Defense spending has been getting the headlines in reporting on President carter's proposed fiscal 1981 budget. But social welfare -- the programs run by the Department of Health and Human Services (HHS) -- accounts for more than one-third of the $616 billion budget. Defense gets $146.2 billion, HHS $222.9 billion.
The old Department of Health, Education, and Welfare dominated federal budgets in the last several fiscal years. Now, even with the removal of education to form a separate Cabinet department, the renamed HHS holds its position as the No. 1 government spender.
Three factors account for much of this: Americans on fixed incomes, especially retirees, are hard hit by 13 percent inflation; the percentage of the US population in the "elderly" category and in need of aid is growing; and the cost of medical care, paid for in part by the government for the elderly and other groups, is a major contributor to the inflation rate.
Overall, the proposed budget for the fiscal year starting Oct. 1, 1980, is 13 .5 percent higher than the fiscal 1980 budget, but that may be only a marginal increase when compared with the inflation rate. What's more, certain items within the budget which are not being boosted to compensate for inflation may indicate a long-term shift in emphasis -- especially in continually controversial welfare programs. Neither aid to families with dependent children (AFDC) nor supplemental security income (SSI) is being increased significantly for 1981. Both programs have long best targets of congressional criticism.
But Head Start, Child Welfare Services, programs in aging, nutrition, work incentives, and in protection of victims of family violence are due for sizable increases.
HHS Secretary Patricia Roberts Harris calls the health and welfate programs for 1981 "balanced and compassionate," even though "the President's budget was constructed in the context of overall fiscal restraint, the necessity to curb inflation, and the requirement to meet needs made compelling by international events."
Most of the HHS money (95 percent, according to HHS) automatically goes to Americans who entitled by law to federal assistance under one or more of the big five: social security, SSI, AFDC, medicare, and medicaid. Social security takes up $135 billion; SSI and AFDC, $13 billion; and medicare and medicaid, $51 billion.
To cope with the first of the three trends cited earlier, HHS plans to initiate a 13 percent cost-of-living raise in social security payments this July , followed by a 9.9 percent increase one year later. The average monthly social security benefit to the 36 million people classified as retired, disabled, and survivors would jump to $350 by 1981.
Even though AFDC and SSI are held near 1980 levels in the new budget, both programs already had been scheduled for expanded coverage in the neat future. AFDC payments to low-income families will cover 300,000 new recipients, and there will be higher benefits.
SSI cash supplements to the aged, blind, and disabled had been scheduled for a 13 percent cost-of-living adjustment this July. But increases proposed for fiscal 1981 are marginal. AFDC and SSI cover 14.5 million persons.
Medicare and medicaid are being extended to 700,000 more Americans; 47 million already are covered. Another 2 million low-income children and 100,000 low-income pregnant women will be eligible for medical aid if the Child Health Assurance Program is enacted.
Secretary Harris says HHS is turning more attention towards some other areas:
* A "major effort" ($1.8 billion) to provide medical treatment to persons in rural and inner-city locations. This is aimed mostly at migrants and the urban unemployed.
* A $859 million promotional campaign to bolster preventive health programs. This includes more money for water flouridation projects, protection from environmental hazards, and consumer and worker safety. The antismoking campaign -- dramaticaly intensified by former HEW Secretary Joseph A. Califano Jr. (its funding went from $3 million in 1979 to $13 million in 1980) -- was strongly criticized by the tobacco lobby. But it will remain at the 1980 level.
* More money for Head Start to help migrant and urban poor. Coverage of Hispanic children would increase by almost 50 percent. This patterns the needs of a growing minority population.
* Increases for mental health, drug abuse, and alcoholism research. These follow recommendations by the President's Commission on Mental Health.
There are many other areas within the Gargantuan department that are scheduled for chanes in 1981. Health and welfare get close scutiny -- and frequent criticism -- in congress. Emphasis undoubtedly will be changed in many areas before the budget proposal is adopted next fall.