This week, Planet Money and This American Life feature a long reported piece by Chana Joffe-Walt regarding the two federal disability programs, Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI).
The cleverly titled story, “Trends with Benefits” is gracefully presented and gets some things right. It depicts with human texture some unpleasant realities facing millions of displaced workers with health difficulties whom our economy has left behind. With the exception of nutrition assistance, our safety-net has failed to keep pace with the Great Recession. Disability assistance has naturally filled the gap. SSI and SSDI expenditures have correspondingly increased. This is an important story.
Still, I fear the misimpressions this piece leaves behind. Particularly in the area of childhood disability, Joffe-Walt presents an awfully incomplete picture. Listeners are invited to conclude that many kids are brought onto SSI who really don’t need the help, that overly lax program requirements and loopholes, exploited by the “disability-industrial complex,” have produced exploding caseloads and an unsustainable budget problem.
Joffe-Walt says little about the mechanics of the eligibility determination process, or how it might be improved. She doesn’t discuss how the administrative capacities of SSI and SSDI might be bolstered to reduce errors in both directions that have large consequences for human lives.
Listeners might be surprised to discover that the final award rate for disability applications has averaged about 45 percent. Moreover, low employment rates among denied applicants suggest that disability assistance is not inducing otherwise-employable people out of the workforce. The misfortunes of people wrongly denied benefits, the problem of sick people bleeding money as the ponderous bureaucratic process moves along, the plight of disabled people stick on the Medicare waiting period—these matters were also left unexplored.
Disability programs face inherent difficulties and tensions. For starters, eligibility is a binary outcome, whereas actual disability reflects a continuous, multi-dimensional range of underlying functional limitations. When disability is the only available gateway to health coverage and needed services, this doesn’t lessen the problem.
The scale and complexity of disability policy presents further problems. With hundreds of thousands of applicants presenting with hundreds of conditions across the country, the Social Security Administration cannot run an OJ trial for every person. Since the inception of SSI and SSDI, many people have expressed precisely the worry Joffe-Walt does: that disability will become a backdoor guaranteed income program to marginally qualified applicants. Jerry Mashaw’s magisterial Bureaucratic Justice describes the rather admirable structure SSA created to address this possibility.
Eligibility determination could be tightened to better-deter fraud and to reduce the number of errors, if Congress appropriated greater funding for continuing disability reviews and other administrative capacities. Still, it’s a pretty stringent system. Despite the ministrations of what Joffe-Walt labels the “disability industrial complex,” the majority of disability applicants are actually denied. SSI and SSDI are not boondoggles.
Joffe-Walt’s depictions of welfare reform and the childhood SSI program were especially incomplete, inviting stereotypes and misinterpretation. Doing poorly in school doesn’t, by itself, get you benefits. Most kids who seek SSI benefits based on primary diagnoses of mental illness or ADHD are denied.
Child SSI caseloads are not exploding. Nor are large numbers of single moms transitioning from traditional welfare (Temporary Assistance to Needy Families, or TANF) to SSI. Planet Money included supplemental materials with additional data. Yet Joffe-Walt’s presentation remains troubling.
For example, Joffe-Walt displays a graph of the rising number of children receiving SSI over time. Out of context, it appears that the child SSI caseload has ballooned. Caseloads were tiny until the 1990 Supreme Court decision Sullivan v. Zebley overturned roadblocks in eligibility. Since then, caseloads have indeed risen.
Yet you can’t see two critical things in Planet Money’s graphs. First, readers of the fine print who click all the way through to a supplemental page will see that post-welfare-reform caseloads look more stable when graphed as a percentage of kids living in low-income families. Rising poverty rates, not lax program rules, is the critical factor.
More important, the rise in the child SSI caseloads is dwarfed by the decline in the number of children receiving cash assistance after the 1996 welfare reform. The trends look rather different when one views SSI caseloads alongside the number of kids on AFDC/TANF.
That’s obvious in the below graph I posted last year depicting the percentage of low-income kids on the two major forms of federal cash aid. Child SSI is simply a small matter when shown alongside one of the tragic policy failures of the Great Recession: TANF’s failure to remotely keep pace with macroeconomic crisis and rising child poverty.
Joffe-Walt juxtaposes two other graphs in a way that invites trouble:
These graphs just don’t go together. They cover different populations, whose dynamics are influenced by different processes.
One might look at these pictures and conclude that there has been a big migration between the two programs. The radio episode’s account of “the disability industrial complex” was even more explicit. The program’s account of contractors such as Public Consulting Group invites listeners to conclude that states are shifting TANF recipients in large numbers to SSI or SSDI.
Some of that flow has always occurred, for the simple reason that AFDC/TANF has always included some adults who are legitimately disabled. As TANF becomes progressively lousier, states and individual recipients have obvious incentives to make the switch.
Joffe-Walt presents no numbers here. I haven’t seen evidence to support the program’s clear implication.
Between 1997 and 2003, Sheldon Danziger and colleagues tracked a cohort of Michigan welfare recipients in the Women’s Employment Study (WES). WES was designed to disproportionately sample long-term welfare recipients who experienced severe material hardships and a variety of obstacles. These women lived in a chronically-depressed area hammered by a succession of economic blows. By the end of the survey period, 37 out of 532 women ended up on SSI or SSDI. 114 others had applied for disability benefits, but were found ineligible within a supposedly lax disability system.
Especially striking was Joffe-Walt’s interview with ten-year-old SSI recipient Jahleel Duroc. The clear undertone was that this appealing, gap-toothed, and enthusiastic kid has nothing fundamentally wrong with him. I’m not sure what people expect children with serious learning delays to sound like. Many sound, well, like Jahleel Duroc. Kids with daunting mental health, behavioral, or developmental issues are often perfectly terrific and engaging in casual conversation or a short cordial interview.
As in other moments of this sometimes-moving, sometimes-misleading program, the warm humanity of its host in conversation makes it too easy to neglect other matters under the surface, and thus left unexplored.