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.
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.
Rourke L. O'Brien is a postdoctoral fellow in population health at Harvard University.