Americans support administrative burdens for tax-funded program integrity but also want more efficiency

Policymakers who want the broadest public support for their social support programs should consider a trade-off of between lower enrollment and increasing program integrity, according to a researcher with the Texas A&M University School of Public Health.

That’s because a major survey found that adults in the United States want to ensure the integrity of taxpayer-funded safety nets such as Medicare, Social Security and unemployment insurance while also ensuring access to these programs by those who need them.

“The balance here concerns the issue of administrative burden—the cost in terms of time and effort that it takes someone to learn about, enroll in and use these programs—which can be significant,” said Simon Haeder, PhD, with the Department of Health Policy & Management.

Haeder and a colleague with Utah Valley University conducted the study, which was published in the Policy Studies Journal.

Overseeing social benefit programs is one of the major functions of modern governments, but enrollment rarely automatic. Many programs require applicants to take additional steps, such as interviewing or providing government documents to verify their identity. These tasks to access benefits can be time consuming and challenging. Once enrolled, participants often face obstacles such as ongoing documentation requirements and the need to keep contact and income information updated.

These obstacles, according to Haeder, are more than mere nuisances. They create hurdles that prevent some people from enrolling or cause others to drop out, often affecting those with the greatest need. In addition, evidence suggests that administrative burdens can be used to reduce access to services and circumvent transparency requirements while avoiding public scrutiny.

On the other hand, Haeder said administrative burdens also ensure a program’s integrity by weeding out unqualified participants, which increases program support.

Although research on administrative burdens has grown in recent years, Haeder said that prior to this study, little was known about the public’s preferences regarding them and whether characteristics related to a program or its benefits might affect these preferences.

To answer these questions, the researchers asked 2,904 adults in the United States about their support for programs that required two administrative burdens: in-person interviews and submitting government-issued documents for verification purposes. They also asked for opinions about reducing these burdens by using presumptive eligibility—allowing access to services before a full application is processed—and “express lane” eligibility—verifying eligibility using information available from other government programs—for Social Security, Medicare, Medicaid, and Temporary Assistance for Needy Families (TANF) in the United States.

“We chose these four programs because they fall along two continuums identified in previous research,” Haeder said. “One deals with ‘earned’ benefits such as Medicare and Social Security, which participants are forced to pay into over time, and ‘unearned’ benefits like Medicaid and TANF. The other deals with whether benefits are cash payments, which gives recipients control over their use, or in-kind services, which are controlled by the providers.”

The respondents were randomly assigned to one of the four public assistance programs. After learning about the differences between the four, they used a four-point scale to answer questions about their assigned program.

“In general, we found no strong and consistent differences along both dimensions,” Haeder said. “Americans support administrative burdens in the form of documentation requirements across all programs. However, they also were open to burden decreases.”

Statistical analyses found that Republicans, conservatives and those high in racial resentment consistently favored increasing burdens and opposed decreasing burdens with the opposite effect for Democrats, liberals and those low in racial resentment.

“Notably, the findings largely did not support our hypotheses that burden tolerance was associated with the type of benefit or whether the benefit was earned or not,” Haeder said. “In addition, support for administrative burdens and for easing these burdens was relatively consistent across the four programs, with the major exceptions of in-person interviews.”

Haeder said the study has several policy implications. First, program integrity seems to be the overarching concern, although the public also supports increasing program efficiencies through both presumptive eligibility and express lane eligibility.

“Our study indicates that the American public supports at least some efforts to add administrative burdens, so those seeking to maximize enrollment might have to make some trade-offs in this area,” Haeder said.