Administrative Burdens Exacerbate Inequities and Must Be Reduced
“When agencies work to mitigate administrative burden, their efforts can significantly enhance their ability to comprehensively advance equity, meet the needs of underserved communities, and improve operational efficiencies.” – Study to Identify Methods to Assess Equity: Report to the President, July 2021
One of the first actions President Biden took after his inauguration was to issue an Executive Order committing the federal government to advancing racial equity and supporting underserved communities. A July report to the President from the Office of Budget and Management responds to this order by examining methods agencies may use to assess equity and recommending actions for improvement.
One key finding of the report is that administrative burden – the time and energy spent accessing and maintaining enrollment in public benefits – creates barriers to access that are greatest for those who need the benefits the most, and therefore exacerbates inequality. Over the years, CLASP has worked with both states and advocates through Work Support Strategies (WSS) and Advancing Strategies to Align Programs (ASAP) projects to reduce administrative burden in public benefit programs, and our experience aligns with the findings in the report.
Administrative burdens — time spent waiting in offices, sitting on hold on the phone, or tracking down documentation, money spent traveling to appointments or paying for help filling out forms — make it more difficult for eligible people to access the supports they need to afford food, receive medical care, or have child care assistance or cash to help make ends meet. Systemic racism throughout our country’s history has caused Black people and other communities of color to be more likely to have incomes under or near poverty. And too often, government policy has reinforced systemic racism rather than combating it.
Policies from redlining in the housing system, funding formulas for public education, to tying health insurance to full-time employment, have meant that most people of color haven’t had access to the same opportunities that most white people have—resulting in disparate outcomes and income levels. We have built a two-tier benefit system, where people with higher incomes have their retirement, housing, and health care subsidized through the tax system, while people with lower incomes must seek help through more burdensome – and stigmatized – public benefit programs. As a result, people of color are overrepresented among the enrollees of benefit programs.
Because of the systemic and historical aspects of public benefits eligibility – particularly that it’s means-tested and people must prove their “worthiness,” administrative burdens fall more heavily on people accessing public benefit programs. A family with Medicaid for their health insurance faces significantly different barriers to enrollment than my family does enrolling in employer-sponsored insurance. I fill out a form with our family members’ names, birthdates, and other identifying information. I submit the paper and have insurance for the next year. I don’t have to submit any income information or proof of where I live. If I move and my insurance company receives returned mail from me, they don’t drop my insurance, they find my new address. I don’t have to make phone calls to ensure my paperwork was processed and everything is in order. I don’t have to report household income changes throughout the year. If my family were insured through Medicaid, we’d face the numerous obstacles detailed above.
Even among those who are eligible for public benefits, administrative burdens fall hardest on those who are economically marginalized. For example, both income reporting requirements and work reporting requirements are most burdensome for those whose work hours and earnings fluctuate. Online reporting is harder for those without home computers. Attending meetings in person is harder for those with disabilities, or without reliable transportation. Reducing these barriers across programs, not only in Medicaid, is an equity issue.
The OMB report provides concrete steps agencies states can take to reduce administrative burden and improve equity, starting with a “burden audit.” Other recommendations include improving application forms, reducing the need for documents to be provided and verified by the state, streamlining processes, and improving communication. More ideas can also be found in our ASAP guide to using Administrative Advocacy to Improve Access to Benefits.
Policymakers and administrators often justify requirements that increase administrative burdens in the name of program integrity, but why should that burden fall to the public? What if we held the agencies that administer programs accountable for ensuring that people who are eligible for programs can easily enroll? We are pleased to see the Biden-Harris Administration highlighting the problem of administrative burden and look forward to seeing them use the resources of the federal government to combat it.