Rhetoric and Disability in America
SSA
statistics indicate that since 2008 over 2.5 million individuals annually have
applied for disability benefits. Allowance rates were roughly 37 percent in
2009. It is noteworthy that the disability laws have not changed, yet allowance
rates have dipped to 33 percent in 2013 and continued to decline in 2014. The
result - each year over 100,000 additional claims and appeals are
denied. This results in about 400 families a day receiving disability denials.
Political pressure on adjudicators, lack of adequate staffing for SSA,
Congressional ineptitude and less than active intervention by this
Administration play a role. While there is pressure on adjudicators, SSA must
work to check any lack of adherence to the law, as difficult as
that is, it is the agency's role. There have been reviews by SSA of
decisions (some of allowed cases) and some of outlier adjudicators. However,
more emphasis has been placed on "fraud waste and abuse" when
fraud by most reports remains
around one percent. SSA's charge may be hindered by
another factor - public bias against the disabled. This recent Op Ed from
the LA Times succinctly demonstrates many of the problems facing
today's disability programs in our country.
Date Line January 21, 2015,
From the LA Times, an OP ED entitled Bias against the disabled is as American as apple pie
By Rourke L. O'Brien a postdoctoral fellow in population
health at Harvard University.
On the first day of the 114th Congress, Republican lawmakers
quickly lighted the fuse for a major battle over entitlements using an unlikely
piece of leverage: the Social Security Disability Insurance program, which is
expected to run out of money in late 2016..
“As we work to improve [disability] programs, we must not
let the rhetoric of fraud, abuse and 'welfare queens' ... frame the
conversation.” The fact that the SSDI trust fund is running dry is no
surprise. Congress historically has authorized “reallocation” of dollars from
the Social Security trust fund (which has enough money to last through 2034) to
cover SSDI. Now, Republicans have made that once-routine maneuver — it has been
done 11 times before — much more difficult, passing a rule stating that any
reallocation must be accompanied by policies that improve the financial footing
of Social Security.The wording may be vague, but the intention is clear. And while many are right in surmising that it's a move to push an overhaul of Social Security retirement benefits, it also presents an opportunity for conservative lawmakers who have been calling for larger reforms in disability programs.
About $145 billion is spent annually through SSDI (payroll tax-funded insurance for disabled workers). An additional $40 billion is spent on disability benefits through the Supplemental Security Income program (means-tested cash assistance), which isn't directly on the chopping block, although we shouldn't be surprised if it is soon. If the price tag wasn't enough to put these programs in congressional crosshairs, recent media attention on how disability programs can be a disincentive to work, as well as on a few cases of fraud and abuse, certainly helped seal the deal.
It is important to understand why the rolls have grown
before making any cavalier changes in policy to curb enrollment. Basic
demographic shifts explain most of it. It's also critical that we appreciate the role these
programs play in our postindustrial economy and our post-welfare-reform social
safety net. But as we work to improve these programs, we must not let the
rhetoric of fraud, abuse and “welfare queens” that accompanied the end of
welfare as we know it in the 1990s frame the conversation.
Americans generally are skeptical of individuals who receive
government benefits, biased to think that they are undeserving. It may be our
unyielding belief in everyone's ability to bootstrap his or her way to success
through hard work or just the way we esteem self-sufficiency. In the context of
cash welfare, research shows that this bias leads us to assume all benefit
recipients are lazy. In the context of disability — where benefits are predicated on the existence of a qualifying health condition — our skepticism toward recipients of government assistance may influence the way we evaluate their health.And new evidence suggests that it does just that.
As part of a nationally representative survey I conducted, about 1,000 individuals were asked to read several vignettes, each describing an individual with a health condition such as chronic back pain, depression or symptoms consistent with attention deficit hyperactivity disorder (for children).
Respondents were then asked to rate the severity of each condition and the degree to which they considered it “disabling.” Before reading the vignettes, the respondents had been randomly assigned to either a treatment or control group. After reading instructions for the study, those in the treatment group read an additional sentence noting that individuals with disabilities may be eligible for government benefits.
The result? Respondents primed with a reference to government assistance were less likely to consider the health conditions described as severe or disabling relative to the control group. Just hinting at the existence of government assistance was enough to change their evaluation of health conditions. What's more, in follow-up questions, respondents in the treatment group were more likely to blame the individual for her health condition.This study builds on earlier cross-national work on disability, which finds that Americans have a significantly higher threshold for what they consider disabling compared with their European counterparts.
In efforts to paint some of those applying for disability benefits as undeserving, we tend to question both the severity and the legitimacy of the qualifying health condition. We tell ourselves they don't deserve assistance because the condition just isn't that bad, and regardless, they are to blame for their health problems anyway.
Disability is a remarkably complex concept that involves the
person's health, labor market conditions, adaptive technologies, discrimination
and social welfare policy. What it means to be disabled has varied over time,
along with changes in the nature of work and our understanding of health.
As we reexamine the role of disability programs in our
social safety net, it is crucial to appreciate the multifaceted pathways that
shape what it means to be disabled before crying fraud.
Copyright © 2015, Los Angeles Times
