Five Questions for Pamela Loprest

Pamela Loprest, a senior research associate in the Urban Institute's Income and Benefits Policy Center, is a national expert on disabilities and employment. Her research details how the current benefit structure for the Social Security Administration's disability programs uses a one-size-fits-all eligibility definition that often leads to lifelong benefits. Loprest urges a stronger return-to-work focus. Policymakers, she writes, must weigh the costs of expanding current disability eligibility criteria to focus on work against the costs of the current all-or-nothing disability definition.

Five Questions Archives

It is important to know first that people with disabilities in the United States have much lower income and much lower employment rates than people without disabilities. Household income is about half of what it is for persons without disabilities, and only about a third of working-age adults with disabilities work versus about 90 percent of adults without disabilities. This has been true for a long time.

Obviously, work largely determines income—one reason that government policies for people with disabilities have tried to support and encourage employment. The concern is that, over the 1990s, the trend in employment of persons with disabilities fell considerably. It fell for both men and women with disabilities while other groups such as single women with children had increases in employment. The late 1990s was a great labor market. So for people with disabilities to not connect into that booming labor market is a very big concern.

2. Has government encouraged work among disabled adults?

The federal government supports people with disabilities mainly through two large government benefit programs: Social Security Disability Insurance (SSDI) and the Supplemental Security Income (SSI). Both of these large benefit programs provide cash assistance to people with severe disabilities. But you have to prove that you can't work to become eligible. So these programs already start with a presumption of people having a very tough time working.

Government has tried to encourage work among people with disabilities. Since 1999, the Ticket to Work program has offered incentives and services to help people on benefit programs go back to work. But these very same people have already had to prove, in a very rigorous eligibility process, that they can't work.

Another issue is the connection between getting those cash benefits and getting public health insurance. The risk of losing that insurance looms very large for the people who are trying to return to work.

So there has been some effort by government to encourage employment among disabled adults, but with relatively little success. A greater focus has been on getting people with disabilities into the workforce if they are receiving welfare. These are generally people not eligible for the two major disability benefit programs because their disability does not meet SSA's relatively strict disability definition. Work is a more central part of TANF [Temporary Assistance to Needy Families] than of the disability benefit programs.

3. What has the 1990 Americans with Disabilities Act done?

The Americans with Disabilities Act was passed in 1990 to provide civil rights protections to people with disabilities and to require that employers provide reasonable accommodations for workers with disabilities. There is some controversy about the extent to which it has been effective.

The law's purpose, of course, was to expand opportunities to people with disabilities by increasing access to appropriate accommodations in the workplace. But some research points to such unintended consequences as increased costs to employers and even the threat of litigation, which may have made employers less likely to hire them. Because of fluctuations in programs and the economy in the decade after passage, the extent of these unintended consequences is difficult to assess. The research is mixed.

4. How does health insurance factor into these trends?

As you might suspect, health costs can be considerable for people with disabilities, especially those with chronic conditions. So health insurance can be a very important factor, both in their income and their ability to work—providing the care that allows them to go to work and continue working.

One difficulty for would-be workers with disabilities is that SSDI and SSI provide either Medicaid or Medicare health insurance along with cash assistance. Those that leave that program for work risk losing that health insurance. And with rising health care costs and many working people already uninsured, the loss of public health insurance can be very difficult and costly.

Rising health care costs can also affect employers' view of hiring someone with disabilities. And, as we know, employers are passing on more of their health care costs to individuals through higher premiums and deductibles. Much higher costs of health insurance relative to public insurance can make it difficult for a person with disabilities to take a job.

In addition, people on Medicaid and SSI receive prescription drug benefits—a very large benefit for people. It's a "Catch-22": Health care access makes work possible, but if you go to work, you lose that access.

5. Are disabled youth being prepared for the workforce?

Young people with severe disabilities who receive cash assistance through the Supplemental Security Insurance Program face a difficult choice when they move to adulthood. On top of the normal challenges that all young people face in deciding how to prepare themselves for future education or the workforce, those with disabilities face the challenge of getting the training and preparation that will work for them within the special education system and within the structure of the SSI program.

When they turn 18, young people on SSI will be reevaluated to see if they still qualify for cash benefits as an adult. Those who decide to try to prove that they can't work may be making a choice of a lifetime of cash assistance at a very tender age. The either/or nature of the SSI program makes the transition very challenging for young people with disabilities and for their families.

The statistics on young people with disabilities show that many of them do often end up on cash assistance for life. So many do not graduate from high school or go on to higher education. And, a high percentage of them wind up in the juvenile justice system. Certainly, the current system could do more to ease the transition for these young people.