The GOP’s Health-Care Bill Would Push More Disabled People Into Poverty
The system around disability benefits is already broken — and it could soon get exponentially worse.
Over the last few months, Trump’s Budget Director, Mick Mulvaney, has frequently turned Social Security disability insurance into a punching bag. In March, he called it “a very wasteful program.” In May, he declared, “If you’re on disability insurance and you’re not supposed to be, you’re not truly disabled, we need you to go back to work.” A day later, presenting Trump’s budget proposal, he stated he is “a lot less comfortable” with telling taxpayers “look, I need to take this money from you to give to this person over here who really isn’t disabled but is getting a disability benefit.”
Mulvaney’s language surrounding disability insurance, though perhaps particularly sharp, is not unusual. The GOP has long suggested that the system is ruinous and routinely abused by lecherous fraudsters. The problem? Such claims do not hold up to factual scrutiny — statistics show that abuse is, in reality, extremely rare. The disability error rate, which counts both overpayments and underpayments to beneficiaries, is well below 1% of all benefits, as then-Acting Social Security Commissioner Carolyn Colvin testified to Congress in 2012. If anything, in fact, the program is so strict that it makes it too difficult to secure disability insurance in the first place — only 40% of applicants are awarded benefits.
Meanwhile, while Republican leaders crow about a problem that hardly exists, a real issue is often ignored: Disabled people are frequently pushed into poverty, or further into poverty, as a direct result of their efforts to secure financial assistance.
The situation has been dire for a while. And if Trump’s draconian budget is signed, and the Senate’s health-care bill passes, it could get even worse.
Many people are unaware that Social Security disability actually takes two forms: Social Security Disability Insurance (SSDI) is granted to disabled people who have worked in the past but are currently unable to do so, while Supplemental Security Income (SSI) is reserved for those who have never worked or only worked a small amount. While SSI is a welfare program, SSDI is insurance — a payroll-tax-funded program the recipient has paid into throughout their adult life.
Award benefits for both programs are meager. For an individual, annual SSI payments top out at about $3,000 less than the federal poverty line. SSDI awards, which are based on the claimant’s previous income rather than on financial need, end up being about $2,000 above the annual poverty line for a one-person household.
Meanwhile, the time between application and approval is, for both programs, prohibitively long: The process can span years, often requiring numerous appeals. And this wait, in turn, can have dire impacts.
Take the case of Courtney, an SSI applicant who shared their experience with me. Since age 11, they have been diagnosed with 13 disorders, the most severe of which are POTS, which causes fainting, lightheadedness, and fatigue, and Myasthenia Gravis (MG), an autoimmune neuromuscular disorder which causes the major muscles to fatigue and stop working. Every five weeks Courtney, now 26, receives treatments to boost immunity and minimize MG symptoms. Treatment and recovery take five days — and without these treatments, Courtney says, they could go into myasthenic crisis, which could cause stop them to stop breathing and halt their heartbeat. Yet even with these treatments, Courtney is unable to meet the physical requirements for available jobs in their area.
Courtney first applied for SSI in February 2016, and has been denied three times. Initially, their disabilities were deemed insufficiently severe. Later Courtney was told that their ability to fill out the appeals paperwork indicated they could work a sedentary job. This kind of justification for denial is not uncommon. Dana Duncan, a Wisconsin attorney who has worked on behalf of disability claimants for 27 years, says that while he doesn’t “want to seem too cynical,” some decision-makers “have gotten jaded, and they’ll put anything down if they want to deny the case.”
Some decision-makers ‘have gotten jaded.’
The success of Social Security claims is further complicated by vocational experts, witnesses who testify for the Social Security Administration (SSA) regarding the availability of jobs that claimants can perform. But as Duncan points out, these experts work with outdated and inaccurate data. Some formerly “unskilled” jobs, for example, now require limited computer knowledge, classifying them as “semi-skilled” — but this change is not reflected in the Dictionary of Occupational Titles (DOT), the reference text used by vocational experts. Despite this, disability claims are often denied on the basis of vocational expert testimony. (The SSA is in the process of replacing the DOT, which was last updated in 1991, with a new Occupational Information System that will more accurately represent job descriptions and requirements. However, this system will not be complete until 2019.)
The resulting appeals process may further intensify financial difficulties. According to Duncan, “Most of my clients, by the time they get to a point where they realize they’re going to be disabled, they don’t have any money. They’re already missing a lot of work, usually before they ever lose their jobs. They have a huge amount of hospital or medical expenses, because even if they were having coverage, between deductibles and co-pays, they have thousands of dollars a lot of times in medical bills.” So even if these clients are approved, by the time they start receiving benefits they “are so far in debt that they can’t even dig their way out.”
‘Most of my clients, by the time they get to a point where they realize they’re going to be disabled, they don’t have any money.’
The financial burdens of medical care and loss of employment are so significant that some disabled people, particularly those lacking strong personal safety nets, become homeless. Though non-institutionalized disabled people account for only 16% of the U.S. population, over 40% of the country’s homeless is disabled. Duncan has had clients who lose their homes during the appeals process and move “from family member to family member,” live in unheated cabins in the woods, or are forced to stay with their ex-spouses. As a result, not only are applicants stripped of their independence, they can be difficult to locate — which, in turn, affects the success of their claims. In fact, disability and homelessness are so entwined that there is government-funded outreach to help the homeless acquire disability benefits.
Successful applicants typically receive back payments for the time they were unable to work and not receiving benefits. However, debt and interest can accumulate quickly. Simone, a 30-year-old SSI recipient I interviewed over email, waited over two years before receiving benefits. According to Duncan, it is common for applicants to wait three to four years, making Simone’s wait relatively short. Even so, most of Simone’s over $13,000 in “back pay” went toward credit card debt and stopping foreclosure proceedings on her home. By the time she received her benefits, one $1,500 credit card payment had ballooned to $6,000. And although she and her husband only owed about $900 on their home, they ended up paying an additional $6,000 in lawyer’s fees, which, Simone says, would not have happened if they had been able to pay sooner. After quickly depleting thousands in back pay, Simone had only her husband’s income of under $5,000 per year and her monthly SSI payments of $698 to live on.
Simone’s situation has stabilized somewhat. Last year, between her SSI and her husband’s job, her household income exceeded $30,000. This is enough to provide for Simone, her husband, and their young child, but, she says, “We’re still scared.” When determining SSI eligibility and award amounts, the SSA accounts for spousal income and family size, which can result in reduced payments or loss of benefits entirely. If Simone’s husband makes more than $31,000 a year, Simone says, she will lose her SSI, “so we are nervous that right when things look up we could end up stuck again, before I have a chance […] to help the household somehow.”
As for Courtney, their second appeal was denied in September 2016, and they have been waiting on a hearing for nine months. If approved, Courtney says, “I would like to move in with my fiancée and start an actual life.” But they still worry about life on disability, saying that even with benefits, “I have no idea if we can ever get married for real, because I will probably lose my Medicaid if we do and without that I can’t afford to live.” And while Courtney would like to have children one day, they are concerned about the expense. Because SSI award amounts are need-based, Courtney’s benefits will be restricted to less than $400 a month as long as they live with their mother. If they move out and support themselves, they can expect around $730.
‘We are nervous that right when things look up we could end up stuck again.’
Such financial struggles would only worsen under the GOP agenda, especially the proposed budget and the new Senate health bill. The budget would cut $72 billion from Social Security disability programs, further restricting the number of people who can access benefits. It would also slash $616 billion from Medicaid and the Children’s Health Insurance Program, which would result in loss of insurance for the poor and sick and lead to incomplete documentation of disability and worse health outcomes.
Changes to the Affordable Care Act would only compound these issues. According to a CBO report released on Monday, the Better Care Reconciliation Act — the Senate’s rushed version of a health-care bill — could result in loss of insurance for an additional 22 million people by 2026, raising the total number of uninsured Americans to 49 million. And while the bill does not let insurance companies deny coverage to people with preexisting conditions, it does allow states to alter essential health benefits, meaning that sick people can be forced to settle for worse coverage. These changes would reduce quality of care and increase medical debt — and these gaps in health care would make disability claims even harder to win.
Limited health-care access also increases the number of people who need disability benefits in the first place. Duncan points out that many disability recipients are only sick because “they don’t get the medical care they need.” For example, someone with heart palpitations or high blood pressure might not go to a doctor until they suffer a heart attack. “If they would have been treated for it when it first started, they probably wouldn’t need to be on disability,” he says. “But no one thinks of that.”
This is not to suggest that the current system needs no reform. Currently, an applicant who tries to work while their case is pending is often penalized with denial of benefits. As a result, it can be easier for people to “sit around […] and wait for [their] benefits to start.” Duncan suggests reforms in this area, as well as the option of a “partial disability benefit,” where the recipient is covered under Medicare and can work part-time. These changes could ease recipients’ financial struggles.
Mulvaney has promised that “We’re not going to measure compassion by the amount of money we spend, but by the number of people that we help.” But this reluctance to spend is the problem — with wait times spanning years, and benefits so meager, it is often impossible for disability recipients to rise above the level of survival.
And as for the implied epidemic of abled people exploiting the system? It “doesn’t happen,” Duncan says. Not only is the process of acquiring disability complicated and long, the payout isn’t worth it.
The Trump administration’s agenda for health care and social programs, he adds, “isn’t making America great again. It’s taking away the basics of what we should have as a country.”
“It feels like the government sees my existence as a burden,” Courtney says, “and so does everyone else.”