SOCIAL SECURITY ADMINISTRATION BALTIMORE, MD 21235-0001

SOCIAL SECURITY

Office of the Chief Actuary

September 23, 2022

The Honorable Kathy Castor

United States House of Representatives

Washington, D.C. 20515

Dear Representative Castor:

I am writing in response to your request for estimates of the financial effects on Social Security 

of enacting H.R. 3183, the Metastatic Breast Cancer Access to Care Act, which you introduced 

on May 13, 2021. The estimates provided here reflect our understanding of the intended effects 

for Social Security beneficiaries from enacting the provisions of the bill consistent with the 

intermediate assumptions of the 2022 Social Security Trustees Report. We note that while the 

bill indicates that changes would apply for “disability insurance benefits,” which might be 

interpreted as only benefits payable from the Disability Insurance (DI) Trust Fund, we 

understand from your staff that the provisions are also intended to apply for disability benefits 

payable from the Old-Age and Survivors Insurance (OASI) Trust Fund, including benefits 

payable to disabled surviving spouses. We have enjoyed working with Nora Blalock of your staff 

in evaluating this proposal. The estimates and analysis provided here reflect the combined effort 

of many in the Office of the Chief Actuary, but particularly Craig Feinstein, Michael Stephens, 

Chris Chaplain, and Karen Glenn.

Enactment of this proposal would eliminate the 5-month waiting period for receipt of Social 

Security disabled worker and disabled surviving spouse benefits based on entitlement with a 

diagnosis of metastatic breast cancer. In addition to accelerating the availability of monthly 

Social Security benefits for qualifying individuals, enactment of this proposal would eliminate 

the 24-month waiting period for eligibility for Medicare coverage, thus accelerating Medicare 

entitlement by a total of 29 months. Our estimates presented here do not include the direct 

financial effects on the Medicare program. For this estimate, we assume that both waiting 

periods would be eliminated for initial applications for Social Security disabled worker, disabled 

surviving spouse, and disabled adult child benefits filed on January 1, 2023 or later.1

Over the long-range 75-year projection period, we estimate that the net effect of enacting the bill 

on the Social Security (OASDI) program would be negligible (i.e., less than 0.005 percent of 

taxable payroll for each year and over the period as a whole).

1 Note that disabled adult child beneficiaries are subject to the 24-month Medicare waiting period but not the 5-

month Social Security waiting period. We assume elimination of the 24-month Medicare waiting period alone would 

have a negligible effect on entitlement for Social Security disabled adult child benefits (i.e., a change of less than 

$500,000). 
Page 2 – The Honorable Kathy Castor

Over the 10-year period 2023 through 2032, we estimate that DI benefits for disabled workers

and their dependents would be increased by a total of $928 million, and that OASI benefits for 

disabled surviving spouses would be increased by a total of $6 million. We further estimate a net

reduction in OASI benefits of $25 million over the same period, reflecting the fact that some of 

the additional benefits paid based on disabled worker benefit entitlement would be in lieu of 

OASI benefits that would otherwise be paid to the same individuals under current law. The net 

effect on the benefits paid by the combined OASI and DI Trust Funds would be an increase of 

$909 million over the period 2023 through 2032. The net effect on the trust funds would be 

slightly less over the period due to the combined effects of: (1) revenue that would be transferred 

to the trust funds based on income taxation of the additional benefits, (2) reductions in interest 

earned by the invested assets of the trust funds, and (3) increases in administrative expenses. The 

table below shows the estimated net changes in OASI and DI benefit payments for each calendar 

year 2023 through 2032.

We hope these estimates are helpful. Please let me know if we may provide further assistance.

Sincerely,

 Stephen C. Goss, ASA, MAAA

Chief Actuary

Estimated Net Change in OASI and DI Benefit Cost in Millions, Calendar Years 2023 through 2032

Program 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2023-27 2023-32

OASI 

(a/)

(b/) (b/) (b/) (b/) -$1 -$2 -$3 -$4 -$4 -$5 -$1 -$19

DI $37 $60 $78 $90 100 104 108 111 117 123 365 928

OASDI 37 60 78 90 99 103 105 107 112 118 364 909

a/ Net effects of changes in benefit cost to retired workers, their dependents, and disabled surviving spouses.

b/ Between -$500,000 and $500,000.

Note: Components may not sum to totals because of rounding.