
|
|
|
|
|
|
Summary of Other OPDIV Budgetary Accounts |
||||||
|
|
Budgetary
|
|
Status of |
|
Net |
|
|
|
|
|
|
|
|
|
|
ACF |
$ 50,387 |
|
$ 50,387 |
|
$ 47,527 |
|
|
AoA |
1,318 |
|
1,318 |
|
1,312 |
|
|
AHRQ |
355 |
|
355 |
|
202 |
|
|
CDC |
6,485 |
|
6,485 |
|
5,656 |
|
|
CMS |
99,976 |
|
99,976 |
|
95,195 |
|
|
FDA |
1,911 |
|
1,911 |
|
1,396 |
|
|
HRSA |
7,634 |
|
7,634 |
|
6,354 |
|
|
IHS |
4,403 |
|
4,403 |
|
2,870 |
|
|
NIH |
29,705 |
|
29,705 |
|
22,825 |
|
|
OS |
2,825 |
|
2,825 |
|
1,727 |
|
|
PSC |
835 |
|
835 |
|
302 |
|
|
SAMHSA |
3,374 |
|
3,374 |
|
3,047 |
|
|
|
$209,208 |
|
$209,208 |
|
$188,413 |
1"Other OPDIV Budgetary Accounts" includes the budgetary accounts of the
eleven HHS OPDIVs other than CMS, as well as the remaining
budgetary accounts not reported by CMS under Medicare and
Medicaid.
HHS NIH Combined Assets Fund Balance with Treasury
$ 34 $ 272 $ 306 Accounts Receivable, Net 161 3 164 Property, Plant and Equip, Net 15 119 134 Other Assets 21 14 35 Total Assets $231 $408 $639 Liabilities Accounts Payable $ 50 $ 42 $ 92 Other Liabilities 20 231 251 Total Liabilities $70 $273 $343 Net Position Cumulative Results of Operations $161 $135 $296 Total Liabilities and Net Position $231 $408 $639 Program/Business Line Gross Costs Less: Earned Net Costs HHS Service and Supply Fund Administrative Operations Services
$ 203 $ (189) $ 14 Financial Management Service 48 (59) (11) Human Resources Service 59 (68) (9) Federal Occupational Health 153 (160) (7) Total $463 $(476) $(13) NIH Service and Supply Fund Administrative Services $ 472 $ (490) $ (18) Information Technology 220 (233) (13) Instrumentation Services 11 (11) - Animal Services 47 (48) (1) Total $750 $(782) $(32) The Program Support Center (PSC), a component of the Office of the
Secretary, manages the HHS Service and Supply Fund. The PSC
provides support services to federal agencies on a competitive,
“service-for-fee” basis. Services and products
are available in the areas of Acquisitions, Finance, Medical Supply
Operation, Health Services, Personnel and Payroll and Support
Services. Major customers are other HHS Operating Divisions
and components of many federal agencies including Departments of
Defense, Education, Housing and Urban Development, Interior,
Energy, Labor, State, Transportation, Treasury and other
independent federal organizations.
NIH provides administrative services, which include
facilities management, supply stores, printing and reproduction,
medical arts and photography, procurement, and a wide range of
other research support services. The information Technology
includes the regional data processing center, which sells computing
services and programming services and enterprise IT software
development. Instrumentation Services include biomedical
fabrication and instrumentation activities, which entails creating
highly technical bioengineering structures. The Animal
Services entails purchasing, housing and feeding animals used in
research. NIH’s major customers are the NIH Research
Institutes and Centers and for computer services, the Department of
Defense.
Deferred maintenance is maintenance that was not performed when it
should have been, was scheduled and not performed, or was delayed
for a future period. Maintenance is the act of keeping fixed
assets in acceptable condition, including preventive maintenance,
normal repairs, replacement of parts and structural components and
other activities needed to preserve the asset so that it continues
to provide acceptable services and achieves its expected
life. Maintenance does not include activities aimed at
expanding the capacity of an asset or otherwise upgrading it to
serve needs different from, or significantly greater than, those
originally intended. Maintenance expense is recognized as
incurred. The Centers for Disease Control and Prevention, the
National Institutes of Health, and the Food and Drug Administration
all use the condition assessment survey for all classes of
property. The Indian Health Service uses two types of surveys
to assess installations – annual general inspections and deep
look surveys.U.S. Department of Health and Human Services
Condensed Balance Sheet
Franchise and Intra-Governmental Support Revolving Funds
As of September 30, 2003
(in millions)
Service and
Supply Fund
Service and
Supply Fund
Totals
U.S. Department of Health and Human
Services
Condensed Statement of Net Cost
Franchise and Intra-Governmental Support Revolving Funds
For the Fiscal Year Ended September 30, 2003
(in millions)
Revenue
U.S. Department of Health and Human Services Deferred Maintenance For the Fiscal Years Ended September 30, 2003 and 2002
Category of Asset |
Condition |
Cost to Return to |
|
2003 |
2002 |
||
General PP&E |
|||
Buildings |
3 – 4 |
$618 |
$718 |
Equipment |
4 |
8 |
0 |
Other Structures |
4 |
37 |
16 |
Total |
$663 |
$734 |
Asset Condition is assessed on a scale of 1-5 as follows: Excellent-1; Good-2; Fair-3; Poor-4; Very Poor-5. A “fair” or 3 rating is considered acceptable operating condition. Although PP&E categories may be rated as acceptable, individual assets within a category may require maintenance work to return them to acceptable operating condition. Therefore, asset categories with an overall rating of “fair” or above may still report necessary costs to return them to acceptable condition.
|
|||||
Agency |
TFM Dept |
Fund Bal. |
Investments |
Accounts |
Other1 |
Dept of Agriculture |
12 |
|
|
2 |
4 |
Dept of Commerce |
13 |
|
|
6 |
20 |
Dept of Defense |
17,215,797 |
|
|
200 |
20 |
Dept of Education |
91 |
|
|
8 |
- |
Dept of Energy |
89 |
|
|
14 |
- |
Dept of Housing & Urban Development |
86 |
|
|
14 |
- |
Dept of the Interior |
14 |
|
|
1 |
- |
Dept of Justice |
15 |
|
|
5 |
- |
Dept of Labor |
16 |
|
|
1 |
- |
Dept of State |
19 |
|
|
2 |
- |
Dept of Transportation |
69 |
|
|
1 |
- |
Dept of the Treasury |
20 |
86,289 |
282,350 |
149 |
11,853 |
Dept of Veterans Affairs |
36 |
|
|
5 |
283 |
Agency for International Development |
72 |
|
|
7 |
- |
Environmental Protection Agency |
68 |
|
|
51 |
- |
Dept of Homeland Security |
70 |
|
|
10 |
- |
General Services Admin |
47 |
|
|
2 |
- |
National Aeronautics & Space Admin |
80 |
|
|
1 |
- |
National Science Foundation |
49 |
|
|
1 |
- |
Nuclear Regulatory Commission |
31 |
|
|
- |
- |
Office of Personnel Mgmt |
24 |
|
|
- |
- |
Small Business Admin |
73 |
|
|
- |
- |
Social Security Admin |
28 |
|
|
2 |
- |
RRB |
60 |
|
|
406 |
- |
All other Federal agencies |
|
- |
- |
11 |
- |
Total |
|
$86,289 |
$282,350 |
$899 |
$12,180 |
1Includes Anticipated Congressional Appropriation of $11,830
| ||||
Agency |
TFM Dept |
Accounts |
Accrued Payroll & |
Other |
Dept of Agriculture |
12 |
- |
- |
- |
Dept of Commerce |
13 |
- |
- |
- |
Dept of Defense |
17,215,797 |
6 |
- |
48 |
Dept of Education |
91 |
- |
- |
- |
Dept of Energy |
89 |
- |
- |
2 |
Dept of Housing & Urban Development |
86 |
- |
- |
29 |
Dept of the Interior |
14 |
- |
- |
- |
Dept of Justice |
15 |
- |
- |
10 |
Dept of Labor |
16 |
- |
19 |
- |
Dept of State |
19 |
- |
- |
- |
Dept of Transportation |
69 |
- |
- |
- |
Dept of the Treasury |
20 |
- |
5 |
244 |
Dept of Veterans Affairs |
36 |
- |
- |
1 |
Agency for International Development |
72 |
- |
- |
- |
Environmental Protection Agency |
68 |
- |
- |
26 |
Dept of Homeland Security |
70 |
- |
- |
82 |
General Services Admin |
47 |
15 |
- |
112 |
National Aeronautics & Space Admin |
80 |
- |
- |
- |
National Science Foundation |
49 |
- |
- |
- |
Nuclear Regulatory Commission |
31 |
- |
- |
- |
Office of Personnel Mgmt |
24 |
- |
46 |
- |
Small Business Admin |
73 |
- |
- |
- |
Social Security Admin |
28 |
246 |
- |
- |
RRB |
60 |
- |
- |
- |
All other Federal agencies |
|
4 |
- |
40 |
Total |
|
$271 |
$70 |
$594 |
|
||||||||
Non-exchange Revenue |
||||||||
Agency |
TFM Dept |
Earned |
Gross Cost |
Transfers-In |
Transfers- |
|||
|
|
|
|
|
|
|||
Dept of Agriculture |
12 |
8 |
(10) |
- |
- |
|||
Dept of Commerce |
13 |
10 |
(36) |
- |
- |
|||
Dept of Defense |
17,215,797 |
132 |
(77) |
32 |
- |
|||
Dept of Education |
91 |
6 |
(67) |
- |
- |
|||
Dept of Energy |
89 |
26 |
(54) |
- |
- |
|||
Dept of Housing & Urban Development |
86 |
32 |
- |
- |
- |
|||
Dept of the Interior |
14 |
5 |
(156) |
- |
- |
|||
Dept of Justice |
15 |
43 |
(148) |
- |
- |
|||
Dept of Labor |
16 |
22 |
(31) |
- |
- |
|||
Dept of State |
19 |
4 |
(66) |
- |
- |
|||
Dept of Transportation |
69 |
4 |
(15) |
- |
- |
|||
Dept of the Treasury |
20 |
16 |
(293) |
- |
- |
|||
Dept of Veterans Affairs |
36 |
36 |
(62) |
- |
- |
|||
Agency for International Development |
72 |
31 |
(2) |
- |
- |
|||
Environmental Protection Agency |
68 |
42 |
(4) |
82 |
- |
|||
Dept of Homeland Security |
70 |
177 |
(38) |
- |
- |
|||
General Services Admin |
47 |
6 |
(645) |
- |
- |
|||
National Aeronautics & Space Admin |
80 |
3 |
- |
- |
- |
|||
National Science Foundation |
49 |
2 |
(3) |
- |
- |
|||
Nuclear Regulatory Commission |
31 |
2 |
- |
- |
- |
|||
Office of Personnel Mgmt |
24 |
- |
(1,204) |
- |
- |
|||
Small Business Admin |
73 |
1 |
- |
- |
- |
|||
Social Security Admin |
28 |
9 |
(3) |
2 |
(1,236) |
|||
RRB |
60 |
- |
- |
389 |
(5) |
|||
All other Federal agencies |
|
34 |
(79) |
- |
(9) |
|||
Total |
|
$651 |
$(2,993) |
$505 |
$(1,250) |
|
||||||||||
|
Education, |
Health |
Medicare |
Income |
Admin. of |
Natural Resources & |
OPDIV |
Intra-HHS |
HHS |
|
Assets (Note 2) |
|
|
|
|
|
|
|
|
|
|
Intragovernmental |
|
|
|
|
|
|
|
|
|
|
Fund Balance with Treasury (Note 3) |
$ 6,541 |
$ 64,034 |
$ (384) |
$ 16,074 |
$ 7 |
$ 17 |
$ 86,289 |
$ - |
$ 86,289 |
|
Investments, Net (Note 5) |
- |
2,050 |
280,300 |
- |
- |
- |
282,350 |
- |
282,350 |
|
Accounts Receivable, Net (Note 6) |
4 |
436 |
6,699 |
1 |
- |
- |
7,140 |
(6,241) |
899 |
|
Anticipated Congressional Appropriation (Note 7) |
- |
8,449 |
3,381 |
- |
- |
- |
11,830 |
- |
11,830 |
|
Other (Note 11) |
- |
674 |
3 |
- |
- |
- |
677 |
(327) |
350 |
|
Total Intragovernmental |
$ 6,545 |
$ 75,643 |
$ 289,999 |
$ 16,075 |
$ 7 |
$ 17 |
$ 388,286 |
$ (6,568) |
$ 381,718 |
|
|
|
|
|
|
|
|
|
|
|
|
Accounts Receivable, Net (Note 6) |
- |
764 |
2,053 |
- |
- |
- |
2,817 |
- |
2,817 |
|
Loans Receivable and Foreclosed Property (Note 8) |
- |
387 |
- |
- |
- |
- |
387 |
- |
387 |
|
Cash and Other Monetary Assets (Note 4) |
- |
- |
843 |
- |
- |
- |
843 |
- |
843 |
|
Inventory and Related Property, Net (Note 9) |
- |
93 |
- |
- |
- |
- |
93 |
- |
93 |
|
General Property, Plant & Equipment, Net (Note 10) |
- |
3,236 |
12 |
- |
- |
1 |
3,249 |
- |
3,249 |
|
Other (Note 11) |
- |
23 |
62 |
- |
- |
- |
85 |
- |
85 |
|
Total Assets |
$ 6,545 |
$ 80,146 |
$ 292,969 |
$ 16,075 |
$ 7 |
$ 18 |
$ 395,760 |
$ (6,568) |
$ 389,192 |
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities (Note 12) |
|
|
|
|
|
|
|
|
|
|
Intragovernmental |
|
|
|
|
|
|
|
|
|
|
Accounts Payable |
$ 13 |
$ 105 |
$ 6,355 |
$ 1 |
$ - |
$ - |
$ 6,474 |
$ (6,203) |
$ 271 |
|
Accrued Payroll and Benefits |
2 |
65 |
3 |
- |
- |
- |
70 |
- |
70 |
|
Other (Note 17) |
- |
760 |
199 |
- |
- |
- |
959 |
(365) |
594 |
|
Total Intragovernmental |
$ 15 |
$ 930 |
$ 6,557 |
$ 1 |
$ - |
$ - |
$ 7,503 |
$ (6,568) |
$ 935 |
|
|
|
|
|
|
|
|
|
|
|
|
Accounts Payable |
16 |
866 |
- |
6 |
- |
- |
888 |
- |
888 |
|
Entitlement Benefits Due and Payable (Note 13) |
- |
17,784 |
30,339 |
- |
- |
- |
48,123 |
- |
48,123 |
|
Environmental and Disposal Costs (Note 15) |
- |
39 |
- |
- |
- |
- |
39 |
- |
39 |
|
Accrued Grant Liability (Note 16) |
501 |
1,996 |
- |
1,253 |
- |
2 |
3,752 |
- |
3,752 |
|
Loan Guarantees Liability (Note 8) |
- |
362 |
- |
- |
- |
- |
362 |
- |
362 |
|
Federal Employee and Veterans Benefits (Note 14) |
5 |
6,887 |
10 |
- |
- |
1 |
6,903 |
- |
6,903 |
|
Accrued Payroll and Benefits |
14 |
661 |
43 |
- |
- |
- |
718 |
- |
718 |
|
Other (Note 17) |
(2) |
1,072 |
250 |
17 |
1 |
1 |
1,339 |
- |
1,339 |
|
Total Liabilities |
$ 549 |
$ 30,597 |
$ 37,199 |
$ 1,277 |
$ 1 |
$ 4 |
$ 69,627 |
$ (6,568) |
$ 63,059 |
|
|
|
|
|
|
|
|
|
|
|
|
Net Position |
|
|
|
|
|
|
|
|
|
|
Unexpended Appropriations |
6,022 |
51,139 |
3,425 |
14,799 |
- |
- |
75,385 |
- |
75,385 |
|
Cumulative Results of Operations |
(26) |
(1,590) |
252,345 |
(1) |
6 |
14 |
250,748 |
- |
250,748 |
|
Total Net Position |
$5,996 |
$49,549 |
$255,770 |
$14,798 |
$6 |
$14 |
$326,133 |
$ - |
$ 326,133 |
|
Total Liabilities and Net Position |
$6,545 |
$80,146 |
$292,969 |
$16,075 |
$7 |
$18 |
$395,760 |
$(6,568) |
$389,192 |
|
|||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ACF |
AoA |
AHRQ |
CDC |
CMS |
FDA |
HRSA |
IHS |
NIH |
OS |
PSC |
SAMHSA |
OPDIV Consolidated Totals |
Inter-OPDIV Eliminations |
HHS Consolidated Totals |
Assets (Note 2) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Intragovernmental |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fund Balance with Treasury (Note 3) |
$ 22,073 |
$ 549 |
$ 154 |
$ 4,463 |
$ 18,536 |
$ 688 |
$ 5,945 |
$ 1,428 |
$ 26,581 |
$ 3,264 |
$ 92 |
$ 2,516 |
$ 86,289 |
$ - |
$ 86,289 |
Investments, Net (Note 5) |
- |
- |
- |
- |
280,300 |
- |
2,030 |
- |
20 |
- |
- |
- |
282,350 |
- |
282,350 |
Accounts Receivable, Net (Note 6) |
5 |
- |
5 |
50 |
700 |
27 |
3 |
28 |
19 |
22 |
149 |
4 |
1,012 |
(113) |
899 |
Anticipated Congressional Appropriation (Note 7) |
- |
- |
- |
- |
11,830 |
- |
- |
- |
- |
- |
- |
- |
11,830 |
- |
11,830 |
Other (Note 11) |
- |
- |
- |
305 |
3 |
- |
23 |
- |
20 |
- |
- |
- |
351 |
(1) |
350 |
Total Intragovernmental |
22,078 |
549 |
159 |
4,818 |
311,369 |
715 |
8,001 |
1,456 |
26,640 |
3,286 |
241 |
2,520 |
381,832 |
(114) |
381,718 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts Receivable, Net (Note 6) |
- |
- |
- |
3 |
2,620 |
58 |
4 |
115 |
6 |
- |
7 |
4 |
2,817 |
- |
2,817 |
Loans Receivable and Foreclosed Property (Note 8) |
- |
- |
- |
- |
- |
- |
387 |
- |
- |
- |
- |
- |
387 |
- |
387 |
Cash and Other Monetary Assets (Note 4) |
- |
- |
- |
- |
843 |
- |
- |
- |
- |
- |
- |
- |
843 |
- |
843 |
Inventory and Related Property, Net (Note 9) |
- |
- |
- |
51 |
- |
- |
- |
9 |
12 |
- |
21 |
- |
93 |
- |
93 |
General Property, Plant & Equipment, Net (Note 10) |
- |
- |
- |
486 |
13 |
292 |
1 |
795 |
1,618 |
29 |
15 |
- |
3,249 |
- |
3,249 |
Other (Note 11) |
- |
- |
- |
2 |
72 |
- |
- |
- |
4 |
7 |
- |
- |
85 |
- |
85 |
Total Assets |
$ 22,078 |
$ 549 |
$ 159 |
$ 5,360 |
$ 314,917 |
$ 1,065 |
$ 8,393 |
$ 2,375 |
$ 28,280 |
$ 3,322 |
$ 284 |
$ 2,524 |
$ 389,306 |
$ (114) |
$ 389,192 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities (Note 12) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Intragovernmental |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts Payable |
$ 12 |
$ 1 |
$ 3 |
$ - |
$ 246 |
$ 11 |
$ 18 |
$ 3 |
$ 6 |
$ 36 |
$ 2 |
$ 8 |
$ 346 |
$ (75) |
$ 271 |
Accrued Payroll and Benefits |
2 |
- |
- |
6 |
3 |
8 |
3 |
16 |
20 |
5 |
6 |
1 |
70 |
- |
70 |
Other (Note 17) |
- |
- |
11 |
113 |
233 |
50 |
43 |
52 |
49 |
- |
- |
82 |
633 |
(39) |
594 |
Total Intragovernmental |
$ 14 |
$ 1 |
$ 14 |
$ 119 |
$ 482 |
$ 69 |
$ 64 |
$ 71 |
$ 75 |
$ 41 |
$ 8 |
$ 91 |
$ 1,049 |
$ (114) |
$ 935 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts Payable |
21 |
1 |
11 |
296 |
- |
67 |
23 |
45 |
304 |
46 |
48 |
26 |
888 |
- |
888 |
Entitlement Benefits Due and Payable (Note 13) |
- |
- |
- |
- |
48,123 |
- |
- |
- |
- |
- |
- |
- |
48,123 |
- |
48,123 |
Environmental and Disposal Costs (Note 15) |
- |
- |
- |
3 |
- |
5 |
- |
23 |
8 |
- |
- |
- |
39 |
- |
39 |
Accrued Grant Liability (Note 16) |
1,669 |
86 |
15 |
170 |
- |
1 |
384 |
14 |
1,280 |
146 |
- |
(13) |
3,752 |
- |
3,752 |
Loan Guarantees Liability (Note 8) |
- |
- |
- |
- |
- |
- |
362 |
- |
- |
- |
- |
- |
362 |
- |
362 |
Federal Employee and Veterans Benefits (Note 14) |
5 |
- |
1 |
20 |
11 |
22 |
36 |
86 |
65 |
26 |
6,605 |
26 |
6,903 |
- |
6,903 |
Accrued Payroll and Benefits |
13 |
1 |
3 |
90 |
46 |
94 |
30 |
114 |
258 |
34 |
29 |
6 |
718 |
- |
718 |
Other (Note 17) |
16 |
(1) |
(1) |
31 |
256 |
149 |
688 |
129 |
72 |
1 |
- |
(1) |
1,339 |
- |
1,339 |
Total Liabilities |
$ 1,738 |
$ 88 |
$ 43 |
$ 729 |
$ 48,918 |
$ 407 |
$ 1,587 |
$ 482 |
$ 2,062 |
$ 294 |
$ 6,690 |
$ 135 |
$ 63,173 |
$ (114) |
$ 63,059 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net Position |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Unexpended Appropriations |
20,359 |
462 |
10 |
4,203 |
13,441 |
407 |
5,063 |
1,297 |
24,635 |
3,049 |
40 |
2,419 |
75,385 |
- |
75,385 |
Cumulative Results of Operations |
(19) |
(1) |
106 |
428 |
252,558 |
251 |
1,743 |
596 |
1,583 |
(21) |
(6,446) |
(30) |
250,748 |
- |
250,748 |
Total Net Position |
$ 20,340 |
$ 461 |
$ 116 |
$ 4,631 |
$ 265,999 |
$ 658 |
$ 6,806 |
$ 1,893 |
$ 26,218 |
$ 3,028 |
$ (6,406) |
$ 2,389 |
$ 326,133 |
$ - |
$ 326,133 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Liabilities and Net Position |
$22,078 |
$549 |
$159 |
$5,360 |
$314,917 |
$1,065 |
$8,393 |
$2,375 |
$28,280 |
$3,322 |
$284 |
$2,524 |
$389,306 |
$(114) |
$389,192 |
|
|||||
|
2003 |
||||
|
OPDIV |
Inter-OPDIV Eliminations |
HHS |
||
|
Consolidated |
|
Earned/Exchange |
Consolidated |
|
Responsibility Segments |
Totals |
Costs (-) |
Revenues (+) 1 |
Totals |
|
|
|
|
|
|
|
ACF |
$ 47,615 |
$ (31) |
$ 9 |
$ 47,593 |
|
AoA |
1,317 |
(2) |
- |
1,315 |
|
AHRQ |
217 |
(9) |
103 |
311 |
|
CDC |
5,279 |
(92) |
219 |
5,406 |
|
CMS |
416,198 |
(193) |
4 |
416,009 |
|
FDA |
1,409 |
(83) |
35 |
1,361 |
|
HRSA |
6,707 |
(87) |
28 |
6,648 |
|
IHS |
3,109 |
(88) |
27 |
3,048 |
|
NIH |
23,051 |
(423) |
95 |
22,723 |
|
OS |
2,023 |
(64) |
207 |
2,166 |
|
PSC |
345 |
(17) |
225 |
553 |
|
SAMHSA |
3,034 |
(30) |
25 |
3,029 |
|
Net Cost of Operations |
$ 510,304 |
$ (1,119) |
$ 977 |
$ 510,162 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2002 Restated |
||||
|
OPDIV |
Inter-OPDIV Eliminations |
HHS |
||
|
Consolidated |
|
Earned/Exchange |
Consolidated |
|
Responsibility Segments |
Totals |
Costs (-) |
Revenues (+) 1 |
Totals |
|
|
|
|
|
|
|
ACF |
$ 45,959 |
$ (27) |
$ 4 |
$ 45,936 |
|
AoA |
1,104 |
(2) |
- |
1,102 |
|
AHRQ |
276 |
(5) |
- |
271 |
|
CDC |
4,553 |
(113) |
93 |
4,533 |
|
CMS |
384,924 |
(46) |
1 |
384,879 |
|
FDA |
1,298 |
(78) |
19 |
1,239 |
|
HRSA |
5,825 |
(102) |
27 |
5,750 |
|
IHS |
2,882 |
(29) |
20 |
2,873 |
|
NIH |
20,575 |
(438) |
93 |
20,230 |
|
OS |
1,285 |
(73) |
115 |
1,327 |
|
PSC |
936 |
(22) |
208 |
1,122 |
|
SAMHSA |
2,905 |
(34) |
9 |
2,880 |
|
Net Cost of Operations |
$ 472,522 |
$ (969) |
$ 589 |
$ 472,142 |
|
|
|
|
|
|
1Eliminations for non-exchange revenue are reported in the Statement of Changes in Net Position
|
||||||||||
|
Education, |
Health |
Medicare |
Income |
Admin of |
Natural |
OPDIV |
Intra-HHS
|
HHS |
|
|
||||||||||
Responsibility Segments: |
Cost (-) |
Revenue |
||||||||
|
|
|
|
|
|
|
|
|
|
|
ACF |
$ 10,595 |
$ - |
$ - |
$ 37,021 |
$ (1) |
$ - |
$ 47,615 |
$ (31) |
$ 9 |
$ 47,593 |
AoA |
1,317 |
- |
- |
- |
- |
- |
1,317 |
(2) |
- |
1,315 |
AHRQ |
- |
217 |
- |
- |
- |
- |
217 |
(9) |
103 |
311 |
CDC |
- |
5,278 |
- |
- |
- |
1 |
5,279 |
(92) |
219 |
5,406 |
CMS |
- |
166,124 |
250,074 |
- |
- |
- |
416,198 |
(193) |
4 |
416,009 |
FDA |
- |
1,409 |
- |
- |
- |
- |
1,409 |
(83) |
35 |
1,361 |
HRSA |
- |
6,707 |
- |
- |
- |
- |
6,707 |
(87) |
28 |
6,648 |
IHS |
- |
3,109 |
- |
- |
- |
- |
3,109 |
(88) |
27 |
3,048 |
NIH |
- |
23,051 |
- |
- |
- |
- |
23,051 |
(423) |
95 |
22,723 |
OS |
- |
2,023 |
- |
- |
- |
- |
2,023 |
(64) |
207 |
2,166 |
PSC |
- |
345 |
- |
- |
- |
- |
345 |
(17) |
225 |
553 |
SAMHSA |
- |
3,034 |
- |
- |
- |
- |
3,034 |
(30) |
25 |
3,029 |
|
|
|
|
|
|
|
|
|
|
|
Net Cost of Operations |
$ 11,912 |
$ 211,297 |
$ 250,074 |
$ 37,021 |
$ (1) |
$ 1 |
$ 510,304 |
$ (1,119) |
$ 977 |
$ 510,162 |
|
|||||||||
Responsibility |
Intragovernmental |
With the Public |
HHS Consolidated |
||||||
Gross Cost |
Less: Exchange Revenue |
Gross Cost |
Less: Exchange Revenue |
||||||
Combined |
Eliminations |
Consolidated |
Combined |
Eliminations |
Consolidated |
||||
|
|
|
|
|
|
|
|
|
|
ACF |
$ 153 |
$ (48) |
$ 105 |
$ 30 |
$ (26) |
$ 4 |
$ 47,492 |
$ - |
$ 47,593 |
AoA |
12 |
(2) |
10 |
- |
- |
- |
1,305 |
- |
1,315 |
AHRQ |
31 |
(9) |
22 |
103 |
(103) |
- |
289 |
- |
311 |
CDC |
549 |
(100) |
449 |
355 |
(227) |
128 |
5,086 |
1 |
5,406 |
CMS |
479 |
(193) |
286 |
6 |
(4) |
2 |
444,216 |
28,491 |
416,009 |
FDA |
471 |
(83) |
388 |
42 |
(35) |
7 |
1,226 |
246 |
1,361 |
HRSA |
408 |
(94) |
314 |
90 |
(35) |
55 |
6,517 |
128 |
6,648 |
IHS |
396 |
(90) |
306 |
80 |
(29) |
51 |
3,437 |
644 |
3,048 |
NIH |
2,616 |
(1,926) |
690 |
1,652 |
(1,598) |
54 |
22,136 |
49 |
22,723 |
OS |
310 |
(71) |
239 |
241 |
(214) |
27 |
1,952 |
(2) |
2,166 |
PSC |
99 |
(26) |
73 |
475 |
(234) |
241 |
738 |
17 |
553 |
SAMHSA |
141 |
(30) |
111 |
107 |
(25) |
82 |
3,000 |
- |
3,029 |
Totals |
$ 5,665 |
$ (2,672) |
$ 2,993 |
$ 3,181 |
$ (2,530) |
$ 651 |
$ 537,394 |
$ 29,574 |
$ 510,162 |
Last revised: January 16, 2004