Work Ought to Mean Getting Ahead : Welfare reform: The government saves plenty when disabled people have jobs. Why not make it more rewarding?

There are many junctions between welfare reform and health-care reform, and scores of inequities that mar our current systems. But among the cruelest and most inefficient practices are the rules that govern disabled people who have jobs.

Consider the case of Ted (he prefers that his last name not be used), a quadriplegic with some use of his arms. He is assisted by an attendant, uses a power wheelchair and drives a wheelchair lift-equipped van. His van is 17 years old and about to give out. Although has worked for 20 years and is close to retirement age, Ted cannot afford to replace his van. He is trapped in a cycle of poverty perpetuated by outdated welfare policies.

Because Ted does not earn enough to fully pay his attendant, without whom he would be forced into a nursing home (a fate justifiably dreaded by the disabled), he must rely on government programs for aid. To remain qualified for an attendant, his earnings and resources are restricted to meet Social Security guidelines for Supplemental Security Income. Out of gross wages of $2,000, Ted pays $354 toward his attendant’s salary, leaving $1,646 in monthly income before taxes. After taxes, Ted has approximately $1,200 for rent, food, utilities--everything else. Little is left to put away to replace an outworn van. But even if Ted could scrape together some savings, anything over $2,000 would cause him to lose his attendant and thus his independence.

A non-working SSI recipient in California receives $603 per month. By working, paying taxes and having his medical insurance paid by his employer, Ted has saved taxpayers about $360,000 over 20 years. If Ted did not have an attendant and had been in a nursing home for those 20 years, the cost to taxpayers would have been about $600,000.

But what is the economic incentive for Ted to work? He can never get ahead. He can’t save much, for fear of losing his eligibility for an attendant. His retirement income will be the same as if he never worked, because any portion of his combined pension and Social Security retirement payments above $623 a month would go to pay his attendant.

The government spends $4 billion a month on Social Security disability benefits for 7.5 million disabled people, most of whom, like anyone, want to work and create a better life for themselves. But while the Americans with Disabilities Act holds a promise of a barrier-free environment in the workplace, Social Security policies erect other, invisible barriers.

Private insurance company practices compound the difficulties. Companies exclude certain conditions or treatments from eligibility for payment or use them as a basis to deny coverage altogether; most policies will not pay for durable medical equipment such as power wheelchairs and respirators, and most lack provisions for personal attendant services. The only way many disabled persons can get health care is through Social Security programs such as Medicaid and Medicare. Dependent on these programs, many disabled are locked out of the work force or prevented from getting equipment, like a new van, that could keep them working.

President Clinton has acknowledged that the work issue is at the center of the health-care reform debate for disabled persons. Some of the proposals being debated in Congress include provisions that would prevent insurance-company discrimination and modernize both SSI and Medicaid practices. Those who would “save” by axing these reforms simply don’t understand that the government will reap substantial savings by freeing the work ethic of all people, including people with disabilities.