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.     

An analysis of the relationship between various redistributive programs and poverty

This paper utilizes multivariate exogeneity (causality) tests to analyze the relationship between various income policy programs and the poverty rate. The framework we develop allows us to make a distinction between intended poverty reduction objectives and automatic stabilizing behavior. Since we find that the poverty in a given year affects the funding of social programs in later years, we conclude that these programs are primarily acting as automatic stabilizers (i.e., the poverty reduction instruments do not appear to have been implemented with a relentless intent to reduce poverty, a result consistent with Tullock's [1983, 1986] theorem).     

The Characteristics and Unmet Housing Program Needs of Disabled HUD-Assisted Households

The mismatch between the housing needs of persons with a disability and the housing programs designed to accommodate those needs is an important housing policy concern. The U.S. Department of Housing and Urban Development (HUD) sponsors several programs designed to improve the housing conditions of persons with a disability, but we know little about the characteristics of persons with a disability, among those receiving federal housing assistance, or the degree to which persons with a disability are served by HUD-sponsored housing programs that are designed to meet the needs of persons with a disability. Our study relies on administrative data from HUD and the U.S. Census Bureau to address this research gap. We find that many persons with a disability are served by HUD-sponsored programs that are not designated for persons with a disability, even when disability accommodations have been requested, and a similarly large share of persons with a disability live in potentially eligible low-income households that do not receive HUD assistance.     

Medicare premium buy-in programs: results of SSA demonstration projects.

Three programs known collectively as the Medicare buy-in programs are available to pay Medicare Part B premiums and, in some cases, other medical expenses for certain low-income individuals. The Health Care Financing Administration administers those programs, with most functions performed by the states. The Social Security Administration (SSA) plays an indirect role in the buy-in programs: with certain exceptions, people who qualify for Medicare and hence for buy-in are beneficiaries of Social Security retirement or disability programs. SSA is often cited as an agency that might be able to increase enrollment in the buy-in programs through outreach to its beneficiaries and by acting as an intermediary in the enrollment process. The three buy-in programs have different requirements for eligibility. The Qualified Medicare Beneficiary (QMB) program includes individuals who have Part A Medicare benefits and whose income does not exceed 100 percent of federal poverty guidelines. People in the Specified Low-Income Medicare Beneficiary (SLMB) program are individuals who would otherwise be QMBs but whose income is more than 100 percent but less than 120 percent of poverty guidelines. People in the Qualified Individual (QI) program are those who meet the other criteria but whose income is less than 175 percent of poverty guidelines. Various reports and studies by government agencies and advocacy organizations conclude that the buy-in programs are not reaching many of the people who are eligible. Low enrollment appears to be a particular issue for the SLMB and QI programs. States have tried various outreach efforts, but the effectiveness of those efforts has not been adequately assessed. In 1998, Congress mandated that SSA conduct a demonstration project to determine how to increase participation in the buy-in programs. The project tested six different administrative models in which outreach letters were sent to potential beneficiaries asking them to contact SSA and then be screened for eligibility and referred for enrollment. SSA was able to screen about 7.1 percent of letter recipients for buy-in eligibility: 4.2 percent were potentially eligible for the programs based on income and resources, and 3.7 percent enrolled in a buy-in program. An evaluation of the probability that letter recipients would contact SSA to be screened found that: Among the elderly, older individuals were less likely to be screened but more likely to enroll. Among the disabled, older individuals were more likely to be screened but less likely to enroll. The disabled were less likely to be screened but more likely to enroll. Individuals with higher Social Security benefits were more likely to be screened but less likely to enroll. Women were more likely to be screened and to enroll. Being married did not appear to affect screening but negatively affected enrollment. Individuals with a preference for materials in Spanish were much more likely to be screened and enrolled. In some of the demonstration sites, enrollment in a Medicare+Choice plan increased the probability of being both screened and enrolled. SSA conducted a survey of some people who did not respond to the outreach letter. Most of those from whom explanations of the nonresponse were obtained had not responded because they were not eligible on the basis of their income or resources. If SSA were to reproduce the demonstrations in a nationwide outreach effort, a national mailing would include nearly 20 million individuals. If response rates were similar to those seen in the 1999 demonstrations, outreach would produce over 740,000 new buy-in enrollees. That number might be increased modestly by conducting additional outreach efforts in conjunction with the mailing.     

改革开放的孩子们——中国“70后”和“80后”青年的公平感和民主意识研究

改革开放之后成长起来的青年一代,在特定的社会历史条件下,形成了自己在学历、收入、就业、生活方式和态度表达方面的特点。70后和80后青年的社会态度也与众不同,更倾向于认为社会不公平和更强调个人权利和责任。针对当代青年的特殊性,本文提出了有利于青年发展的政策建议。     

The devil may be in the details: how the characteristics of SCHIP programs affect take-up.

In this paper, we explore whether the specific design of a state's program has contributed to its success in meeting two objectives of the Children's Health Insurance Program (SCHIP): increasing the health insurance coverage of children in lower income families and doing so with a minimum reduction in their private health insurance coverage (crowd-out). In our analysis, we use two years of Current Population Survey data, 2000 and 2001, matched with detailed data on state programs. We focus on two populations: the eligible population of children, broadly defined--those living in families with incomes below 300 percent of the federal poverty line (FPL)--and a narrower group of children, those who we estimate are eligible for Medicaid or SCHIP. Unique state program characteristics in the analysis include whether the state plan covers families; whether the state uses presumptive eligibility; the number of months without private coverage that are required for eligibility; whether there is an asset test; whether a face-to-face interview is required; and specific outreach activities. Our results provide evidence that state program characteristics are significant determinants of program success.     

Frontiers of social policy in Europe and America

The cumulative growth of social programs and public income distribution is leading to a grave need for policy harmonization, i.e., efforts to take into account interdependencies across formerly distinct areas of public and private activity. This need is particularly severe with regard to income support programs, labor market relations and taxation systems. While any fundamental backlash against the welfare state is unlikely, so too is any comprehensive solution through negative income taxation or other abstract forms of economic planning. Prospects for coping with problems of policy harmonization differ among nations, but all countries face the challenge of building consensus around noneconomic values lying at the heart of social policy. Without this cushion of legitimacy, increased policy complexity and higher public expectations threaten to overwhelm democratic political systems.     

Cash at Your Fingertips: Biometric Technology for Transfers in Developing Countries*

In recent years, interest has soared in the development potential of well‐designed cash transfer programs. One particular application is the use of transfers by resource‐rich countries (as recently initiated by Iran) to distribute rents across their populations. An emerging body of research suggests that the development impact of such programs tends to be positive and that, especially when received by poor individuals or households, they can unlock constraints on economic activities, allowing a further increase in income. This paper considers the use of biometric technology to underpin transfer programs and how new technology is opening up possibilities for effective transfer programs that, up to now, have only been a theoretical option in the institutional conditions that prevail in many developing countries. Once implemented, biometric identification systems can be used to support a wide range of other development initiatives including banking, voting, health care, and general identification systems. The paper reviews some of the programs using these technologies and how it is enabling poor countries to leapfrog rich ones in the area of identity, much as the cellphone revolution did in the area of communications.     

Rural Development Policy: Rationale and Reality

America's rural communities have fared poorly in economic termscompared to metropolitan areas. After a spurt of growth in the1970s that seemed to be closing the gap, rural areas are againlosing ground. Rural communities have argued for special helpfrom the national government. Such help can be justified tofacilitate balanced economic growth, create "more equal" standardsof living, and benefit small farmers, a group for whom the nationhas a special regard. The counter-arguments are that specialhelp to rural areas postpones adjustments to an increasinglyurban world and that federal rural programs subsidize a favoredlife-style. In fact, several federal development programs serverural areas. President Carter announced a rural policy in 1979.In 1980 the Congress enacted legislation requiring future administrationsto address rural concerns systematically. The Reagan administrationhas sent Congress the rural development strategy required bythe law, and two annual updates. However, if having a policymeans having a systematic approach to reaching defined objectives,the U.S. has had no rural policy. The objectives of federalrural efforts have never been settled on, and approaches torural problems continue to be unsystematic.     

A Matter of Fairness: The Equity of Urban General Assistance

General assistance is the "safety net" of the welfare system, γet, most general assistance programs reflect the goals of cost containment more clearly than the goal of equity. Data from a 1982 survey of general assistance programs provide the basis for a causal analysis. The substantial variation across states seems based on willingness to provide services, rather than need. State welfare commitment is the most influential explanation on general assistance coverage, although per capita income, percent metropolitan, political culture, and percent unemployment also have some effect. Perhaps centralization at the federal level will provide equitable coverage; however, the current political environment makes such an outcome unlikely without major changes in public opinion.     

Results of the Office of Policy's 2001 User Satisfaction Survey

In the summer of 2001, individuals who had an active professional interest in research or policy issues related to Social Security or to Supplemental Security Income (SSI) were surveyed by the Gallup Organization, under contract to the Social Security Administration (SSA). The survey had two goals. One was to determine the extent to which SSA's research, statistical, and policy analysis work was focusing on topics and issues of widespread concern to users. The other was to gauge user satisfaction with the products of that work. Most of SSA's research and analysis is carried out by the Office of Policy. Responses were obtained from 1,043 persons out of a sample of 1,800. Respondents were most likely to have been interested in Social Security or SSI issues for at least 10 years, to have used information from SSA multiple times during the preceding 2 years, and to have worked for the government, a college or university, or a nonprofit service organization. Results suggest that most users were satisfied with the quality of SSA's research, statistical, and policy analysis information products. Overall, 86 percent of those who had used products from SSA in the preceding 2 years were very or somewhat satisfied, 10 percent were neither satisfied nor dissatisfied, and only 4 percent were somewhat or very dissatisfied. 70 percent to 89 percent of users were satisfied with the accuracy, clarity, comprehensiveness, objectivity, timeliness, usefulness, and ease of finding the information. They were most satisfied with accuracy and objectivity and least satisfied with timeliness and the accessibility of products. 62 percent of respondents were very or somewhat satisfied with SSA's identification of and work on new and emerging research and policy issues over the past 2 years, 24 percent were neither satisfied nor dissatisfied, and 15 percent were somewhat or very dissatisfied. Respondents were asked to characterized their professional interests in two ways--as related primarily to Social Security, SSI, or both programs, and as related primarily to retirement issues, disability issues, or issues in both areas. Satisfaction varied, sometimes substantially, with professional interests. On all measures, Social Security specialists were more satisfied than SSI specialists, and retirement specialists were more satisfied than disability specialists. Note that of respondents interested primarily in the SSI program, 93 percent were also more interested in disability issues. The survey asked users to recommend ways of improving SSA's research, statistical, and policy analysis, and to recommend issues for SSA's research and policy agenda in the near future. Only 39 percent of users offered recommendations for improvement, and of those recommendations, no single issue predominated. In general, the most common recommendations were for increased data analysis in particular areas and for improved dissemination of information. A large proportion of respondents (77 percent) suggested issues that SSA should include in its research and policy agenda. Although the recommendations were quite diverse, two types appeared to dominate--disability issues and programs, and Social Security solvency and reform proposals. Some of the suggestions for disability research and policy work seem to suggest that the lower satisfaction ratings of specialists in this area reflect generalized dissatisfaction with the structure and administration of disability programs themselves rather than dissatisfaction with the quality of SSA's research and policy products. The Office of Policy is developing specific proposals for improving products and services, based on the survey's findings. By improving the quality and content of its statistical and analytical information, SSA will continue its efforts to meet the needs of a diverse research and policy community.     

Long-term disability programs in selected countries

In 1985, the Social Security Administration commissioned an 18-month research project to study disability in eight industrialized countries: Austria, Canada, Finland, the Federal Republic of Germany, Israel, the Netherlands, Sweden, and the United Kingdom. The study focused on three key areas: (1) the initial determination of disability, (2) the methods of monitoring disability, and (3) the incentives to return to work. Although the study revealed great variations among the countries in the definition of long-term disability, the approach followed in providing benefits, and the organization and features of the programs, some basic similarities were also found. Among the similarities are: (1) most countries have several income-maintenance programs to protect workers in the event that they are disabled, and (2) the disability test to determine whether a person is eligible for a disability benefit is ambiguous in that the various programs each have different eligibility criteria, different definitions of disability, different considerations given to labor-market conditions, and so forth. This article examines the diversity among the countries and attempts to highlight unique approaches to adjudicating disability, providing linkages to rehabilitation, and creating incentives for returning to work.     

A Historical Assessment of Home Buyout Policy: Are We Learning or Just Failing?

Households face many difficult decisions after a disaster, including decisions about whether to rebuild their homes or relocate to a new area. These decisions are bounded by federal housing recovery policy and the ways it is interpreted and applied. In this article, we examine the use of home buyout programs as housing recovery policy tools and assess buyout policy using policy learning theory. According to policy learning theory, policies should evolve and improve over time. Instead, a historical review of buyouts implemented in the United States suggests that policy learning related to buyouts has been, at best, limited. Rather than showing evidence of learning from one iteration to the next, individual buyout programs continue to reflect unique objectives and features, lacking evidence of an iterative process. We propose a novel typology for organizing buyout programs and conclude by exploring implications of this finding and offering recommendations for moving forward.     

How the Clinton Administration Can Make Foreign Aid Work

The changes taking place in the world today are exposing the inadequacies of the U.S. foreign assistance program. Beyond external changes such as the fall of communism, internal changes have occurred in the policy decisions and purposes governing the program, management and operations of the U.S. Agency for International Development (USAID), level of public attention on scandal, and aggressiveness of congressional oversight. After describing the purposes of the foreign assistance program, this article assesses the evolving role of the agencies involved in foreign assistance planning, budgeting and implementation processes; the processes themselves; the changes affecting the program; and the decision-making structure. Three reforms are needed to make the U.S. foreign aid program more responsive to U.S. foreign policy interests and more effective in accomplishing its development mandate. First, a strong policy focus is needed to direct the program toward realistic objectives and the best mechanisms for achieving those objectives. Second, the foreign aid program must move away from implementing projects with limited objectives and toward programs that promote broad-based economic growth, pluralism and democracy. Finally, AID should be merged into the State Department, and its field structure reorganized and reduced to better integrate development and foreign policy considerations.     

THE ROLE OF STATE ECONOMIC DEVELOPMENT PROGRAMS IN NATIONAL INDUSTRY POLICY

A decade of economic stagnation has produced a plethora of calls for government action to stimulate economic growth in employment. Arguing that activists federal industry policy is likely not to emerge in the United States, Rasmussen and Ledebur examine the potential role of states in a "federalist industry policy." States presently administer effective programs of financial assistance to business enterprises. These efforts are "rationally parochial" in that their purpose is served equally well by cresting a new job or pirating from other jurisdictions. This paper considers how state programs can be reoriented to serve national growth and development objectives as well as those of specific jurisdictions. It concludes that a subnational industry policy offers a unique opportunity to reallocate existing state resources to achieve a much higher social return.     

Retirement income security in the United Kingdom.

This article examines the U.K. retirement income security system from the American perspective. It addresses issues that most concern U.S. analysts: how the United Kingdom has kept its future public pension costs at a manageable level, the extent to which privatization of public pensions has contributed to low pension costs, the popular appeal of individual pension accounts, and the impact of privatization on retirement income. These issues are best understood in the context of the U.K. pension program's particular institutional structure and policies, two of which--"contracting out" of public pensions, and strong reliance on means-tested benefits--have been largely rejected in the evolution of U.S. policy to date. Particular use is made of recently available data on coverage rates for public and private pension programs over the total working population and administrative records on inactive personal pension accounts.     

Drivers of Policy Instrument Selection for Environmental Management by Local Governments

Local governments commonly pursue environmental objectives that exceed state and federal minimum requirements. Although research informs our understanding of factors that lead cities to adopt such policy goals, the underlying mechanisms employed to achieve them are not well understood. This article examines factors that drive the choice of policy instruments that cities use to pursue local environmental objectives. The literature links the structure of the local governing body, characteristics of the community and target populations, and the nature of the policy problem to instrument selection. Building on this, the authors model the dynamics shaping cities' use of regulations, financial incentives, or combination thereof, to pursue a variety of different environmental objectives. Results indicate that community racial composition and political leaning influence instrument choice when policy targets the public at large. Alternatively, when policy targets particular stakeholder groups, such as developers, the characteristics of the local governing body are of greater importance.     

Rental vacancy rates: A policy primer

Abstract

This article examines how policy makers use rental vacancy rates as indicators of housing market condition. The common practice of assuming that any rental market is in equilibrium when its rental vacancy rate is approximately 5 percent is criticized. Based on theoretical and empirical literature, the case is made that the rental vacancy rate that prevails when the supply and demand for rental units are in balance varies among areas and types of units and is not always 5 percent. The Department of Housing and Urban Development is faulted for not recognizing these variations and, therefore, misusing rental vacancy rates in its formula allocations for the Section 8 and HOME programs.

Observed vacancy rates offer meaningful insight into rental market conditions only when they are compared with empirically derived estimates of equilibrium vacancy rates. The methods for estimating these rates, however, are still being refined, and the data needed to derive such estimates are available only for a limited set of metropolitan areas. Other measures are available that policy makers could use to judge the adequacy of low‐income housing supply in local markets, but they are also somewhat problematic.     

LOCAL IMPLEMENTATION OF NATIONAL POLICY

This article is an examination of failures in implementing intergovernmental programs. The programs were failures in the sense that actions to implement programs were delayed far beyond the expected dates of completion. Two such failures in cities implementing two different programs (wastewater management and Section 8 housing programs) are contrasted with one instance of success (in Section 8 housing). If a Sharkansky's discussion of political and policy routines is found to be a useful explanation of the different results. When local government routines must be broken to comply with the goals and objectives of federal programs, local actors will do all they can to resist the federal program. This finding demonstrates the importance of varying local political environments in explaining varying patterns of implementation of federal programs.     

Meeting basic needs in Asia,Part I: Government capacity and performance

Questions concerning the distribution of income and wealth, and access to services have attracted increased attention during the 1970s to complement the earlier emphasis on the promotion of macro-economic development. This article provides a comparative review of service needs in Asia. It presents an inventory of the types of services provided by, or through, government, and assesses their adequacy for rural development. It explores problems with mobilizing resources and delivering services, and it identifies arrangements that appear most effective. The article emphasizes the problem of extending the coverage, and increasing the quality, of social and productive support services for vast rural populations and it stresses that more appropriate ways must be found of delivering services that are needed. A second article, to appear in the next number of Public Administration and Development, reviews ways of improving the capacity of governments and local communities to provide services needed by rural populations.