House Subcommittee Holds Hearing On Identifying Supports People with Disabilities Need to Achieve Independence

July 13, 2000

Subcommittee Members Present

Republicans: Shaw, Chairman (FL); Weller (IL), McCrery (LA)

Democrats: Matsui, Ranking Member (CA); Tanner (TN)

Purpose of Hearing

The focus of the hearing was on the characteristics of people with severe disabilities and identifying the supports they need to achieve independence, as well as examining how disability systems in other countries and the private sector have adapted to meet the changing needs of people with disabilities.

Opening Statements

Chairman Shaw spoke of the need to secure the financial future of disability insurance, and the many medical and technological advances occurring over the life of the program and the changes in expectations of work for people with disabilities.

Representative Matsui spoke of the need to maximize the Social Security Administration's (SSA's) impact on returning people with disabilities to work, along with the need to involve the Federal government as a whole.

Witnesses and Their Testimony

Barbara D. Bovbjerg, Associate Director, Education, Workforce and Income Security Issues, Health, Education and Human Services Division, General Accounting Office, accompanied by Carol Petersen, Assistant Director, Education, Workforce, and Income Security Issues, Health, Education and Human Services Division, General Accounting Office, testified that significant differences exist between SSA's disability programs and those of foreign and private sector programs, with little hard data available, especially on costs. SSA needs to develop a comprehensive return-to-work strategy and integrate it with initiatives to improve disability decisionmaking. She said that this may require fundamental change, and policymakers need to weigh the various implications carefully.

In response to a question by Representative Matsui, Ms. Bovbjerg said that SSA needs to examine the best practices of other programs and determine what will work best for SSA. In response to a question from Representative Weller about how SSA should best implement early intervention, she said that GAO was recommending that SSA carefully consider early intervention as part of a comprehensive strategy. When Representative McCrery asked about what the Subcommittee could do to encourage SSA in early intervention activities, Ms. Bovbjerg replied that SSA was thinking about doing a demonstration project on early intervention but has not yet designed it. In response to Chairman Shaw's question whether the Ticket would get people back to work efficiently, Ms. Bovbjerg indicated that they did not know yet what the costs of the program would be, whereupon Chairman Shaw suggested that the results of the demonstration projects should reveal this cost information.

Edward D. Berkowitz, Ph.D., Professor and Chair, Department of History, George Washington University; Donald Lollar, Ed.D., Chief, Disability and Health Branch, National Center for Environmental Health, Center for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia; Richard C. Baron, M.A., Project Director, Pew Fund for Health and Human Services for Vulnerable Adults, OMG Center for Collaborative Learning, Philadelphia, Pennsylvania; Richard V. Burkhauser, Ph.D., Sarah Gibson Blanding Professor of Policy Analysis and Chair, Department of Policy Analysis and Management, Cornell University, Ithaca, New York; Ralph Mohney, Senior Vice President, Customer Care Center, UnumProvident Corporation, Portland, Maine; Tony Young, Co-Chair, Social Security Taskforce, Consortium for Citizens with Disabilities and Director, Governmental Affairs, NISH, Vienna, Virginia; appeared as a panel.

Mr. Berkowitz spoke about the history of the disability program, including early debates over rehabilitation versus cash benefits, the miscalculations made about disability trends when Supplemental Security Income (SSI) was established, and the unintended consequences of trying to tighten the program in the early 1980s. Mr. Lollar spoke about the vital role social and physical environment plays in encouraging or inhibiting work for people with disabilities and about how the World Health Organization's new International Classification of Functioning and Disability (ICIDH-2) might help society better define and meet the needs of people with disabilities. Mr. Baron testified that most people with serious mental illness who are or have been employed have low wage, minimal benefit jobs, that vocational rehabilitation (VR) doesn't help them get better jobs, and that getting people off the Social Security rolls and extending medical insurance eligibility is not enough to help these people escape poverty.

Mr. Burkhauser pointed to the experience of the disability policy in the Netherlands as being instructive. The Dutch working age population had a high percentage of people entitled to disability benefits in the 1970s, but policy changes in the 1980s slowed that growth and dramatic policy changes in the 1990s have turned it around. He said that not only did U.S. employment rates for people with disabilities fall during the business cycle trough of the early 1990s but they continued to decline thereafter despite six consecutive years of economic growth. Mr. Mohney pointed to the success of UnumProvident in handling disability insurance claims and provided four recommendations for SSA: triage, early intervention, continual claim management, and adaptable benefits and incentives for workers and employees. Mr. Young testified about the weaknesses he saw in the Federal disability program: the definition of disability, low thresholds for substantial gainful activity (SGA), poor coordination of inter-agency efforts, and how older children transition from SSI to work. He also listed some of the challenges facing SSA in the disability area: a more elderly population (and work force), more non-English-speaking claimants, and increasing requirements to provide more return-to-work services, conduct more CDRs, and protect against waste, fraud, and abuse. In light of this, he said, SSA must begin to modernize the disability program and coordinate across the boundaries of congressional committees.

In response to several questions from Chairman Shaw, Mr. Baron recommended investing in education for those who could benefit and providing financial and other support for those who cannot, while Mr. Mohney indicated that his experience has been that most disabilities do not last a long period of time. Mr. Young said that there are several programs in several agencies to help educate people with disabilities, but that their efforts need to be coordinated, and Mr. Berkowitz suggested a new congressional Committee on Disability.

In response to several questions from Representatives Tanner and McCrery about the definition of disability and early intervention, Mr. Mohney suggested partial disability benefits; Mr. Berkowitz said that partial disability had been a major problem for workers compensation programs and might prove problematic for SSA, and instead suggested consideration of interim benefits; Mr. Young said that a functional-based system was needed; and Mr. Burkhauser said that the Dutch had run into problems with partial disability. He suggested either no cash benefits until after a year of VR services had been undertaken, or perhaps temporary benefits along with VR services based on a screen-in at first, followed by a later, in-depth decision about permanent benefits.