A poignant article in The Post by Terrence McCoy explored the decision-making of an impoverished former construction worker as he weighed the pros and cons of applying for Social Security Disability Insurance, a federal program that has become a lifeline for many in the rural Alabama county where he lives, and in similar hardscrabble places across the country. Much recent controversy has surrounded SSDI’s growing costs — $143 billion in 2015, plus billions for Medicare, which SSDI recipients get — and the causes thereof.
The debate is sharpened by official forecasts showing that the disability portion of the Social Security Trust Fund will be exhausted by 2022, if present trends continue, triggering sharp automatic benefit cuts.
Congress probably would step in with a fix of some sort before letting that happen, as it did in 2015, when lawmakers transferred funds from Social Security’s main trust fund to shore up disability. Nor is the program’s growth the result of rampant fraud, as sometimes alleged; structural factors such as population aging explain much recent growth. Nevertheless, at a time of declining workforce participation, especially among so-called prime-age males (those between 25 and 54 years old), the nation’s long-term economic potential depends on making sure work pays for all those willing to work. And from that point of view, the Social Security disability program needs reform.
In particular, SSDI’s rules require that applicants be unable to engage in any significant paying work, or “substantial gainful activity,” in the program’s argot. Would-be recipients thus have every incentive to cease working completely to qualify — and to avoid rehabilitation lest they lose cash benefits and that all-important health care. And, in fact, only a tiny percentage of SSDI beneficiaries return to the labor force once they exit. “The decision to apply, in many cases, is a decision to effectively abandon working altogether,” as Mr. McCoy wrote. “For the severely disabled, this choice is, in essence, made for them. But for others, it’s murkier. Aches accumulate. Years pile up. Job prospects diminish.” The typical SSDI recipient now is a middle-aged worker whose main ailment is musculoskeletal or psychological.
It is this group, those who are physically or psychologically challenged but employable with appropriate aid and opportunity, that reform would seek to reconnect with the labor force. Specifically, SSDI should no longer present applicants with a binary choice between work and benefits. Instead, benefits, including health insurance, should phase out gradually as earnings from employment rise. Economist David H. Autor and Mark Duggan proposed such a plan, which relied in part on subsidized private-sector disability insurance, in a 2010 paper jointly published by the Center for American Progress and the Brookings Institution. There are other ideas.
Budget savings are not the main goal, although they might well materialize. The point, rather, is to strike a better balance between what we spend to support people for whom work is, indeed, not an option and resources we devote to help people with disabilities retain the earnings and dignity that come from work.