If you’ve ever tried to get one of the many benefits offered by the federal government to help people out in need, you’ve probably run into a thorny problem: time-consuming and often confusing paperwork.
The federal government offers a plethora of benefits designed to help alleviate poverty and help those in dire straits, whether it’s Medicaid, disability, food assistance, unemployment insurance ― or any of the thousands of other programs offered from farm loans to disaster relief. But too often, the discovery and application processes are designed not to facilitate enrollment, but rather to hinder those trying to sign up.
Fewer than 50% of those eligible for Medicaid are signed up for it. More than half of those potentially eligible for unemployment insurance in 2022 did not apply because they weren’t aware they were eligible. And 28% of those eligible for supplemental food assistance ― colloquially known as food stamps ― do not receive it. Recent scholarship from academics and government agencies shows that paperwork burdens and informational hurdles impose a real cost on people seeking to access benefits, reducing enrollment, kicking people off of programs they’re eligible for, and making it hard to learn about them in the first place. And these costs perpetuate inequality and poverty.
The Biden administration is finally trying to do something about this.
In an executive order issued in 2021, President Joe Biden directed agencies to reduce burdens and improve customer experience for government benefit programs with the aim of helping everyone who is eligible to be able to access and receive benefits.
“Biden is really the first to try to tackle this as a whole in the agencies across the executive branch,” said Pamela Herd, an expert on administrative burdens at Georgetown University.
This is part of Biden’s hope to restore faith in government by showing that it can work for Americans. Making government work requires doing the big things, like the new industrial policy vision embedded in the Inflation Reduction Act and CHIPS Act, and also the small things, like eliminating barriers people face to get health care or housing or unemployment insurance.
While agencies have been taking on this work for some time, this is the first presidential directive running through the Office of Management and Budget (OMB) that seeks to make burden reduction a permanent part of the culture of the federal bureaucracy.
Agencies are already responding by increasing outreach to underserved communities eligible for unemployment insurance, streamlining disability renewal applications, reducing paperwork for those impacted by disasters, making it easier to access student loan relief, and increasing cross-agency information sharing. These may appear to be minor changes at first glance, but the overall effort marks a sea-change away from the days when agencies were primarily concerned with fighting the waste, fraud and abuse mythologized by Ronald Reagan in his welfare queen myth.
“This is a really big paradigm shift because part of Reaganomics was not just trickle down, but also the period of the welfare queen with attacks on people who were relying on the safety net and really trying to kick people off the rolls as much as possible,” said K. Sabeel Rahman, who helped spearhead this policy as associate administrator of the Office of Information and Regulatory Affairs under Biden until January 2023. “What you’re seeing with this administration is a very different mentality.”
The Time Tax
You’ve probably heard the old aphorism that “time is money.” In its American attribution to Benjamin Franklin, the saying upholds the protestant ethic that one should not waste time in idleness, and instead spend it working to earn money.
In the case of government benefit programs, time is wasted on paperwork ― finding it, understanding it, filling it out, obtaining necessary documentation and answering psychologically distressing questions ― and often at a time when you are in greatest need.
The imposition of unnecessary paperwork burdens on those seeking benefits operates as a tax on the time of those who need help, as journalist Annie Lowery put it in a 2021 article for The Atlantic: “At some point, I started thinking about these kinds of administrative burdens as the ‘time tax,’” she wrote. This “time tax” acts as “a public-policy cancer, mediating every American’s relationship with the government and wasting countless precious hours of people’s time.”
The Biden administration’s effort to root out this cancer runs through a 1980 law called the Paperwork Reduction Act: This law created the Office of Information and Regulatory Affairs (OIRA) inside of OMB, and gave it the charge of overseeing agency efforts to reduce paperwork burdens when the public interacts with the government. However, the law has mostly been used to reduce paperwork burdens for businesses when they deal with the government.
“The focus has tended to be on reducing burdens for small businesses, which is a worthy goal, but you saw less of what we’re seeing from the Biden administration now,” said Bridget Dooling, a professor at The Ohio State University Moritz School of Law and a former deputy chief at OIRA.
Officials in the Biden administration looked at this failure to apply the law to how actual people interact with the government, and concluded they weren’t living up to the letter of the law.
“This is one of those things where the government has really not been meeting that statutory mandate from Congress if we’re not evaluating burden in this way,” Rahman said.
The change in direction follows an increase in scholarship on the issue of administrative burdens over the past decade, which informed the administration’s new goalposts.
“There wasn’t this agenda or framework or ideas that communicated that this was a big deal,” said Don Moynihan, a social science professor at Georgetown University, who along with Herd published the book Administrative Burden: Policymaking By Other Means, which brought together disparate research and data on how burdens created gaps in enrollment for eligible populations.
Now, the government would use this research, and the law already on the books, to fulfill a promise to deliver benefits to the American people.
“How can we help [the] government to better serve underserved communities and vulnerable communities?” Rahman said. “The burden reduction initiative is something that emerged pretty quickly.”
According to OMB, the American public spent a collective over 10 billion hours each year responding to federal government requests for information from 2018-2021. The administrative burdens created by these requests appear in different forms for different people as they seek to access benefits.
First, someone seeking benefits simply has to know they exist. This learning cost routinely reduces applications. One study found that 43% of people eligible for the earned income tax credit, which covers low-to-moderate income households, didn’t know about it.
Once you know about the program, then come the compliance costs: the amount of time and effort it takes to gather documentation in order to qualify for the program. Applicants for the Women, Infants and Children food assistance program, for example, are required to attend numerous in-person meetings and clinical evaluations, which requires flexible work scheduling and child care many working people don’t have. The same goes for those seeking Social Security disability benefits.
“[My physicians] told me I had over 1,000 pages of medical records” documenting her disability, one recipient told the Center for American Progress. However, the disability examiner sent her to see a different doctor who “spoke to me for five minutes, didn’t touch me … and then advised the Social Security office that they did not agree that I was disabled.”
This process can also impose psychological costs through stressful time management and intrusive questions.
Senior citizens face burdens in applying for SNAP because they may need to calculate medical expenses into their income to prove eligibility, which requires the collection of documentation from providers. Some programs, like SNAP, can have such confusing requirements that even social workers helping applicants have a hard time navigating them. And for so many others, they are simply unaware that they are eligible.
To begin to solve these issues, OIRA issued guidance to agencies with directions to gather information from current benefit recipients and those who are eligible, but have, for whatever reason, not signed up to work collaboratively with other agencies and to develop new tools to help the public access benefits.
“People recognize forms are annoying, but the real extent that it can dissuade people can be surprising.”
– Sam Berger, associate administrator for the Office of Information and Regulatory Affairs
The guidance also provided a new cost calculation for agencies to use when judging the amount of time it takes for people to fill out forms. Previously, agencies simply calculated the amount of time it would take to fill out the forms provided. Now, agencies are asked to calculate learning costs, compliance costs and psychological costs.
“We’re trying to make it easier for people to get benefits they deserve,” Sam Berger, the current associate administrator for OIRA, said. “People recognize forms are annoying, but the real extent that it can dissuade people can be surprising.”
That became clear when the Social Security Administration sought feedback in the fall of 2021 from disability benefit recipients about the program’s recertification process. Every few years, disability recipients are required to submit documentation to retain their benefits. This process can be extremely onerous. One recipient told the agency that it was, “More frightening than having cancer ― twice.” Others described it as inducing “anxiety,” “fear,” and “dread.”
This led the Social Security Administration to greatly change the recertification form by shortening it by one-fifth, prepopulating information already on file, allowing recipients to file online and removing the psychologically burdensome essay questions like, “Describe what you do in a typical day” and “Do you have any hobbies or interests?” in 2023.
The changes to the SSA’s disability recertification process is one of a handful of burden reduction efforts adopted in response to Biden’s executive order that OIRA highlighted in a progress report released in July.
Other policy efforts highlighted in the report include the Department of Labor’s grants to states to help them better reach people eligible for unemployment benefits but not receiving them; a 20 million hour paperwork reduction effort by the Department of Homeland Security at points of contact like airport security and immigration offices; and the Department of Education’s simplification of the process to discharge student loan debt for the total or permanently disabled, among others.
The Department of Education’s new process for discharging student loan debt for those who qualify with a total and permanent disability is instructive in showing how burden reduction efforts provide immediate help, how this process has been ongoing but turbocharged under Biden and in highlighting existing challenges.
Previously, the process for disabled people to get their debt discharged required them to prove their disability through the submission of proper medical documentation and earnings data by themselves and their physicians. This system let hundreds of thousands of applicants and people who were eligible, but did not apply, fall through the cracks.
In 2012, the agency allowed applicants who were already approved to receive disability benefits from the Social Security Administration to use that status when applying for the debt discharge. Then, in 2016, these two agencies entered into a data-sharing agreement that enabled the Department of Education to send letters to approved disability benefit recipients telling them to apply for the debt discharge program. Still, hundreds of thousands who were eligible did not apply.
Instead of relying on this nudge to get eligible people to apply, the Biden administration simply removed the application process entirely and automatically discharged the debt of everyone who was already approved by Social Security as disabled. Since then, 450,000 people have seen their student loan debt automatically discharged.
This process shows two key ways the government can reduce burdens and improve benefit delivery by, one, automating approval instead of relying on nudges and, two, using crossagency data-sharing to do so. Getting agencies to share their data is itself a challenge.
“One of the biggest hurdles is figuring out ways for agencies to really effectively work with each other,” Herd said.
In some cases, agencies may be reluctant to share data to help another agency because they have different statutory goals. There may also be privacy concerns that need to be addressed before data can be shared. And, for probably the most important data available ― held by the IRS ― privacy laws prevent cross-agency sharing without statutory approval.
“Congress should lay out some general principles that reflect the 21st century when it comes to data sharing and give some license for agencies to think about how to share data that helps members of the public,” Moynihan said.
A stand-out example of agencies working together, according to Herd, is the current data-sharing effort by the Department of Agriculture’s Food And Nutrition Service, which oversees food assistance programs, and the Center for Medicare and Medicaid Services that aims to increase enrollment in the Women, Infants, and Children (WIC) nutrition program. This program encourages states to enact strong data-sharing agreements and is backed with money from the American Rescue Plan.
But it also highlights a key problem for the Biden administration’s burden reduction efforts: federalism.
Many of the most important safety-net benefit programs are funded through the federal government, but administered by the states. That means there is great variability in the delivery of programs like Medicaid, unemployment insurance, food assistance and direct-support for families that can be based on political considerations and ideology. This was evident in the chaos that ensued during the pandemic when unemployment systems across the country faced different pressures.
“Federalism is one reason why it’s just harder to reduce burdens in U.S. government,” Moynihan said. “You’ve added extra veto points to the process and sometimes the actors involved don’t want the programs to succeed.”
That doesn’t mean it’s impossible though. In making this an agency priority, Biden’s executive order created “this huge ripple effect where the federal government is a first mover,” Rahman said. That’s a signal to states that they should look to the best practices coming out of the federal government for how to better administer their programs.
The government can also deploy carrots and sticks to get states to act. With money from the American Rescue Plan, the Department of Labor provided the carrot of grants to states to help them increase uptake in their unemployment insurance programs among underserved communities. On the other hand, the federal government could deploy the stick of its waiver power and reject state plans that would increase burdens to access these programs.
But there are limits here, especially for the use of sticks. When Biden came into office, his administration used its waiver power to rescind work requirement rules for Medicaid imposed by 10 states. But after Georgia sued and won in federal district court, the administration declined to appeal ― likely fearing a broader ruling against it affecting the whole nation.
This issue is now evident in the great unwinding of the pandemic emergency safety-net expansion. The pandemic saw the federal government greatly expand benefits and eliminate burdens to access to keep people whole during the worst of the emergency. This helped government agencies see how important reducing burdens could be. But now, with that expansion receding, millions are now losing benefits solely due to administrative errors and unnecessary burdens.
“The big story right now is Medicaid,” Herd said.
During the pandemic, the government temporarily eased access to Medicaid by lowering burdens to access and allowing coverage to continue without the need to reestablish eligibility. This increased the Medicaid rolls by more than 20 million from 2020 to 2023 ― an increase as large as that seen after the passage of the Affordable Care Act. With the end of the public emergency declaration, that is all being unwound.
“What we’re seeing on the ground is complete chaos,” Herd said. “States are starting to go through the process again, and we’re now up to 7 or 8 million people who’ve lost service. What’s consistent about it is that close to 70% of the people are losing those benefits for procedural reasons, meaning no one’s actually documented that they’re not still eligible, there’s just some administrative flaw.”
The Biden administration publicly released letters to all state Medicaid agencies in August directing them to ensure eligible beneficiaries are not kicked off the rolls simply for administrative reasons, and threatened them with punitive action if they don’t act to fix these administrative errors. But, as in the case of Georgia’s Medicaid work requirements, the conservative federal courts look unfavorably on the federal government imposing too many restrictions and requirements on state-run programs.
In the face of all of these challenges, those who study the role of administrative burdens are incredibly optimistic about the Biden administration’s burden reduction program.
“The administration has been remarkably aggressive at making government more attentive to the negative experiences that people encounter when they interact with government and trying to make those experiences better,” Moynihan said. “I haven’t seen another administration commit this much effort to the topic any time in the past.”
The end goal, according to Herd, is for benefit programs to have the same uptake as the Social Security retirement program, where 97% of eligible recipients receive it.
“That should be the end goal,” Herd said. “That everyone eligible for these programs is actually receiving benefits, and they’re not spending enormous amounts of time and energy to have access to those benefits.”
She thinks that it’s possible to get “pretty close” to reaching this goal “without huge statutory changes.”
But it’s going to take time. The effort remains in its infancy and agencies will need to continue to experiment and build institutional muscle-memory to ensure that this project becomes ingrained in all bureaucratic decision-making.
“If you look 10 years down the line, it’s normal for government employees when they’re designing program implementation choices to really think about the user experience and to put themselves in the shoes of the members of the public,” Moynihan said. “That will be a triumph.”