Theorising Disability: Beyond 'Common Sense'

This article seeks to introduce the topic of disability to political theory via a discussion of some of the literature produced by disability theorists. The author argues that these more radical approaches conceptualise disability in ways that conflict with 'common-sense' notions of disability that tend to underpin political theoretical considerations of the topic. Furthermore, the author suggests that these more radical conceptualisations have profound implications for current debates on social justice, equality and citizenship that highlight the extent to which these notions are also currently underpinned by 'common-sense' notions of 'normality'. ¹     

Disability benefits suspended or terminated because of work

We use a new variable in the Social Security Administration's Ticket Research File to produce statistics on the first month of suspension or termination for work (STW) for Social Security Disability Insurance (DI) and Supplemental Security Income (SSI)-only beneficiaries as well as on the number of months in nonpayment status following suspension or termination for work (NSTW) before their return to the rolls, attainment of the full retirement age, or death--in each year from 2002 through 2006. Less than 1 percent of beneficiaries experienced their first STW in each year, but more were in NSTW in at least 1 month. Ticket to Work (TTW) participants were more likely to have a first STW than nonparticipants, but most of those who had an STW were not TTW participants, reflecting low use of TTW. Employment networks often failed to file claims for outcome payments during months when their TTW clients were in NSTW.     

The Social Security Administration's Disability Service Improvement process

Reprinted here in its entirety is Commissioner Jo Anne B. Barnhart's statement of June 15, 2006, to the Subcommittee on Social Security of the House Committee on Ways and Means. In her statement, Commissioner Barnhart outlines the improved disability determination process and how the changes to the process were decided. The key elements are collectively referred to as the Disability Service Improvement (DSI) and represent the most significant changes in the Social Security Administration's 50-year history of determining disability for workers seeking Social Security Disability Insurance benefits. Commissioner Barnhart's statement underscores that while the need for change in the disability determination process was clear, both she and SSA staff listened carefully to all points of view in the decisionmaking process. The end product of this outreach effort and deliberative process is the final rule that was published on March 31, 2006. The new procedures outlined in the final rule will take advantage of the new electronic disability claims system, or eDib, and will shorten times to make disability decisions and will allow benefits to be paid sooner to people who are clearly disabled. Key elements include a new Medical and Vocational Expert System to improve the quality and availability of such expertise at all levels of adjudication, review of state agency determinations by a Federal Reviewing Official to ensure more accurate and consistent decisionmaking earlier in the process, and a newly created Decision Review Board to identify and correct decisional errors and to identify quality issues at all levels. Two improvements underlying the new process at all levels include better documentation of the record and more effective quality feedback loops for continuous improvement. Read Commissioner Barnhart's statement for a further explanation of DSI, how the changes were decided, and her plans for implementation.     

Analysing Choice in Australian Individual Funding Disability Policies

The Australian National Disability Insurance Scheme (NDIS) will allocate funding packages to people with disability who are assessed as needing paid support. The NDIS is an example of individual funding, which is currently not the dominant way of organising disability support in Australia. Individual funding aims to increase opportunities for personal choice. We present a framework for understanding current individual funding policies in each Australian jurisdiction according to two policy dimensions that potentially enable greater personal choice for people with disability: who holds their allocated funds and where support can be purchased. The findings show wide disparities in choice across the country, particularly due to constrained funds and the shortage of support to purchase in regional areas. The analysis demonstrates that NDIS implementation will need to consider that, while individual funding can be empowering for some people with disability, enabling choice can be challenging for administrators and service providers.     

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.     

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.     

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.     

The Politics of Ideas in Reforming the Dutch Disability Fund

This article looks at the long struggle to reform the Dutch disability insurance fund, which covered close to 10% of the labor force in 2002. Ideas played a strategic role in the framing and discourse of the policy reforms. A template propagated by the European Commission was used by center‐left reform advocates to soften a neoliberal campaign to overhaul the disability insurance scheme. Center‐left politicians used European deliberations to convince their colleagues to accept increased spending on activation programs rather than rely on rounds of cutbacks. Labor market activation also resonated with voters, for very different reasons. Voters in the 2000s rallied around activation in order to bar ethnic minorities from taking advantage of the disability program. By the time that the disability law was repealed in 2006, many voters had altered their minds about the disability fund, resenting the fact that “problematic” minorities lived off welfare state benefits.     

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.     

ADA, Disability Rights, and Evolving Regulatory Federalism: Articles

This article explores the evolution of regulatory federalismby examining the shifting basis of disability rights mandatesfrom conditions-of-aid to federal preemption. It also examinesthe disability rights mandates placed on state and local governmentsby the Americans with Disabilities Act (ADA) and compares themwith those provided in earlier federal laws. The central thesisis that by adopting a preemptive approach, the U.S. Congressclaimed for itself the dominant role in creating and enforcingnondiscrimination mandates to protect the rights of people withdisabilities. While several organizing principles and implementationdirectives stipulated in ADAwerefirst devised in earlier federallaws and administrative regulations, their application throughfederal preemption strengthened the force and reach of disabilityrights protections. In the process, preemption substantiallyreduced the authority of state and local governments to createand implement their own disability rights measures.     

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.     

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.     

Reconsidering Citizenship in the Light of the Concerns of the UK Disability Movement

Perhaps largely due to the successful campaigning of a number of pressure groups and social movements, but also due to the established position of related subjects within academia, there is a now almost routine consideration of class, ethnicity, gender and sexuality in relation to citizenship. Disability and the position of disabled people as “citizens” has not, however, received as much attention. It is the assertion of this article that this is a significant fact, for a consideration of disability in relation to citizenship provides useful insights into the strengths and weaknesses of some important theories of citizenship. Further, it demonstrates the need for an approach that takes account of the increasing uncertainty of groups such as disabled people towards their own identities and that conceives citizenship as being a process of “proactive engagement” towards a “reflexive position”.