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Apr 6, 2013

Open Letter From Eight Former Social Security Commissioners

April 4, 2013 

     As former Commissioners of the Social Security Administration (SSA), we write to express our significant concerns regarding a series recently aired on This American Life, All Things Considered, and National Public Radio stations across the U.S. ("Unfit for Work: The Startling Rise of Disability in America"). Our nation’s Social Security system serves as a vital lifeline for millions of individuals with severe disabilities. We feel compelled to share our unique insight into the Social Security system because we know firsthand the dangers of mischaracterizing the disability programs via sensational,anecdote-based media accounts, leaving vulnerable beneficiaries to pick up the pieces.           
     Approximately 1 in 5 of our fellow Americans live with disabilities, but only those with the most significant disabilities qualify for disability benefits under Title II and Title XVI of the Social Security Act. Title II Old Age, Survivors, and Disability Insurance (DI) benefits and Title XVI Supplemental Security Income (SSI) benefits provide critical support to millions of Americans with the most severe disabilities, as well as their dependents and survivors. Disabled beneficiaries often report multiple impairments, and many have such poor health that they are terminally ill: about 1 in 5 male DI beneficiaries and 1 in 7 female DI beneficiaries die within 5 years of receiving benefits. Despite their impairments, many beneficiaries at tempt work using the work incentives under the Social Security Act, and some do work part-time. For example, research by Mathematica and SSA finds that about 17 percent of beneficiaries worked in 2007. However,their earnings are generally very low (two-thirds of those who worked in 2007 earned less than $5,000 for the whole year), and only a small share are able to earn enough to be self-sufficient and leave the DI and SSI programs each year. Without Social Security or SSI, the alternatives for many beneficiaries are simply unthinkable. 
     The statutory standard for approval is very strict, and was made even more so in 1996. To implement this strict standard, Social Security Administration (SSA) regulations, policies, and procedures require extensive documentation and medical evidence at all levels of the application process. Less than one-third of initial DI and SSI applications are approved, and only about 40 percent of adult DI and SSI applicants receive benefits even after all levels of appeal. As with adults, most children who apply are denied SSI, and only the most severely impaired qualify for benefits. 
     Managing the eligibility process for the disability system is a challenging task, and errors will always occur in any system of this size.But the SSA makes every effort to pay benefits to the right person in the right amount at the right time. When an individual applies for one of SSA’s disability programs, the agency has extensive systems in place to ensure accurate decisions, and the agency is home to many dedicated public servants who take their ongoing responsibility of the proper stewardship of the programs very seriously. Program integrity is critically important and adequate funds must be available to make continued progress in quality assurance and monitoring. In the face of annual appropriations that were far below what the President requested in Fiscal Year 2011 and Fiscal Year 2012, the agency has still continued to implement many new system improvements that protect taxpayers and live up to Americans’ commitment to protect the most vulnerable in our society. 
     It is true that DI has grown significantly in the past 30 years.The growth that we’ve seen was predicted by actuaries as early as 1994 and is mostly the result of two factors:baby boomers entering their high -disability years, and women entering the workforce in large numbers in the 1970s and 1980s so that more are now "insured" for DI based on their own prior contributions. The increase in the number of children receiving SSI benefits in the past decade is similarly explained by larger economic factors, namely the increase in the number of poor and low-income children. More than 1 in 5 U.S. children live in poverty today and some 44 percent live in low-income households. Since SSI is a means-tested program, more poor and low-income children mean more children with disabilities are financially eligible for benefits. Importantly, the share of low-income children who receive SSI benefits has remained constant at less than four percent. 
     Yet, the series aired on NPR sensationalizes this growth, as well as the DI trust fund’s projected shortfall. History tells a less dramatic story. Since Social Security was enacted, Congress has "reallocated" payroll tax revenues across the OASI and DI trust funds–about equally in both directions – some 11 times to account for demographic shifts. In 1994, the last time such reallocation occurred, SSA actuaries projected that similar action would next be required in 2016. They were right on target. We are deeply concerned that the series “Unfit for Work” failed to tell the whole story and perpetuated dangerous myths about the Social Security disability programs and the people helped by this vital system. We fear that listeners may come away with an incorrect impression of the program — as opposed to an understanding of the program actually based on facts. 
     As former Commissioners of the agency, we could not sit on the sidelines and witness this one perspective on the disability programs threaten to pull the rug out from under millions of people with severe disabilities. Drastic changes to these programs would lead to drastic consequences for some of America's most vulnerable people. With the lives of so many vulnerable people at stake, it is vital that future reporting on the DI and SSI programs look at all parts of this important issue and take a balanced, careful look at how to preserve and strengthen these vital parts of our nation’s Social Security system. 

Kenneth S. Apfel 
Michael J. Astrue 
Jo Anne B. Barnhart 
Shirley S. Chater 
Herbert R. Doggette 
Louis D. Enoff 
Larry G. Massanari 
Lawrence H. Thompson

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    Anonymous Anonymous said...

    As usual, the "higher ups" view of the programs is usually quite different from the people at the field office levels dealing with it daily. I have no problem with a "safety net" being in place for those in need. We just need to bring the programs up to date.

    As for the letter, I strongly disagree with one section. The former commissioners stated "extensive medical documentation is needed at all levels during the disability process". This is NOT true. Anyone can walk in an office and apply for disability with zero documentation to back it up. This, in my opinion, is one of the reasons DDS gets so back logged leading to hearings backlogs. If SSA required medical documentation to file, I bet the number of initial app denials would decline over time. Maybe it's just my office's service area, bust most people come in to file expecting Social Security to send them to a doctor so the can get evaluated. It shouldn't be the federal govts responsibility to prove the applicant is disabled. I believe this is a major disconnect they needs to be addressed in the near future. Lots of wasted time on unfounded claims.

    7:05 AM, April 06, 2013  
    Anonymous Anonymous said...

    "Anyone can walk in an office and apply for disability with zero documentation to back it up"

    Yes, anyone can file an application without medical documentation, but you can't get benefits without documentation. It is the "getting" of benefits that matters.

    This reminds me of a Seinfeld sketch about having a reservation for renting a care and being told they have the reservation, just not the car.

    9:46 AM, April 06, 2013  
    Anonymous Anonymous said...

    @ 9:46 - the end result of getting the benefits is what matters to the people that only look at the budgetary side. The real problem with letting EVERYONE file with little or no documentation is why so many cases are back logged. Sure, they may file an initial claim with no evidence and get denied. Justice served, right? Wrong, they then file an appeal and then a hearing and then add to the "log jam" of claims in back log. That was the point of the comment. It slows down the process for the ones who may truly have a case.

    9:59 AM, April 06, 2013  
    Anonymous Anonymous said...

    @ 9:59

    I get your point.But after having been in the process, on both sides for over thirty years, the numbers of claims lacking any, or very little, documentation, represent an exceedingly small percentage of the cases.

    10:15 AM, April 06, 2013  
    Anonymous Anonymous said...

    Even with zero documents, 404.1512 and 416.912 pretty clearly state that it is SSAs responsibility to help a claimant develop the record, and if the development is insufficient, to obtain a consultative exam(s).

    10:57 AM, April 06, 2013  
    Anonymous Anonymous said...

    @ 10:57 am: Even if it is the SSA responsibility to do this and that, without proper medical evidence that are verifiable, one won't get any benefits, their very strict about that and that's not fraud or waste. Objecting to someone getting benefits when their disabled and have gone through the process, is based on ignorance, possibly jealousy and being a 'know it all' who is not an expert w/a medical degree and a license, except at flapping their jaws...

    Just sayin...

    11:41 AM, April 06, 2013  
    Anonymous Anonymous said...

    Is it hard to believe that improvements in health care and medication, rehab and physical therapy services, ADA, work and hiring incentives for the disabled, etc. over the last 20 years have such poor results? We are moving backwards. I guess this matches the success of the government's wars on poverty and drugs over even a longer period. There are people who are disabled and cannot work whatsoever even with improvements in health care and the incentive programs that are now in place, and they should be helped. However, disability benefits have become a relief valve for both those who find little incentive to provide for themselves or for them to develop and apply necessary job skills, and for the failures of government imposing itself on businesses and individuals in the creation of the nanny state. Fundamental change is needed, and the solutions proposed are little more than moving the deck chairs on the Titanic.

    12:42 PM, April 06, 2013  
    Anonymous Anonymous said...

    Where I work, an urban, lower income area, disability claims with zero documentation other than an allegation are the norm, not the exception.

    I'm not saying there aren't deserving people of all ages that need assistance. I just wish our government would stop telling them to give up and rely on the goverment programs to survive. I'm sure that existence can't be all that great, although plenty in my area seem to do just fine.

    12:47 PM, April 06, 2013  
    Anonymous Anonymous said...

    Denial rates don't back up your claim. If SSA would stop taking apps for broken toes and the " I just don't like people, they make me mad" syndrome, I think those denial rates would decline.

    12:49 PM, April 06, 2013  
    Anonymous Anonymous said...

    "ADA, work and hiring incentives for the disabled".

    Currently i'm a beneficiary. The ADA does not provide full protection against hostle employers and co workers although it may provide some relief but it can be considered barely relief. I wish the government would sponsor certain employers similar to an enhanced ADA act that would give employers more incentive to not only help a person with disabilities but treat that impaired person with respect and or dignity.

    Such a sponsorship would perhaps be effective in lowering the disability rolls.

    1:52 PM, April 06, 2013  
    Anonymous Anonymous said...

    I'm a beneficiary too, no one at the SSA asked Me to sign up or join, I became one cause I felt I could go no farther, My income was not the problem, My body had just had enough and being homeless isn't appealing and dying is not either.

    3:05 PM, April 06, 2013  
    Anonymous Anonymous said...

    In response to Anon 12:42 PM, April 06, 2013

    Oh, for an original retort. This is hackneyed rhetoric lacking facts and probably FOX-induced
    “Nanny state and Titanic “
    People are not chairs or valves.
    And Speculation
    “those who find little incentive to provide for themselves or for them to develop and apply necessary job skills...”
    is not fact.

    Change is more than pointing a finger at those who are the weakest amongst us.

    3:20 PM, April 06, 2013  
    Anonymous Anonymous said...

    The standard for SSA is not strict. While disbled means cannot work at any job for at least one year, once weighing a person's credibility enters the picture, so goes the strict standard. It may be more fair or compassionate, but any strictness is gone.

    Perhaps many in SSA are concerned with proper stewardship, and perhaps many are concerned with accurate decisions. However, SSA management's policies, and particularly Astrue's, only play lip-service to that. SSA management does not care whether too many or too few cases are paid, and they do not care whether the people granted or denied were actually disabled, they just want the cases moved, so they can go to Congress and show how much work they are doing.

    A real critique of SSA would include an intelligent and informed discussion of how ODAR judges can do 500 cases a year when their cases can easily be 500-1000 pages long. Let's see how those high producing judges do that. The number of cases granted or denied is only part of the picture. It is only a problem if the wrong ones are granted or denied, and SSA is mostly concerned with disposing of cases and not the correct decision -- that is the real problem.

    12:07 AM, April 07, 2013  
    Anonymous Anonymous said...

    @ 12:07. Priority 1, disposing cases. Priority 1A, paying cases. SSA goes out of their way to find people disabled.

    9:05 AM, April 07, 2013  
    Anonymous Anonymous said...

    @9:46 AM, April 06

    Requiring medical evidence before filing a claim would make things faster no doubt. Unfortunately it would leave a lot of genuinely disabled people without help.

    I grant you it's frustrating, but it is a fundamental access to justice issue, especially for low income claimants. No claim can be ultimately granted without medical evidence, and it's a fact that many claimants don't have the money, knowledge,or ability to gather that evidence on their own.

    10:30 PM, April 07, 2013  
    Anonymous Anonymous said...

    Then why not make CE's a requirement for those with little or no evidence. We waste enough money on other things, might as well spend it toward something that may help. Right now, aren't CE's DDS discretion? In not really sure who decides one is needed, but claimants always ask if they can have a medical examination.

    8:03 AM, April 08, 2013  
    Anonymous Anonymous said...

    Nice to see that SSA employees, paid for with our tax money, with cheap healthcare, are not judgemental against the poor. Sounds like CRs want to do the "judging" of who is disabled at the interview. Goodness knows all CRs have a medical background, have read thousands of pages of medical and know the listings forward and backward to support the attitude displayed here.

    If that is how you truly feel, you need to resign, you are not provide service to the nation on our dollar, you are shaming the system like those you judge.


    9:33 AM, April 08, 2013  
    Anonymous Anonymous said...

    You have no idea what your talking about.

    11:44 AM, April 08, 2013  
    Anonymous Anonymous said...

    I was watching a show about polio vaccines in Pakistan (different topic) but I saw this guy whose leg is pretty much useless and he goes up and down stairs, walks cobblestone, dirty streets and works at an automobile shop every single day. My thought? If THIS guy can work, through his pain, then what about the others who are on disability who PROBABLY COULD WORK but don't. I understand there are many many factors (i coordinate a program to help people who are homeless get disability benefits who qualify) and that it's not 'that simple.' However, I do believe there is a segment of the population who feel they're entitled and don't want to work. Case in point: I have a friend who installed pools last summer. He's on medication for some mental health issues but is pretty much under control. in fact i think the meds are making things worse but that's another point. So he installed pools last summer, didn't find work after that and could work installing pools again this summer but chose to apply for disability. I told him 'i've seen you, i've known you, you are not disabled.' he has an attorney helping him who said it's a slam dunk case. I know him and he is one of those who feel entitled to let others take care of him and doesn't want to work. I actually wonder if they really evaluated those on disability every 6 months to a year (like they're supposed to) if they would find people they could move towards work incentive programs, ticket to work, etc. I think that we're raising a whole generation of cradle to grave government subsidized people who will never one day in their life have to work and it's not really going to help those it was intended for (the most vulnerable and in need).

    12:32 PM, April 08, 2013  
    Anonymous Anonymous said...

    Walked away from my SSA GS 11 job because I felt the agency was not doing the best it could for retirement or disability. I went to work for half the money with a NFP and pay 5 times what I paid for health insurance with SSA.

    As a Certified TII and TXVI CR and Medicare Outreach Coordinator, I think I have an idea.

    12:51 PM, April 08, 2013  
    Anonymous Anonymous said...

    We can agree to disagree.

    10:38 PM, April 08, 2013  
    Anonymous Anonymous said...

    "Providing service to the nation" doesn't mean coddling everyone who walks through the door! You quit, good for you. If you couldn't have found another job, would you have filed for disability?

    10:44 PM, April 08, 2013  
    Anonymous Anonymous said...

    And that's ptobably why Social Security will have a hard time seeing any meaningful reform. Anyone who says changes are needed are seen as the big bad wolf and are going to starve off all the poor disabled people.

    Maybe we should give everyone on benefits a million dollars each, would that be better?

    10:51 PM, April 08, 2013  

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