Recent trends in the Social Security Disability Insurance Program

Earlier analysis documented the rapid growth of the Disability Insurance (DI) program from 1966 to 1975; this article discusses trends since 1975. Over the decade of the 1970's, the population insured for disability increased by 34 percent, and women as a proportion of the insured population rose from 32.4 percent in 1970 to 39.1 percent in 1980, reflecting the increase in female labor-force participation. Of disabled workers receiving benefits, the proportion that were women rose from 28.4 percent in 1970 to 32.4 percent in 1979. Although inflation caused total benefit costs to rise over the entire period, the number of DI beneficiaries began to decline in 1978. Disabled-worker awards reached a peak in 1975 and fell subsequently so that the 1969 and 1981 figures are approximately equal. Relative to 1970, the fraction of awards going to women increased, the share for persons aged 50-54 rose, and the proportion received by those aged 60-64 declined. Decreased in total awards, and hence recipients, stemmed primarily from higher rates of denial at both the initial application and the reconsideration stages. Higher denials were countered by substantial rises in the number of hearings and reversals by administrative law judges (ALJ's). in 1980, only 65 percent of all awards came from initial applications, while over a fourth resulted from ALJ reversals. In future years, recent legislative changes may be expected to curtail program expansion further.     

Disability benefit coverage and program interactions in the working-age population

Over three-fourths of the working-age population in the United States is insured for Disability Insurance (DI); this group is protected against a total loss of earned income typically associated with severe disability. However, little is known about the role the Supplemental Security Income (SSI) program plays in protecting against the financial consequences of severe disability for this population. We find that over one-third (36 percent) of the working-age population is covered by SSI in the event of a severe disability. Three important implications follow, which we discuss in sequence below: (1) SSI increases the overall coverage of the working-age population; (2) SSI enhances the bundle of cash benefits available to disabled individuals; and (3) interactions with other programs also enhance the safety net, most notably in the area of health insurance coverage. Ignoring these implications could lead to inaccurate inferences about disability program coverage, health insurance coverage, and the well-being of working-age individuals with disabilities. The first major finding is that SSI substantially increases overall cash benefit coverage. Thus SSI dramatically increases protection against the financial risk of disablement in the working-age population. While roughly 23 percent of the U.S. working-age population was not insured for DI in November 1996, SSI provides coverage for more than half of this seemingly "uncovered" population. An important innovation of our analysis is that we account for the possibility that many of those who appear ineligible for SSI based on current income could become eligible as a result of a disability shock that causes their earnings to drop. Thus the estimated proportion that is protected by SSI increases when the possibility of earnings loss because of disability is considered. Considering DI and SSI together, roughly 90 percent of the working-age population would be potentially covered for benefits in the event of a disability. Those who are covered by SSI--as opposed to those covered by DI alone-tend to be relatively young, less educated, and in relatively poor health. The remaining 10 percent or so are not covered by either DI or SSI. This group is economically vulnerable in some sense (they are poorer, older, and more likely to be women than those covered only by DI), but they are not as economically vulnerable in terms of income, resource holdings, and private health insurance coverage as those who are eligible for SSI. A disproportionate share of those who are not covered by either DI or SSI consists of married women. The second major finding is that SSI substantially enhances the bundle of available cash benefits. Roughly one-third of those covered by DI are initially covered by SSI as well. SSI enhances the bundle of available cash benefits through two mechanisms: (1) SSI provides cash payments during the 5-month DI waiting period, and (2) SSI supplements the DI benefit after the DI waiting period for people whose initial SSI payment is larger than the DI benefit. We find that the role of SSI cash payments is temporary for most of those who are initially covered by both SSI and DI: They would receive SSI during the DI waiting period, but would lose SSI eligibility afterwards because the higher DI benefit completely offsets the SSI benefit. However, a smaller group of DI beneficiaries with low DI benefit levels would continue to be covered by both SSI and DI after the DI waiting period because the relatively low DI benefit would not completely offset the SSI benefit. The third major finding is that interactions with other programs also substantially enhance the safety net. The most important interactions involve health insurance coverage. In the working-age population, Medicare is available to DI beneficiaries, but only after a 24-month waiting period. By contrast, SSI is an important pathway to Medicaid benefits for severely disabled adults with limited income and resources and has no waiting period. SSI can provide a pathway to health insurance coverage during the 24-month Medicare waiting period for some DI beneficiaries through providing access to Medicaid. Interactions with other programs, such as Temporary Assistance for Needy Families (TANF), Food Stamp, Unemployment Insurance (UI), workers' compensation (WC), and veterans' disability programs, modify the role of DI and SSI in protecting people against the adverse financial effects of disablement. The nature of the interactions with other programs differs depending on individual circumstances. Employment-related programs (including UI, WC, and veteran's disability programs) are particularly important for those who are covered by DI. By contrast, the means-tested programs (including TANF and Food Stamp) are more important for those who would be eligible for SSI. In conclusion, SSI plays a substantial role in protecting working-age people against the adverse financial consequences of disablement through three mechanisms: (1) providing coverage to many who are not DI insured; (2) providing additional cash benefits to many who are DI insured and also covered by SSI; and (3) enhancing the social safety net by interacting with other programs, most notably Medicaid. Through these mechanisms, the role of SSI is substantial enough that it cannot be safely ignored in econometric and policy research on DI.     

The reservation wages of Social Security Disability Insurance beneficiaries

There exists a lot of research on the reservation wages of the unemployed as a determinant of unemployment duration. Little is known about the reservation wages of those who are not in the labor force but might be potential labor force returnees, such as Social Security Disability Insurance (DI) beneficiaries. The main objective of this article is to assess what can be learned from the subjective reservation wages of DI beneficiaries. Using the New Beneficiary Data System (NBDS), the article assesses the magnitudes of reservation wages compared to the last wage earned and the benefit amount, as well as the determinants of reservation wages in a regression framework. The NBDS is unique in that it provides the reservation wages and the work history of DI beneficiaries before and after joining the DI rolls. The article has several noteworthy results and policy implications: *Data show that a significant portion of beneficiaries report being likely to accept a job if offered one. Based on the NBDS, 13 percent of DI beneficiaries who did not work since joining the rolls in 1981-1982 reported in 1991 that they would be willing to work if offered a job and provided their reservation wages. *DI beneficiaries do not appear to price themselves out of the labor market. Half of them would want a wage that is 80 percent or less of the last wage earned before receiving DI. It is estimated that approximately 7 percent of long-term DI beneficiaries may potentially return-to-work if they search for jobs and have a wage offer distribution with a mean at 80 percent of their last wage. *The nonlabor income in addition to the benefit is positively and significantly associated with the reservation wage, while the benefit amount per se is not. However, this result needs to be treated with caution given that nonlabor income is endogenous to the model. *Heterogeneity exists between persons still under the DI program and those that have moved to the Old-Age program. The subsamples of persons who have shifted to the Old-Age program and those who are still under the DI program have median reservation wage to the last wage ratios of 0.69 and 0.93, respectively. A significantly lower reservation wage for persons who have moved to the Old-Age program was also found in a regression framework. This heterogeneity between the two groups may result in part from the different program characteristics both groups face, for instance, in terms of benefit termination and Medicare eligibility rules. *Subjective reservation wage data can be useful to study populations that are out of the labor force. This article is innovative in that it focuses on a group of persons who are typically considered as being out of the labor force, and therefore are not asked reservation wages in general household surveys such as the Current Population Survey. It would be of great interest to collect more reservation wage data for DI beneficiaries in a longitudinal data set to expand this analysis, for instance, to assess conclusively the effects of changing program characteristics on reservation wages and return-to-work outcomes as beneficiaries transition to the Old-Age program or as new return-to-work programs are put in place.     

How policy variables influence the timing of applications for Social Security Disability Insurance

This article analyzes the impact of policy variables--employer accommodations, state Social Security Disability Insurance (DI) allowance rates, and DI benefits--on the timing of an application for DI benefits by workers with a work-limiting health condition starting when their health condition first begins to bother them. The analysis uses a rich mixture of personal and employer characteristics from the Health and Retirement Study linked to Social Security administrative records. We find that most workers do not apply immediately for DI benefits when they are first bothered by a health condition. On the contrary, the median working-age man with a work-limiting condition waits 7 years after that time before applying, and the median working-age woman waits 8 years. Although the risk of applying for benefits is greatest in the year following onset, only 16 percent of men and 13 percent of women in our sample apply within the first year, and the risk of application falls thereafter. That finding suggests that institutional factors, in addition to health factors, may play a role in the timing of DI applications. Using kernel density estimates of the distribution of application and nonapplication ordered by state allowance rates (the rate of acceptance per DI determination in each state), we find that both men and women who live in states with high allowance rates are disproportionately more likely to apply for benefits in the first year after their condition begins to bother them than are those in states with low allowance rates. Using life-table analysis, we also find that men and women who are accommodated by their employers are significantly less likely to apply for DI benefits in each of the first few years after their condition begins to bother them than are those who are not accommodated. On the basis of this evidence, we include these policy variables in a model of the timing of DI application that controls for other socioeconomic variables as well as health. Using a hazard model, we find that workers who live in states with higher allowance rates apply for DI benefits significantly sooner than those living in states with lower allowance rates following the onset of a work-limiting health condition. Workers who are accommodated following the onset of a work-limiting health condition, however, are significantly slower to apply for DI benefits. Using the mean values of all explanatory variables, we estimate the relative importance of changes in these policy variables on the speed with which workers apply for benefits after onset. We find that the mean time until application for men is 10.22 years. Universal accommodations following onset would delay application by 4.36 years. In contrast, a 20 percent decrease in state allowance rates would delay application by only 0.88 years. For working-age women, the average expected time until application once a condition begins to bother them is 10.58 years. Universal accommodations would delay that by 3.76 years, and a 20 percent decrease in allowance rates would delay it by 1.47 years. A complication in this analysis is that the policy variables are to some degree endogenous. Accommodation is probably offered more often to workers who want to continue working. Allowance rates are chosen by states on the basis of federal policy and local choices and probably in part on the health condition of workers in the state. Therefore, our estimates are upper bounds of these policy effects. Still, we believe we provide evidence that the social environment faced by workers with work-limiting health conditions can significantly influence their decision to apply for DI benefits, holding their specific health conditions constant.     

Workers' compensation, Social Security Disability Insurance, and the offset: a fact sheet

This article offers a brief summary of the workers' compensation and Social Security Disability Insurance programs. Information highlighted includes the differences between the two programs' types and terms of coverage. It compares the differing patterns in workers' compensation and Social Security disability benefits as a percentage of wages over the past few decades and considers the potential causes for such trends. The article also explains the offset provision included in the 1965 Social Security Amendments, the intention behind the offset, and how and when offsets are applied.     

The implementation of complex social policy: Institutional layering and unintended consequences in the National Disability Insurance Scheme

In this article, we identify the unfolding unintended consequences which flow from one instance of policy layering in Australia's National Disability Insurance Scheme (NDIS). We show how use of a causal diagram, which highlights feedback loops and emergent properties, to map complex chains of causal factors can assist policy scholars and policy practitioners to understand the likely direction of change and possible responses. In the case of Australia's National Disability Insurance Scheme, our analysis suggests that the likely direction of change will work against two of the fundamental design features of the NDIS: providing participants with more choice and control, and ensuring all eligible Australians are able to access appropriate services and supports regardless of where they live. Our analysis points to the use of price regulation as the site of potential intervention because of the role it plays in subsequent feedback loops and the development of the two, unwelcome, emergent properties.     

Disability beneficiaries who work and their experience under program work incentives.

This research examines the return to work by Disability Insurance beneficiaries who were first entitled to benefits in 1980-81 and who were originally selected to be interviewed in the New Beneficiary Survey. To facilitate an examination of actual labor-force participation by beneficiaries, information on work and participation in program work incentives was collected from their claims folders. The analysis shows that approximately 10 percent of disability beneficiaries work during their initial period of benefit entitlement. About 80 percent are granted a trial work period, and over 70 percent of those granted trial work successfully complete it. More than half of them, however, were not successful in leaving the rolls through their work effort. In fact, benefit terminations due to work occurred for fewer than 3 percent of all beneficiaries in the cohort; approximately one-third of them had returned to the rolls by the end of the period under study. Beneficiaries most likely to make a work attempt were young and had a high level of education. Those with a high Social Security benefit amount were less likely to make a work attempt.     

The Effect of Lower Transaction Costs on Social Security Disability Insurance Application Rates and Participation

Transaction costs pose significant barriers to participation in public programs. We analyze how Social Security Disability Insurance (SSDI) application behavior was affected by iClaim, a 2009 innovation that streamlined the online application process. We use a difference‐in‐differences design to compare application rates before and after 2009 across counties with varying degrees of access to high‐speed internet. We estimate that counties with internet connectivity one standard‐deviation above the mean experienced a 1.6 percent increase in SSDI applications, and a 2.8 percent increase in appeals after the reform. We estimate that the increase in applications due to iClaim can explain 15 percent of the overall increase in applications between 2008 and 2011. Higher exposure to the online application led to a slightly larger increase in SSDI awards, meaning there was a small but significant increase in the overall award rate. Application rates increased the most in rural areas, while appeals and awards had more significant increases in urban areas. These results suggest that the online application reduced transaction costs to applicants, and the lower costs improved the overall targeting efficiency of the application process.     

Accountability in Public Service Quasi‐markets: The Case of the Australian National Disability Insurance Scheme

Australia's National Disability Insurance Scheme (NDIS) represents the latest in a worldwide shift towards individualised funding models for the delivery of care services. However, market‐based models for care deliveries bring new considerations and dilemmas for accountability. Drawing on previous work by Dickinson et al. (2014), we examine a range of accountability dilemmas developing within the early implementation of the NDIS. These relate to accountability for the following: care outcomes, the spending of public money, care workers, and advocacy and market function. Examining these accountability dilemmas reveals differences in underpinning assumptions within the design and on‐going implementation of the NDIS, suggesting a plurality of logics within the scheme, which are in tension with one another. The contribution of this paper is to set out the accountability dilemmas, analyse them according to their underpinning logics, and present the NDIS as having potential to be a hybrid institution (Skelcher and Smith 2015). How these dilemmas will be settled is crucial to the implementation and ultimate operation of the scheme.     

Longitudinal statistics on work activity and use of employment supports for new Social Security Disability Insurance beneficiaries

We present longitudinal employment and work-incentive statistics for individuals who began receiving Social Security Disability Insurance (DI) benefits from 1996 through 2006. For the longest-observed cohort, 28 percent returned to work, 6.5 percent had their benefits suspended for work in at least 1 month, and 3.7 percent had their benefits terminated for work. The corresponding percentages are much higher for those who were younger than age 40 when they entered the DI program. Most first suspensions occurred within 5 years after entry. Cross-state variation in outcomes is high, and, to the extent observed, statistics for more recent cohorts are lower.     

The impact of changing financial work incentives on the earnings of Social Security Disability Insurance (SSDI) beneficiaries

SSDI beneficiaries lose their entire cash benefit if they perform work that is substantial gainful activity (SGA) after using Social Security work incentive programs. The complete loss of benefits might be a work disincentive for beneficiaries. We report results from a pilot project that replaces the complete loss of benefits with a gradual reduction in benefits of $1 for every $2 earned above an earnings disregard level. Beneficiaries who volunteered to participate in the project were randomly assigned to a group receiving the new program or to a control group. The policy led to a 25 percent increase in the percentage of beneficiaries with earnings above the annualized SGA amount, or $11,760 in 2009 dollars. It did not result in a reduction in benefit payments. © 2011 by the Association for Public Policy Analysis and Management.     

The Impact of Rehabilitation and Counseling Services on the Labor Market Activity of Social Security Disability Insurance (SSDI) Beneficiaries

We use data from a social experiment to estimate the impact of a rehabilitation and counseling program on the labor market activity of newly entitled Social Security Disability Insurance (SSDI) beneficiaries. Our results indicate that the program led to a 4.6 percentage point increase in the receipt of employment services within the first year following random assignment and a 5.1 percentage point increase in participation in the Social Security Administration's Ticket to Work program within the first three years following random assignment. The program led to a 5.3 percentage point increase, or almost 50 percent increase, in employment, and an $831 increase in annual earnings in the second calendar year after the calendar year of random assignment. The employment and earnings impacts are smaller and not statistically significant in the third calendar year following random assignment, and we describe SSDI rules that are consistent with this finding. Our findings indicate that disability reform proposals focusing on restoring the work capacity of people with disabilities can increase the disability employment rate.     

Adjudicating reasonable and necessary funded supports in the National Disability Insurance Scheme: A critical review of the values and priorities indicated in the decisions of the Administrative Appeals Tribunal

Beyond the initial euphoria of the National Disability Insurance Scheme (NDIS), tough choices will be needed for sustainability. Although the spirit of the NDIS is to deliver choice and control, the Australian government's objective is to ensure that rights and aspirations are proportionate to expectations of best practice, aptness of mainstream services and cost effectiveness. The position in this paper is that this test of ‘reasonable and necessary’ when determining funded supports, raises value dilemmas for government and citizens. The objective is to demonstrate this through a critical scrutiny of the reviews and decisions regarding reasonable and necessary funded supports of the Administrative Appeals Tribunal (AAT). In this paper, a synthesis and critique of 35 appeals to the AAT and one Federal Court Appeal are used to make explicit the decisional ambiguities and contestations in the scheme and the values and priorities that are currently dominant in the allocation of reasonable and necessary support. This in turn is used as a basis for a discussion about the operation of rights in the scheme and what counts as legitimate support. The benefit is for scheme transparency and fairness but also broader debate about core principles and values to inform decisions about scarce resources in society.     

Expanding access to health care for Social Security Disability Insurance beneficiaries: early findings from the accelerated benefits demonstration

Most Social Security Disability Insurance (DI) beneficiaries must complete a 5-month waiting period before they become entitled to DI cash benefits and an additional 24-month waiting period before Medicare benefits begin. The Accelerated Benefits (AB) demonstration is a randomized experiment designed to test the effects of providing newly entitled DI beneficiaries who do not have health insurance with a generous health benefits package during the Medicare waiting period. This article presents early findings on the prevalence of health insurance coverage among newly entitled beneficiaries and the characteristics of those without health insurance. It also examines the effects of AB on health care utilization, the extent to which AB reduces unmet medical needs, and the costs of providing the AB health benefits package.     

Increase in the length of incarceration and the subsequent labor market outcomes: Evidence from men released from Illinois state prisons

The sharp rise in U.S. incarceration rates has heightened long‐standing concerns among scholars and policymakers that lengthy incarceration permanently harms the future labor market outcomes of prisoners. If true, then lengthy prison sentences will not only punish criminals for crimes committed, but will also make it far more difficult for ex‐prisoners to reenter society as productive citizens. To investigate this claim I examine how increase in duration of incarceration affects subsequent earnings and employment. Comparing long‐serving prisoners with short‐serving ones in the Illinois state prison system, I find that the length of incarceration is positively associated with earnings and employment, even though these effects attenuate over time. The positive effects are stronger for individuals convicted of economically motivated and less violent crimes (such as property‐ and drug‐related offenses) than for those convicted of violent crimes (such as person‐related offenses). The effect is also stronger for prison entrants with self‐reported drug addiction problems. The deterrent effect of lengthy incarceration and rehabilitation during incarceration are possible reasons for this positive effect. However, because this paper analyzes men who served less than four years in Illinois prison and excludes the population of men who served their terms exclusively in jail, readers should be cautious about generalizing findings of this paper. © 2011 by the Association for Public Policy Analysis and Management.     

Opportunities to enhance relational wellbeing through the National Disability Insurance Scheme: Implications from research on relationships and a content analysis of NDIS documentation

Interpersonal relationships are critically important to ensuring that people with disability can access the benefits of individual funding models such as the National Disability Insurance Scheme (NDIS). The NDIS aims to enhance participants’ self‐determination of supports and social and economic participation, but the emerging evidence indicates that achieving these policy outcomes requires stronger recognition of participants’ relational context, even in a system focused on individual choice and control. This paper reports on a content analysis of the NDIS Act, NDIS Rules, Operational Guidelines, and Price Guide to examine the extent to which the scheme's conceptual foundations and funded supports in individual plans enable it to support relationships. Implications are drawn from this analysis and theory and evidence about the importance of relationships for disability policy and practice. The paper outlines three areas where the approach of the NDIS to relationships is limited and can be improved: first, by conceptualizing relationships as relationships rather than simply sources of informal support; second, through provisions to actively support relationships; and third, by considering the relational appropriateness of support provided by family, carers, and friends. It concludes with suggestions for how relational considerations can be enhanced, including implications for government in administering the scheme.     

Actuarial status of the Hospital Insurance and Supplementary Medical Insurance Trust Funds

This article, adapted from a summary of the 1983 Annual Reports of the Medicare Boards of Trustees, presents the present and projected future actuarial status of the Hospital Insurance (HI) and Supplementary Medical Insurance (SMI) Trust Funds following the enactment of the Tax Equity and Fiscal Responsibility Act of 1982 and the Social Security Amendments of 1983. Although the Trustees characterize the outlook for the HI Trust Fund as slightly more optimistic than it was a year earlier, they report that the fund may be exhausted sometime between 1988 and 1996 unless benefits under the HI part of Medicare are reduced or financing is improved. The SMI Trust Fund, which is financed by premiums adjusted each year to reflect actual experience and by general revenue contributions, is characterized as actuarially sound. The Trustees note, however, the growing extent to which general revenue financing is becoming the major source of income for the SMI part of Medicare.