Immigration reform that provides work authorization, and a pending Social Security Totalization Agreement with Mexico, could mean that a very substantial amount of earnings in the ESF file would be reinstated in the future. Because earnings are used to determine both the number of quarters of coverage worked for insured status, and is used to calculate the initial benefit, this poses a substantial liability to the Social Security Trust Fund worsening its solvency. . What does it mean when a Member of Congress says he favors changing Medicare from a "fee-for-service" model to one where the patients would pay based on health outcomes? Is he suggesting that Medicare should stop covering treatments if the patient can't or doesn't improve? .New Analysis Says Social Security/Medicare in Worse Shape Now than Earlier This Year .Benefits haven't kept pace with the cost of living and all changes that have occurred over the last 50 years. … .Out-of-pocket spending on prescription drugs was the fastest rising expense of retirees from 2000 to 2019, according to a recent study of retiree costs by TSCL. While the annual cost-of-living adjustment (COLA) increased Social Security benefits by 50 percent over the period, out-of-pocket spending on prescription drugs rose more than five times faster — 253%. .Instead, I am a strong supporter of the Consumer Price Index for Elderly Consumers Act of 201This legislation would change the way the Social Security Administration calculates the Cost of Living Adjustments (COLA) by switching from a CPI based on urban wage earners to a formula that would better reflect the spending of seniors. Unlike younger Americans, seniors spend a disproportionate amount of their income on medical expenses and it is crucial that we raise the Cost of Living Adjustment to keep up with the rising cost of medical expenses. .Medicare part B was not paid for by increasing taxes but is paid for by borrowing money. So were the tax cuts that the President supported, and Congress passed in 2017. .Discussion on the bill will likely continue into the summer, and TSCL will continue to monitor the ongoing debate. We remain hopeful that lawmakers will address any loopholes that would allow immigrants to claim Social Security credits based on work done illegally. In addition, TSCL is concerned that those with provisional status could have access to Social Security and Medicare benefits before they are granted citizenship. Both of these issues would put an unnecessary and unspecified strain on the Trust Funds, and we will continue to inform Members of Congress about potential issues in the coming weeks. .It is likely the President will face a legal challenge over these actions. The U.S. Constitution gives Congress the power of the purse and any changes to taxes or spending are supposed to come from Congress.