DACR INC. CLOSING

Greetings. My company DACR Inc. is closing and I am retiring. The website dacrinc.com will no longer be available. 

The previous posts here involved mainly Social Security Disability. 

I am still interested in SSA disability, and other things, and may continue to post here in the future. Thanks to all who read any posts in the past.

Robert J. Edwards CEO DACR Inc.

 

 

Bias and Devastation -

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

 

 

 

 

 

 

 Working for the Disabled - Examining Darrell Issa’s Hubris

 

 

Or don’t you like to write letters. I do because  it’s such a swell way to keep from working and yet feel you’ve done something. – Ernest Hemingway

Darrell Issa, Chairman of the Committee and Oversight and Government Reform recently wrote Acting Social Security Acting Commissioner Carol Colvin a 5 page letter . His intentions may be swell, but his letter is not working for the disabled.

The letter demands SSA produce all documents and communications, referring or relating to actions, taken in response to the focused reviews [of Administrative Law Judges - ALJs] the agency has conducted since they were initiated in 2011. Focused reviews look at “specific issues.” The letter dated July 1, 2014 is ripe with inaccuracies.  The letter attacks Administrative Law Judges, but it is part of a campaign to cast dispersions on the disabled and SSA’s administration of the disability program.  Let’s look at the fabrications Issa et al are parlaying into the request. Issa writes “the agency allowed hundreds of ALJs to rubber-stamp applicants onto disability programs over the past decade, the nation now has an enormous number of people who are inappropriately on disability programs.”

“Hundreds of ALJs” – “inappropriately on disability” - Really? Where’s this documentation from? He cites “strong evidence” from  Senator Tom Coburn, Issa’s republican cohort who  had his staff pull about 300 disability cases last year - a completely non-statistical sample. Their “review” is puzzling because the staffers’ credentials for knowing what is a correct and incorrect SSA disability decision or even one that is flawed is suspicious. Coburn’s opinion of the disabled includes the statement that a claimant should be denied as long as they could do any job. This is not the law which requires consideration of age, education and work experience. We are sure some folks who are wheelchair bound or have had a triple bypass at age 60, might be able to accept tickets 8 hours a day, but when they have already met the medical and legal criteria for disability, discussion of jobs is moot. As Charles Hall said in his blog,

“Social Security isn't supposed to deny the claim of a retired coal miner because he can still be a nuclear physicist.”

Or a ticket taker.

As of this date, Coburn has not identified just who in his staff found the allegedly incorrect determinations and what their credentials were. But Issay didn’t just rely on his astute, global warming denying cohort; he went to the ultimate Sunday Night Science, Sixty Minutes.  On page 5. of his letter, Issa notes he is troubled by Colvin’s admission “that you have not watched the 60 Minutes story from last fall on significant problems with federal disability programs. We expect that all government officials in leadership positions are kept fully informed about key problems, particularly when that agency is charged with management of multi-billion dollar disability programs for our nation's most vulnerable citizens.”

Right, same goes for the chairman of a congressional committee who relies on a widely discredited TV show.  Last year Sixty Minutes featured a show with SSA claims employees who were suing the only claimant representative featured.  The Administrative Law Judge they interviewed was part of a law suit against SSA (since dismissed). No other ALJ who might have offered a counter opinion was allowed to speak and no other claimant representatives, despite scores of organizations that offered to do so. Of course, the producers of 60 minutes avoided contacting a disabled individual.

Media Matters noted the myths pushed by 60 Minutes had been repeatedly debunked by experts. What the show Issa cites failed to note was the vast majority of people applying for benefits are denied, the majority of appeals are also denied, and that award rates have actually fallen during the economic recession. In April, the Wall Street Journal called the claim that federal disability benefits were to blame for people leaving the labor force "exaggerated," explaining that disability was in fact the least common reason individuals left the workforce. Michael Hiltzik at the Los Angeles Times calls the Sixty Minutes story "shameful." Sixty Minutes apparently could not be bothered to present a more balanced picture of the disability program. The Center for Economic and Policy Research posted criticism of the Sixty Minutes show, stating it completely ignored comments from experts in the field and pointed out that fraud is in fact not rampant in the disability program.

Issa’s letter mainly attacks four Administrative Law Judges with high allowance rates. There was a dog and pony show on Capitol Hill last month with these four, but they were given virtually no chance to accurately defend themselves and republicans and democrats alike spewed unfounded accusations ranging from  sexual harassment to judicial malpractice. Congressman, one a dentist (who repeatedly referred to his medical expertise) wanted to know how a judge formulated a diagnosis. The hearing was more disgraceful than the alleged misconduct by the judges. One of the ALJs from New Mexico mounted a reasoned explanation for his allowance rate that involved demographics of his state and adherence to the law, - vocational grids that require a favorable decision in many instances. But Issa makes it clear in his letter, that judge should be fired. Here are the facts: the majority of ALJs follow the law and the statistical outliers are in the minority. Judges who deny 85-95% of cases were not dragged up on the hill by Issa and similarly slandered.

When Issa speaks of “evidence of widespread waste, mismanagement and abuse by ALJs in the disability determination and appeals process” – know he bases this on evidence such as manufactured reports by Coburn, and a widely discredited TV show. Widespread abuse and fraud are words often thrown around. Fact is there is virtually no fraud. The GAO Found That Error Rate In Improper Payments Of Social Security Benefits Is Negligible. Yes, improper payments of Social Security benefits that include Disability Insurance had an error rate of just 0.6 percent, [See Government Accountability Office report, 3/28/12].

Issa’s letter also asserts the trust fund's projected shortfall is around the corner. History tells a less dramatic story. Since Social Security was enacted, Congress has "reallocated" payroll tax revenues across the OASI and DI trust funds - about equally in both directions - some 11 times to account for demographic shifts. In 1994, the last time such reallocation occurred, SSA actuaries projected that similar action would next be required in 2016. They were right on target, [See an Open Letter from Former Commissioners of the Social Security Administration, 4/4/13]. Actually, things are looking better. SSA’s Advisory Board will soon issue a report and it is likely the next action required will be 2017.  

Nowhere in his letter does Issa acknowledge Congress’s role in refusing to budget enough funds for the disabled. Instead, Issa and Senator Coburn repeatedly talk about the disabled who don’t deserve any money. Coburn alleges that a third of disability claims are phony. No evidence for this number is provided but Coburn recently stated his staff – remember those experts who reviewed the 300 cases –are working to ferret out the "scalawags" who have bankrupted SSA and don’t deserve the money. Rather than wasting time and money having staffers write letters requesting old records, subpoenaing Administrative Law Judges for scorn and misstating the facts about what is failing to protect taxpayers and the truly disabled; Issa has the ability to take immediate action, and he should.

Here’s a suggestion and it doesn’t involve requesting all ALJ focused reviews since 2011. We do not have to start borrowing money to pay Social Security benefits once more money starts flowing out of the trust funds than comes in. The trust funds are still large and can support net outflows for decades. So, simply asking high income workers to pay FICA, the Social Security tax, on all their wages will solve the problem without raising the retirement age or cutting back on cost of living adjustments. Social Security payroll taxes only apply to the first $ 113,700 of a worker’s wages. Former SSA Commissioner Astrue in a February 2013 interview stated that “there’s some historic inevitability on at least some lifting of the (payroll tax) cap. I think that most politicians and I think most economists I’ve talked to generally think that that would have less of a negative impact on the economy than raising the rate itself. “

Chairman Issa might get on board and suggest congress fund the SSA budget as requested (that will allow sufficient staff for Administrative Law Judges to review cases and for the claims workers in the field offices and the disability determination offices to accurately determine cases, and resolve his “ALJ production” concerns). And yes the GAO can provide real statistics for accuracy and credentials for those who review cases.

By 2016, a new president and congress will meet and adjust the payroll taxes resolving the real problem with SSA’s disability program. In the mean time, it is likely that Issa, Coburn and those out to undermine the disability program will continually bloviate and pressure the disabled and those who work with them. Writing demanding letters is a swell way to pass the time, but it does absolutely nothing to resolve the real problems SSA’s disability program faces.

One disabled individual who reviewed Issa’s letter later posted on the Internet, “I'm a person with a disability…. I find it remarkable that no detailed example was given of the alleged improperly placed applicants on disability." That’s because it appears facts about the disabled of America are simply not a priority for this Chairman. And that is the real Social Security Crises.

 

Thanks to Charles Hall's SSA Blog Social Security News for many of the above citations. 

 

 

 

Taking Down the Take Down – Facts Matter in Disability Discussion

We recently addressed the sensationalism and mischaracterizations offered by This American Life from WBEZ in their March 2013 broadcast Trends with Benefits.  Along with Media Matters, many individuals and groups who actually understand the disability program have steadily debunked the show’s assertions. To wit, Kathy Ruffing who has countered virtually every incorrect assertion the show so cavalierly alleged.  

Now, eight former SSA Commissioners have offered a take down. We could not agree more. And the entire statement is provided below. We would only offer a qualification and an additional note to the chorus. When the commissioners speak of the 17 percent of disabled who tried to work in 2007 with earnings generally very low (two-thirds of those who worked in 2007 earned less than $5,000 for the whole year) and mention only a small amount managed to earn enough to be self-sufficient to leave the DI and SSI programs;  a clarification is necessary.

We note that often simply returning to work  frequently removes or jeopardizes the benefits. TAL legitimately asked these questions at the end of their drama fest. Had they explored the need for real return to work protection and incentives, the show might have been relevant.  At present, if a beneficiary or recipient reports work - as they are required to do, it can begin a process of removal from benefits (often incorrectly, as SSA underpaid millions in 2012 alone). This is not due to the agency’s ire, although the front line workers must be weary at this point. There are many factors - a hiring freeze for SSA employees as workloads increase, staffing shortage etc.

Finally an additional note to the chorus.  When a show like This American Life attacks the program, perceptions can change the discussion.  For example, Ronald Regan as president changed the term “earned entitlements “to” entitlements” when addressing a gathering of business executives. That false moniker has held,  in relation to the majority of SSA benefits. After all, the very words entitlement and welfare appear in the constitution. Yet these facts did not make into the "6 months of research" TAL devoted to the take down job they attempted. All credit to the past Commissioners whose consensus takes down the take down TAL misguidedly attempted. Words matter and careless incorrect rhetoric has been countered in the past two weeks. We are all disabled eventually. Timing may change one's perspective. So too sloppy journalism. We applaud the response by these commissioners and others who have responded, standing up for the truth and for the most severely impaired amongst us, the disabled.

 April 4, 2013 

An Open Letter from Former Commissioners of the Social Security Administration 

     As former Commissioners of the Social Security Administration (SSA), we write to express our significant concerns regarding a series recently aired on This American Life, All Things Considered, and National Public Radio stations across the U.S. ("Unfit for Work: The Startling Rise of Disability in America"). Our nation’s Social Security system serves as a vital lifeline for millions of individuals with severe disabilities. We feel compelled to share our unique insight into the Social Security system because we know firsthand the dangers of mischaracterizing the disability programs via sensational,anecdote-based media accounts, leaving vulnerable beneficiaries to pick up the pieces.           

     Approximately 1 in 5 of our fellow Americans live with disabilities, but only those with the most significant disabilities qualify for disability benefits under Title II and Title XVI of the Social Security Act. Title II Old Age, Survivors, and Disability Insurance (DI) benefits and Title XVI Supplemental Security Income (SSI) benefits provide critical support to millions of Americans with the most severe disabilities, as well as their dependents and survivors. Disabled beneficiaries often report multiple impairments, and many have such poor health that they are terminally ill: about 1 in 5 male DI beneficiaries and 1 in 7 female DI beneficiaries die within 5 years of receiving benefits. Despite their impairments, many beneficiaries at tempt work using the work incentives under the Social Security Act, and some do work part-time. For example, research by Mathematica and SSA finds that about 17 percent of beneficiaries worked in 2007. However,their earnings are generally very low (two-thirds of those who worked in 2007 earned less than $5,000 for the whole year), and only a small share are able to earn enough to be self-sufficient and leave the DI and SSI programs each year. Without Social Security or SSI, the alternatives for many beneficiaries are simply unthinkable. 

     The statutory standard for approval is very strict, and was made even more so in 1996. To implement this strict standard, Social Security Administration (SSA) regulations, policies, and procedures require extensive documentation and medical evidence at all levels of the application process. Less than one-third of initial DI and SSI applications are approved, and only about 40 percent of adult DI and SSI applicants receive benefits even after all levels of appeal. As with adults, most children who apply are denied SSI, and only the most severely impaired qualify for benefits. 

     Managing the eligibility process for the disability system is a challenging task, and errors will always occur in any system of this size.But the SSA makes every effort to pay benefits to the right person in the right amount at the right time. When an individual applies for one of SSA’s disability programs, the agency has extensive systems in place to ensure accurate decisions, and the agency is home to many dedicated public servants who take their ongoing responsibility of the proper stewardship of the programs very seriously. Program integrity is critically important and adequate funds must be available to make continued progress in quality assurance and monitoring. In the face of annual appropriations that were far below what the President requested in Fiscal Year 2011 and Fiscal Year 2012, the agency has still continued to implement many new system improvements that protect taxpayers and live up to Americans’ commitment to protect the most vulnerable in our society. 

     It is true that DI has grown significantly in the past 30 years.The growth that we’ve seen was predicted by actuaries as early as 1994 and is mostly the result of two factors:baby boomers entering their high -disability years, and women entering the workforce in large numbers in the 1970s and 1980s so that more are now "insured" for DI based on their own prior contributions. The increase in the number of children receiving SSI benefits in the past decade is similarly explained by larger economic factors, namely the increase in the number of poor and low-income children. More than 1 in 5 U.S. children live in poverty today and some 44 percent live in low-income households. Since SSI is a means-tested program, more poor and low-income children mean more children with disabilities are financially eligible for benefits. Importantly, the share of low-income children who receive SSI benefits has remained constant at less than four percent. 

     Yet, the series aired on NPR sensationalizes this growth, as well as the DI trust fund’s projected shortfall. History tells a less dramatic story. Since Social Security was enacted, Congress has "reallocated" payroll tax revenues across the  OASI and DI trust funds–about equally in both directions – some 11 times to account for demographic shifts. In 1994, the last time such reallocation occurred, SSA actuaries projected that similar action would next be required in 2016. They were right on target. We are deeply concerned that the series “Unfit for Work” failed to tell the whole story and perpetuated dangerous myths about the Social Security disability programs and the people helped by this vital system. We fear that listeners may come away with an incorrect impression of the program — as opposed to an understanding of the program actually based on facts. 

     As former Commissioners of the agency, we could not sit on the sidelines and witness this one perspective on the disability programs threaten to pull the rug out from under millions of people with severe disabilities. Drastic changes to these programs would lead to drastic consequences for some of America's most vulnerable people. With the lives of so many vulnerable people at stake, it is vital that future reporting on the DI and SSI programs look at all parts of this important issue and take a balanced, careful look at how to preserve and strengthen these vital parts of our nation’s Social Security system. 

Sincerely, 

Kenneth S. Apfel 

Michael J. Astrue 

Jo Anne B. Barnhart 

Shirley S. Chater 

Herbert R. Doggette 

Louis D. Enoff 

Larry G. Massanari 

Lawrence H. Thompson

Drama vs. Moral Perspective - Response to This American Life's Report on SSA Disability

On March 23, 2013,   This American Life broadcast a show about the disabled. It was an unfortunate endeavor, full of errors and did little to examine the program. The focus was more sensationalism and less responsible reporting. We offered the following response to the reporter and producer. Comments to This American Life may be sent to web@thislife.org.

Our comments are included below. We received a response thanking us for taking the time to write in and expressing sorrow that we were disappointed with the show.


Dear Ms. Joffe-Walt and Mr. Glass, 

As a long time listener and admirer of This American Life, I was extremely disappointed with your recent show, Trends with Benefits.  Having worked for SSA 23 years and then starting a solo practice as a claimant representative for disability clients for an additional 9 years, I have been on both sides of the program. I participated in President Clinton's Welfare reform, by contributing in policy groups. As a claimant representative, I have represented clients in 35 states at initial levels and through Administrate Law Judge hearings and Appeals council reviews. Like the overwhelming numbers of fellow representatives, I have never “sued” the government and found your treatment a sensational approach, from the outset title to the, hey wanna know a secret? introduction.  Equally puzzling that Ms. Chana Joffe-Walt spent 6 months “researching” the problem without mentioning such basics as the payroll contributions workers make (i.e., pay) for SSDI  disability insurance should they encounter a disability in addition to the SSI program. Since Congress holds hearings on disability, virtually monthly, real research would have disclosed the whole program is under constant scrutiny. People get cancer, develop Alzheimer’s, break ankles, and yes rupture multiple discs in their backs after toiling 30 years in construction jobs. Hardly the common back pain you inferred. I won’t even go into Ms. Joffe-Walt’s   query about what jobs remain for people “without hands.”

Rather than a balanced review, which is long overdue and would have been the high ground, the show focused on outliers -a small town in remote area, or a singing representatives or advocates who make millions of dollars. Advocate fees by the way are overwhelmingly paid for by the disabled individual - not “by the government” – and are limited to 25 percent of back due benefits with a limit of $6000, only if they win the case.  Nor was the fact that representatives pay “user fees” that is the right to have SSA send their fees directly if they obtain benefits for claimants. Most representatives do not sing jingles or wear cowboy hats. In addition, advocates are encouraged to include pro bono work. In my small firm, during the last 10 years I have maintained at least 10  percent pro bono case load because  disability includes everyone from chronic schizophrenics without housing  to CEOs who  paralyzed from a stroke, spend down their savings, lose their homes and have a great deal of difficulty finding help when they apply for benefits. In fact, the majority of people who lose homes do so after working and becoming disabled, thus unable to pay their mortgage and then ending up on the street with health declining. 

Fraud in SSA (one of the largest programs in the world) has always been comparatively low and has been studied excessively for the last 30 plus years. Additionally while SSA does make over payments, they also underpaid millions of dollars of benefits in 2012 alone .  This is due in part to the fact that the agency has had a diminished budget, is losing employees, and faced with increased workloads. How is that for a lead story? These are only a few of the observations I would offer.

Media Matters within a day of your broadcast came out with additional accurate, reality based factual retorts to the glossy statistic speed sheets that you both gasped about on the air.  Now you have backtracked on your Planet Monday site with multiple corrections. Then, on March 29, 2013, Ms. Joffe-Walt back tracked on NPR and leaned into advocacy and away from her sensationalism. A less than altruistic shift, but a start. Since the show prides itself on the accuracy of your reporting and in this show the charming love of numbers; perhaps you can spend another 6 months and contribute to reporting real answers to valid questions.

A hard look at the program could clearly improve efforts to get people back to work. However, most individuals who are eventually allowed and draw their 13 K a year are so ill they either die or cling to the meager existence left.  Of course, some disabled individuals could return to work, but that takes programs and the willingness to provide real rehabilitation with support as the beneficiary tries to return to work. That also means money from taxpayers and more programs. Having done this for 32 years, I can safely say most who come to me have done everything they can to keep the dignity that comes from working. 

Your question about what we do with this economy and those who are disabled is an important one. Too important for a skewed perspective composed in large part of  blatant  and erroneous exceptions (mom keeps kid home to “pull” 700 dollars, doctor who “makes” the disability decision )- omitting the DDSs – state agency examiners who make decisions and the extremely complex medical  and vocational criteria required to review claims and appeals, the Administrative Law Judges who make decisions, SSA’s oversight of attorneys and non-attorneys who are required to complete comprehensive testing and continuing education if they wish to practice and review direct pay etc. etc. Reporting on the disabled may increase your ratings at the expense of the most vulnerable amongst us. Indeed, WSJ and FOX diatribes about the “dramatic” growth of free loaders – inaccurate publicity, have decreased allowance rates in the last two years. One would hope the quality of TAL could accurately and substantively engage the reality that in hard times the weakest are easy to attack. They should be more than fodder for a sensational scoop.  This vast and complicated program should have the public interest. But without working for facts, you are just another drive by op- ed. The disabled and those involved in their lives deserve more. FDR’s vision for protecting the disabled remains as does the integrity of his advocacy echoed by Hubert Humphrey. Mr. Humphrey stated that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy, and the handicapped. If This American Life wishes to report on the disabled, I respectfully suggest you keep such moral perspective and an accurate grasp of real facts in mind when you break your next dramatic story. 

The most significant legal appeal in nearly 2,500 years...

Judge Richard A. Posner  who has heard many an SSA appeal on the US 7th Judicial circuit, written extensively on multiple topics – including SSA disability - faces off with former U.S. Attorney Pat Fitzgerald and an esteemed cast tonight in Chicago Illinois. 

Together they will attempt to shed light on the age-old question: why must Athens, the birthplace of democracy, put to death a 70-year-old philosopher who exercised the fundamental right of freedom of speech? 

Yes, Socrates on trial again. You can view the line up here. 

We hope it will be eventually available in one format or another. For tonight, it is sold out.

Misleading the Nation on Social Security Disability - Exposing the Attacks and the Myths

As a member of the National Organization of Social Security Claimants Representatives (NOSSCR), I welcome today’s op-ed, entitled Distorting the Truth about Disability Insurance, which appears in the Hill’s Congressional Blog. 


Charles Martin, the current president of the NOSSCR, and Debra Shifrin the vice president, penned the article. Both are practicing representatives and, just like me happen to work with Disability Insurance claimants. I am excerpting from the article because I want to add some comments of my own. The pundits attacking the disability program have been going at it for close to a year in the Wall Street Journal and other national and local publications and websites. Moreover, there is much speculation that a "grand compromise" will be forged after the presidential election and disability beneficiaries and recipients will lose benefits. This is targeting the weakest in society. For example, the article discusses a delivery truck driver who started having back pain in his 30s, and now might be unable to sit or even move by his 60s. This is an important point for disability and retirement. The notion that the retirement age could be moved upward to 68, 70 or later basically ignores those who work all their life in manual labor, such as construction or other physically demanding jobs and do not have enough skilled job history, or develop  arthritis, cancer, cardiovascular disease and yes, mental illness before age 66. Are these folks supposed to go broke until they are 70? The article mentions the homeless and as a representative for claimants, I can attest to individuals who worked all their lives and sustained a stroke or an infection or catastrophic injury and lost everything paying for their medical costs. In the last two years, several of my clients died or committed suicide due to mental illness in claims that were protracted or denied incorrectly. Most representatives who have practiced for a while have the same experiences. SSA is not demonized in the article and justifiably so as some in Congress have succeeded in stopping SSA from hiring new employees and frozen the wages of current SSA workers. There are also threats that furloughs will be in place next year for many SSA components. Furloughs simply move the work inefficiently to the future and end up forcing over time and delayed claim processing. The work does not disappear because SSA employees are advised they cannot return to their jobs for weeks or months. Furloughs are penny wise and pound-foolish. Currently SSA workloads are so high that many on line employees are taxed beyond their ability to adequately provide the multitude of services SSA is charged with handling. Finally, to those who say that it is easy to lie your way on to the disability rolls and just want a hand out, I say there is no basis in reality for such comments. As someone who has worked with SSA Disability claims for over 30 years and continues to represent claimants, I know how stringent the requirements are for disability and how minimal fraud is in this agency. The facts discussed in this piece, support my opinion. 


With those comments as a preface, here are some excerpts; 

This week is the 56th anniversary of the creation of disability benefits for the most vulnerable members of our society, but this achievement isn't being celebrated by everyone…... some pundits have hyped the coincidence that [in June 2012 ]more people began collecting Social Security Disability Insurance than there were jobs created in the United States. They do this to create the impression the economy is weak and the government is giving away free money. Yes, government reports show that the economy created 80,000 jobs in June, while 85,000 workers enrolled in the Social Security Disability Insurance program. But comparing these figures is extremely misleading. Disability beneficiary numbers are rising due to factors that were set in motion many years ago. First, “Baby Boomers”— Americans born post World War II, between 1946 and 1964 - are reaching the age where injury, illness, or disease more frequently knocks them out of the workforce. As Boomers’ ages increase, so do their medical problems. For example: a delivery truck driver who started having back pain in his 30s, might be unable to sit or even move by his 60s. This leaves him unable to work and therefore eligible for (Social Security Disability benefits). 

Another major factor is that there are more women in the workforce now than ever before, and thus more women are qualified for disability benefits. In 1970, less than 40 percent of women were insured for disability; in 2010, that number was almost 70 percent. And just like men, women too suffer from debilitating health conditions that keep them from being able to hold down a job. Steve Goss, the chief actuary of the Social Security Administration testified about these trends before the United States Congress just a few months ago. Even though this information is publicly available, nearly every article pretending that there is a link between June's job numbers and disability claims ignores the facts. 

A member of Congress recently stated that disability benefits constitute, “a form of slavery.” The Op- Ed notes this is misguided and disrespectful.

....disability benefits protect the most vulnerable members of our society, who have no other options.

As Claimant Representatives, many people come to us for help to collect Disability Insurance. The Op- Ed notes when they arrive they have a mailing address. 

But by the time the daunting claims process is completed, which in 2012 averaged 111 days, many of these folks are living in homeless shelters or worse. Disability claimants are not living large on the government dole. In fact, most claim disability benefits only when everything else they try fails to provide the minimal support disability benefits offer. 

Folks applying for disability in my experience would rather be healthy and working as productive members of society. And to collect Social Security disability insurance benefits claimants had to be employed for years. For SSI the same very tight standard to meet medical disability applies.

The fact is, these folks want to work, and it is just not possible for them. We understand this is a political season and that politics will infect every debate in Washington – including those regarding programs like disability insurance. But the facts must be known. Disability benefits have been growing due to an aging population and changing workforce demographics. While we support finding tools to eliminate waste, fraud and abuse in SSDI -- which accounts for less than one percent of spending -- we all must insist that Washington do the right thing and protect our most vulnerable members of society. It is wrong to use them as pawns in a political drama by promulgating misleading facts about people with disabilities. 

We will keep the facts coming. For more SSA disability information, visit the NOSSCR  website. 

Another Congressional Hearing- Focused for the Disabled?

The House Social Security Subcommittee has scheduled a Hearing for January 24th, 2012 on how to minimize "improper payments and protect taxpayers’ dollars from waste, fraud, and abuse."

While the Social Security Subcommittee must provide oversight, we wonder at times - just how accurate is the focus of such hearings?

In announcing the hearing, Social Security Subcommittee Chairman Sam Johnson (R-TX) said, “Waste, fraud, and abuse in the disability insurance program cheat honest, hardworking American taxpayers. As we work to secure the future of this program, we need to protect the American taxpayer from con artists who are stealing from the system by making sure benefits are paid only to those who deserve them.”

SSA notes that between fiscal years 2006 – 2010 the agency paid approximately $530.5 billion to disability insurance program beneficiaries.

$5.5 billion (1.0%) was estimated to have been overpaid.

$2.3 billion (0.4%) was estimated to have been underpaid.

Rarely mentioned in these planned hearings, is the amount of money wage earners who become disabled are underpaid. While less than half the amount of overpaid funds; $2.3 billion is not chump change, especially if you are disabled and did not receive an accurate payment. If Representative Johnson is so interested in "protecting the American taxpayer from con artists who are stealing from the system by making sure benefits are paid only to those who deserve them,” perhaps his hearing should also focus (or at least mention) those deserving disabled taxpayers who were underpaid over 2 billion in the last 4 years.

We doubt any real discussion of underpayment will occur.Focusing on one aspect of the problem while ignoring the other seems misguided at best. Taxpayers who become disabled want accurate oversight just as much as those who are not disabled. The buzzwords of improper overpayments will be front and center at the hearing and accountability is of course necessary. However real oversight involves perspective and focus.And increasing reviews of improper payments involves skilled staff. If Congress wants to save money by targeting aspects of the Disability program, cutting SSA's budget as proposed, will not increase the staffing needed for oversight of improper payments or lack thereof.

Social Security Administration - Prescription for Real Chaos

Proposed budget will cut close to a billion dollars from the SSA budget and release thousands of employees.


From today’s Federal Times (Copyright © 2011 Gannett Government Media Corporation), comes a succinct assessment of the chaos that close to a billion dollar budget cuts and loss of four thousand employees will have on the Social Security Administration staff and Americans who turn to SSA for retirement, health care and disability benefits. The article, entitled Social Security Administration struggles with budget cuts written by Andy Medici and posted on June 7, 2011; begins seven months ago, with Commissioner Astrue, shovel in hand, discussing the agency’s plans to deal with increased claims:

Social Security Administration Commissioner Michael Astrue broke ground in the small town of Jackson, Tenn., for his agency's first new call center in 10 years. The center, slated to open by the end of this year, would allow the agency to better respond to the fast-growing number of customers.

But the call center sits half-finished — a casualty of congressional budget cuts.

In April, Congress passed a 2011 budget that cut Social Security's administrative budget by almost $1 billion from the Obama administration's requested amount. The cuts not only shut down construction projects like the call center in Tennessee, but also information technology projects, hiring and investments needed to clear a backlog of disability claims.

Social Security was forced to close hundreds of direct contact stations and cancel plans to open eight new hearing centers across the country. Direct contact offices are remote locations open only a few days a week or month. Social Security Administration spokeswoman Dorothy Clarke said that by making "tough choices," the agency can avoid furloughing employees and closing down field offices entirely. "We will continue to review all aspects of our operations, including considering office consolidations, for ways to balance cost savings with our mission to serve the public," Clarke said.

At a March 9 hearing, Astrue warned lawmakers that his agency's staff is declining and that funding is "barely above the level where we have to have furloughs."

Sen. Richard Shelby, R-Ala., said in the same hearing that the Social Security Administration should have spent earlier appropriations on streamlining its claims processes and reducing administrative overhead. He said that its use of stimulus funding instead to address those expenses was a "dangerous mismanagement" of funds and that Congress should not be looking to throw money at the problem. Joe Dirago, president of the National Council of Social Security Management Associations, said he expects even more severe budget cuts next year. The Obama administration's request for 2012 is $12.5 billion, but Dirago said signs point to a budget that will come in below $11.4 billion in 2010.

He also said his organization expects Social Security will lose 3,500 employees this year through attrition and a hiring freeze. If budget cuts continue, he estimates the agency will lose another 4,000 employees in 2012.

Rep. Xavier Becerra, D-Calif., ranking member of the House Ways and Means Committee, which oversees the Social Security Administration, said the agency is "cut to the bone" and its overhead expenses amount to only 1 percent. "Administratively,you will find no business in the private sector or agency in the government sector that is more efficient than Social Security," Becerra said.

He said in the first four months of 2010, there were 246,000 disability appeals, while in the first four months of 2011, there were 294,000 — an increase of almost 20percent.

But because of budget cuts, the agency cannot open the hearing centers to help lessen the backlog, Becerra said. He said that he does not see the budget situation for Social Security improving any time soon and that Social Security may have to shutter field offices to cope with the cuts.

"It's a prescription for real chaos," Becerra said.

Strengthen Social Security - Don't Cut It

This web site, Strengthen Social Security is full of resources for those interested in Social Security matters. Importantly, it features an on line petition one can sign in less than a minute. The petition reads as follows:

Dear Speaker Boehner:

Social Security belongs to the people who have worked hard all their lives and contributed to it. Social Security is a promise that must not be broken. If you pay in, then you earn the right to benefits for yourself, your spouse and your dependent children when you retire, experience a severe disability, or die.

We need to strengthen Social Security, not cut it. That is why I oppose any cuts to Social Security benefits, including increasing the retirement age. I also oppose any effort to privatize Social Security, in whole or in part.

We support the petition and plan to visit the web site often. It has an active blog and provides facts about the program. For example:

The projected point at which the combined Trust Funds will be exhausted comes in 2036 per the SSA Trustees 2011 Annual Report to Congress. And, the Disability Insurance Trust Fund will not run out of money in 2018. Money will be reallocated from the Retirement Trust Fund to the DI Trust Fund.

Now is the time to ask our legislators to stick to facts, not speculation and to act in unity for a program that is integral to the American public. This means also supporting those in the House and Senate who continue to advocate for strengthening Social Security. If we sincerely care about the future we are leaving our children, we would not delay and/or deprive them of the simple trust generations have held. This is not a "hand out" it is a decent tenet of democracy - you pay in and you receive benefits for disability and protection for retirement.

Government would continue to make Social Security payments to 53 million beneficiaries

SSA Commissioner Michael Astrue noted this week he planned to continue services in concert with White House's statement that Social Security checks will continue to go out in the event of a shutdown. He noted SSA’s field and hearing offices, teleservice and program service centers, and State disability determination services will provide "limited services" if there is a shutdown. "Limited services" remains a bit unclear. Speculation continues that interruption of new claims and pending appeals will occur.

The New York Times advises the government would continue to make Social Security payments to 53 million beneficiaries. “We will continue to process applications for benefits, but it might take longer if a shutdown does occur,” said Mark Hinkle, a spokesman for Social Security. “Our local offices will open for limited services. We are working on the specifics.” However, a huge backlog of applications for Social Security disability benefits would grow even larger, agency officials said. Medicare, the program for people who are 65 and older or disabled, would continue to pay doctors and hospitals for several weeks, using money from its trust funds. While Obama administration officials hoped to notify federal employees by Friday April 8th, whether they would be furloughed as nonessential workers, they also expected all federal employees — essential and nonessential alike to go to work on Monday April 11th, to help “close up shop in an orderly way”, the officials said.

Meanwhile, The Office of Personnel Management (OPM) discussed the potential shutdown - asserting that if the current continuing resolution expires at 12:01 a.m. on April 9, 2011 without passage of an FY 2011 appropriations bill or a further continuing resolution, Federal departments and agencies will be required to execute contingency plans for a shutdown. These contingency plans detail which agency activities are allowed by law to continue to operate, and which activities must stop. Employees whose salaries are funded through annual appropriations will not be able to work and will be furloughed, unless their duties qualify under the law as "accepted" to continue to work during periods of lapsed appropriations. During a shutdown, non-excepted employees are not permitted to work. OPM assures it will provide information through its website and updates regarding these matters no later than Friday, April 8th.

Balancing the Texas Budget on the Backs of the Disabled

Jason Embry in today’s American Statesman writes about 50 facts in the House’s proposed state budget.

Texans can be thankful that the republican dominated house has no plans to raise their taxes.

However, if you are disabled, access Medicaid, have a child with autism, suffer from a mental disability, are deaf or hard of hearing, care about abuse at child day care centers, and other residential centers; happen to be aging, require community mental health hospitalization, happen to be a homeless individual or a part of a homeless family, need Medicaid for nursing homes, access or plan to access community mental health services or care about the Children’s Health Insurance Program; the house plans to significantly cut, zero out and downright remove significant services.

Here are just a few:

$3.3 billion short in necessary state funds and $8 billion of all funds of the money that state agencies say they will need to pay for Medicaid, an entitlement program that the state is legally obligated to provide.Reduce funding for state-supported living centers so much that, as a spokeswoman for the Department of Aging and Disability Services told the Texas Observer this week, the state would default on a settlement with the U.S. Department of Justice. During the Bush administration, the Justice Department found the conditions in the homes for Texans with mental disabilities were so bad that the constitutional rights of the residents were violated.

The budget zeroes out $6.7 million from a program that provides services to children with autism.Reduces rehabilitation services to individuals who have general disabilities or are deaf or hard of hearing by 13.5 percent.

Cuts $4 million — 6 percent — from the agency that enforces minimum standards and investigates reports of abuse at child day care centers, residential child care and maternity homes.Cuts Medicaid rates to nursing homes by 10 percent, even though Texas already ranks 49th nationally in Medicaid rates for nursing homes. Many nursing-home operators say the cuts will force them to close.

Cuts funding for community mental health services by $162 million, and it cuts $34 million from state and community mental health hospital funding.In addition to cuts made during the interim, it reduces reimbursement rates for health-care providers that see patients on Medicaid and the Children’s Health Insurance Program by 10 percent.

Virtually eliminates all funding — $20 million — for housing placement and retention services for homeless families and individuals.

Sources: Legislative Budget Board, House Research Organization, Center for Public Policy Priorities, Texas Higher Education Coordinating Board, CSHB 1.

Democratic Members to Speaker Boehner - Abandon Plan to Shut Down SSA

The following is taken from a March 16, 2011
press release by Democrats Ways and Means Committee:

WASHINGTON, DC—Today 125 members of the House Democratic Caucus sent a letter to Speaker John Boehner (R-OH) urging him to restore reasonable funding levels to the Social Security Administration (SSA) in the House Republican 2011 budget to avoid shutting down the agency for the equivalent of a month this year. The letter was spearheaded by Reps. Sander M. Levin (D-MI), Ranking Member of the Ways and Means Committee, Xavier Becerra (D-CA), Ranking Member of the Ways and Means Social Security Subcommittee and Rosa DeLauro (D-CT), Ranking Member of the Appropriations Committee Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.

Ranking Member DeLauro: “Social Security ties generations together, providing economic security to millions of American seniors who otherwise might not be able to afford their daily expenses. And yet, it will be one of the first casualties of the Republican’s spending bill. The $1.7 billion drop in funding to the Social Security Administration could cause a shutdown of four weeks; leaving current beneficiaries without help should they need it, new retirees without benefits, our current workforce without the knowledge that their wages are being accounted for, and even newborn children without Social Security numbers. Americans of all ages depend on Social Security, and we must stand up to defend it against these reckless Republican cuts.”

In a letter to employees last month, SSA cautioned that it may have to furlough workers if cuts to its budget are enacted into law. In their Continuing Resolution, Republicans have proposed cutting SSA’s administrative funding by more than 9 percent in 2011, from $11.8 billion in 2010 to $10.7 billion this year. In addition, the Republican proposal provides for $1.7 billion less than SSA needs to keep pace with inflation and rising workloads.

We note Texas Representative Lloyd Doggett was a signing member and has been active in his support of disability issues. These cuts have real impact on SSA who has suspended sending earning statements, overtime and other services due to the biweekly budget scenario and lack of ability to plan out the rest of the year. We hope Speaker Boehner takes the letter seriously. Disabled Americans are not asking for a stimulus or a bail out. A promise kept for their safety net would be sufficient.

Social Security offices across U.S. to protest cuts

From the Washington Post, Lisa Rein Staff Writer penned an article regarding Social Security workers who will be demonstrating today.

Social Security workers around the country, “Rhode Island to Montana” will be holding demonstrations today. Members of the Strengthen Social Security Campaign and other groups were also scheduled to take part in Wednesday's protests.Last year some state furloughs affected the Disability Determination offices and the agency's workers have consistently warned that drastic cuts in service will impact what the agency's employees can do in this time of increasing claims and limited employment.

Dana Duggins, an official with the American Federation of Government Employees National Council of Social Security Administration locals, states that some SSA workers will hand out fliers and carry signs that read "No furloughs" and "No budget cuts" during a staggered midday lunch period and tell the public what they think would happen if the Republican plan - or a smaller version of it - were to be enacted. Federal workers have been targeted by Republican lawmakers and the White House as both seek to reduce the deficit by reorganizing and reducing government.

We have long felt that cuts to SSA's budget and staffing limitations are pound foolish and not even penny wise. Every cut delays the claims disabled submit and the appeals that occur in the process. The safety net that SSA provides is the last place to look for cuts. We support the union's efforts and agree with employees who are asking for budget and staffing levels that support the disabled who depend on SSA's field offices and Disability Determination Services. You cut SSA staff and you cut services for the disabled. It is that simple.

Project Access – Austin Physician Program Offers Low Income Residents of Travis County Health Care Free of Charge

On April 27, 2010 we attended a conference in Austin, Texas designed to address disability issues and discovered a valuable local program, Project Access Austin. This is a philanthropic program wherein the Travis County Medical Society Foundation provides coordinated health care, essentially free of charge for low-income, uninsured residents of Travis County.
Claimants applying for SSA are often in a bind. Unable to work, disabled and in need of health care, they face waiting periods of months if not years. Where do such applicants turn for health care? Approximately one-third of the Travis County Medical Society Foundation members provide volunteer services for individuals with low incomes (including those applying for but not currently receiving disability benefits).
Individuals applying for enrollment must provide documentation to ensure they meet eligibility criteria. Subsequently, applicants sign a patient responsibility agreement that requires them to be on time for appointments, follow the physician's treatment plans, and inform the program if there are changes in income, address and/or phone numbers. Eligibility includes Travis County residence for six months, US citizen or legal permanent residence. The applicant must have no medical insurance, or be unable to afford medical insurance and, may not be currently eligible for governmental assistance. Thus, an individual who receives SSA disability would likely be ineligible. However, it appears they would be eligible during the application periods (contact the program for more specifics).
Income limits are based on Federal Poverty guidelines or below. Federal Poverty Limits are roughly annual earnings of $11,000 for an individual, $14,500 for a couple and $ 22,000 for a family of four. The program allows for income of up to 200% of these figures. We congratulate the Travis County Medical Association for this innovative and compassionate initiative and ongoing advocacy. The initial application consists of a 3-page form in both English and Spanish and can be downloaded from the website at Projectaccessaustin.com. Applicants may also contact the program volunteers at (512) 206-1164, or mail to Project Access PO Box 4679 Austin, TX 78765.

Commissioner Astrue Speaking of Compassionate Allowances

This program is a win win. SSA should continue to look at fast tracking. If adequately staffed in the field offices and implemented by properly trained personnel in the state medical agencies, such initiatives help avoid repeated applications and other logistical confusion facing claimants. Small steps, smartly taken make more sense than overwhelming plans of agency redesign.


Social Security commissioner: We can fast-track help

by Michael J. Astrue - Jan. 26, 2010 09:56 AM
Special for The Republic

I recently hosted the agency's fifth public hearing on Compassionate Allowances.

I was joined on the panel by Philip Wang, M.D., Dr.P.H., National Institute of Mental Health, National Institutes of Health, and Social Security Executives.
Click here to find out more!

We heard testimony from some of the nation's leading experts on schizophrenia about possible methods of identifying and implementing Compassionate Allowances for young adults with schizophrenia.

Schizophrenia is a devastating disease that affects more than two million Americans, primarily individuals in their teens and twenties. The onset of schizophrenia has life-changing consequences, which can include unemployment and homelessness. This hearing will help us to potentially identify the most severe cases and consider bringing them under our Compassionate Allowances umbrella.

In October 2008, Social Security launched Compassionate Allowances to expedite the processing of disability claims for applicants with medical conditions so severe that their conditions by definition meet Social Security's standards.

To learn more and to view a web cast of November's hearing, go to www.socialsecurity.gov/compassionateallowances.

Our Compassionate Allowances and Quick Disability Determinations processes are making a real difference by ensuring that Americans with devastating disabilities quickly receive the benefits they need. This fiscal year, we expect to fast-track about 150,000 cases and we plan to add more diseases and impairments to these expedited processes in the coming months.

Michael J. Astrue is the Social Security Commissioner.

The Sky is Falling - Purge the SSA Thieves

When money get's tight, folks start looking at the most vulnerable amongst us.

Like the trust fund crises, periodically articles appear whipping up the masses to ferret out the fraud in SSA's program. Usually those who yell loudest know the least. The New York Times recently ran some blog posts and included in the responses was this gem from an Administrative Law Judge. Yep, someone who hears cases, and sees the disabled.

Morley White is an administrative law judge in Cleveland for the Social Security Administration. We agree with his assessment and his comments include the following:

"As a judge who has handled Social Security disability cases for 16 years, I do not believe that there is as much fraud as the press and the public believe when
it comes to the individuals who are making the claims for supplemental security benefits. That does not imply that is no fraud.
I generally believe in the sincerity of what they say. They are poor and the benefits they receive are now only $674 a month for an eligible individual.
What are these people supposed to do in this economy with the limitations they say they have?There is too much emphasis on reputed individual fraud and not enough on how the system itself can be reformed."

Despite such perspectives from those who know what they speak of, every time the economy dips or the trust fund is in need of repair, the recipients are blamed. When this periodic hysteria occurred in the 1980's the Reagan administration with help from David Stockman ( who may reside in a federal penal institution these days), was able to purge the rolls of
beneficiaries, sending cessation letters to mentally retarded individuals suggesting they could perform jobs such as cashiers. After several former recipients chained themselves to federal buildings in protest, congress woke up and regulated the process of removing folks from the rolls, creating a medical improvement process.

Reforms are inevitable, but we would like to see more articles about just what the percentage of "fraud" is in SSA programs. And, it may be surprising
to those who are ready to purge the rolls that millions of recipients are underpaid billions of dollars ( See GAO reports on SSA) due to understaffed and insufficiently trained/motivated/ compensated etc, SSA staff.

We believe the answer to saving money lies in reforms by the agency; consistency in payments and quality review at the front end of SSA's disability process. The problems are legion, but the answer is not in going after the poor.

Medicare Waiting Period and Medicaid Reform

Finally two bills with compassionate potential for the disabled and those in need.

This from the
Disability Policy Collaboration, Capitol Insider

Medicare Waiting Period and Medicaid Reform




Medicare

Sens. Jeff Bingaman (D-NM), Sherrod Brown (D-OH), and Susan Collins (R-ME) and Reps. Gene Green (D-TX) and Lee Terry (R-NE) introduced the Ending the Medicare Disability Waiting Period Act of 2009 (S. 700/H.R. 1708). This bill would phase out Medicare's two-year waiting period for individuals with disabilities under age 65 who receive Social Security Disability Insurance (SSDI) benefits.


Medicaid and Long Term Services and Supports

Last week, two important bills were reintroduced in the Senate and House: the Community Living Assistance Services and Supports Act (CLASS Act) and the Community Choice Act (CCA). The Arc and UCP strongly support these bills.

The CCA was introduced in the Senate (S. 683) by Senators Tom Harkin (D-IA) and Arlen Specter (R-PA) and in the House (H.R. 1670) by Representative Danny Davis (D-IL). This bill would require that states provide Medicaid community based support services to people eligible for institutional level of services. The bill would eliminate the institutional bias in the Medicaid program and making great strides toward eliminating waiting lists for community based services.

The CLASS Act was introduced in the Senate (S. 697) by Senator Ted Kennedy (D-MA) and in the House (H.R. 1721) by Representative Frank Pallone (D-NJ). The bill would establish a national public long term services insurance program that would pay cash benefits to eligible individuals. The benefits would not be means-tested and would not require that people become impoverished in order to receive services. The CLASS Act is expected to take some of the pressure off of the Medicaid program which has become the only significant source of public long term services supports in the nation.

Soup to Nuts

Here are some interesting excepts from the Testimony Before the Subcommittee on Income Security and Family Support of the House Committee on Ways and Means and the Social Security Administration.

The hearing was held on March 24, 2009. For full transcript, visit this link.


All emphasis has been added. The “soup to nuts” (a perhaps unfortunate moniker), review confirms our post before the hearing, that the real problems begin at the state agency DDSs, where 54 different agencies make the first determinations. While the Field Offices or federal agencies that handle the technical aspects of claims, are overwhelmed by logistics, once adequately staffed the inference appears to be problems will be alleviated. Conversely, the DDS is not suffering from lack of staffing as much as lack of expertise. Training is only hinted at by Asture in a new and promising Star Chamber review, but is the other theme that could significantly affect the entire process. Of course, the wait that ensues from the DDS denial to the ALJ hearing reflects on the hearings process. However, since ALJ’s allow about 50 percent of the cases heard, one has to wonder if the DDS was making accurate decisions more often, fewer appeals would exist and the backlogs would be significantly diminished. This is an old battle, but reflects SSA’s decision inconsistency and its effects. Real folks are waiting up to 811 (and beyond) days to get a disability decision.

-------------------------------------------------

Patrick O’Carroll, Inspector General, Social Security Administration found that the average claim adjudicated in 2006, when decided initially by a DDS, was concluded in 131 days, but that if a claim was adjudicated upon a request for reconsideration, that time more than doubled, to 279 days. If a claim was appealed to an ALJ, the 279-day wait almost tripled, to 811 days, or 2.2 years. While issues surrounding the DDSs and the processing of both initial claims and requests for reconsideration are material to the overall backlog, …O’Carroll’s soup-to-nuts review establishes that the real delays begin when an appeal is filed. It was at this stage that the processing time jumped from 279 to 811 days. He recommended, “SSA publish this measure to show disability waiting time from the claimant’s perspective, to better inform Congress and the public.”

From the GAO:

SSA’s total backlog of disability claims doubled from 1997, reaching 576,000 in 2006, which has resulted in claimants waiting longer for final decisions. The backlog was particularly acute at the hearings level. SSA also experienced declines in field office service delivery, with average customer wait times in field offices increasing by 40 percent from 2002 to 2006, and over 3 million customers waiting more than 1 hour to be served in 2008. Two key factors likely contributed to the backlog and service delivery challenges: (1) staffing reductions or turnover of field office staff and key personnel involved in the disability claims process, and (2) increased workloads. In particular, initial applications for disability benefits grew by more than 20 percent over the past 10 years.

Although DDS staff increased about 4 percent from 1997 to 2006, DDSs have experienced high rates of staff turnover and attrition. Attrition rates for DDS disability examiners, who are state employees, were almost double that of SSA federal staff. Many DDS senior managers we spoke with said that turnover of experienced disability examiners has affected productivity. For example, from September 1998 to January 2006, over 20 percent of disability examiners hired during that period left or were terminated within their first year. DDS officials said the loss of experienced staff affects DDS’ ability to process disability claims workloads because it generally takes newly hired examiners about 2 years to become proficient in their role.

In addition to disability claims backlogs and increased processing times, other aspects of SSA’s service delivery at field offices have declined in recent years. From fiscal year 2002 to 2006, the average time customers waited in a field office to speak with an SSA representative increased by 40 percent from 15 to 21 minutes. In fiscal year 2008, more than 3 million customers waited for over 1 hour to be served. Further, SSA’s 2007 Field Office Caller Survey found that 51 percent of customers calling selected field offices had at least one earlier call that had gone unanswered.

Declines in field office service delivery measures coincided with a period of staff turnover and losses agency wide. From fiscal year 2005 to 2008, SSA experienced a 2.9 percent reduction in total employees and a 4.4 percent reduction in field office employees. At the same time, employees and managers reported high levels of stress. When asked, 153 employees at 21 offices rate the stress they experienced in attempting to complete their work in a timely manner and 65 percent reported feeling stress to a great or very great extent on a daily basis, while 74 percent of office managers described high levels of stress.

SSA projects an increase in disability claims and other workloads over the coming years while at the same time anticipates the retirement of many experienced workers. Specifically, SSA projects: overall 13 percent increase in retirement and disability claims from fiscal years 2007 to 2017. A growth of 22 percent in the number of retirement and disability beneficiaries from 2007 to 2015. That nearly 40 percent of its current workforce will be eligible to retire in 5 years and 44 percent will retire by 2016.

From Commissioner Astrue’s Statements

Improve consistency and accuracy on complex policy issues; we have instituted a process for resolving disagreements between DDS disability examiners and Federal quality reviewers. In cases where the two components disagree on substantive issues, staff experts review the case and reach consensus. We anticipate we will resolve our most complex cases through this Request for Program Consultation (RPC) process. In addition, the RPC enables us to quickly pinpoint training needs and clarify or modify policies where necessary.

We plan to develop and implement a common case processing system for the DDSs.Currently, each of the 54 DDSs has its own unique processing system. A common system will help us take advantage of rapidly changing health care industry technology and provide the foundation for a seamless electronic disability case processing system.Our DDS partners agree that we need a common system, and we are working closely with them to develop requirements. This essential improvement will modernize and streamline our disability process, and we can only make important improvements on a timely basis, such as eCat, if we have a common system.