The Trump administration’s proposed changes to two major disability programs, Supplemental Security Income and Social Security Disability Insurance, are presented as merely an administrative update so that the programs can be run more efficiently. The reality is that these changes will strip coverage from people with legitimate disabilities, bringing harm to them and their families.
We have been here before.
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President Ronald Reagan made changes to SSI and SSDI in the 1980s that were catastrophic. Some 20,000 people died subsequent to that policy change, and the benefits were ultimately restored.
Unfortunately, policymakers have not learned from the mistakes of an earlier generation. Last November, the Social Security Administration proposed something that sounded relatively mundane: the creation of a new category of beneficiary, thereby expanding the categories of eligibility from three to four.
A new “Medical Improvement Likely” category will be squeezed in between “Medical Improvement Expected” and “Medical Improvement Possible.” There is a fourth category for those with more significant disabilities called “Medical Improvement Not Expected.”
The reason for creating the new category, and ultimately re-classifying some of the people receiving benefits under SSI and SSDI, is to more aggressively perform eligibility reviews. The stated goal is what they call program integrity, but there is no doubt that thousands of people who are too disabled to work will lose their coverage.
We are witnessing a case of serious scope creep across the safety net programs, where the administration has gone from an attempt to remove ineligible people to going after those who fairly and squarely qualify.
President Donald Trump ran for office with a vow to protect safety net programs, yet his administration has undermined them at every turn. For example, the administration’s enthusiastic approval of work requirements for people covered by Medicaid — a regulatory change that will never work and overlooks the fact that most people who have been made eligible under Medicaid state expansions actually work — is mean-spirited. It demonstrates a lack of empathy or a simple understanding of the needs of people with disabilities.
Having spent a career working with the beneficiaries of public insurance programs, I can absolutely affirm that nobody wants to be reliant on public assistance of any kind. Moreover, nobody wants to be disabled. They are on these programs usually because of very tough circumstances. Often, they have mental illness or a substance use disorder, which if left untreated leads to intentional or accidental death.
In the case of SSI or SSDI, many people cannot return to work because they are not well enough to return to a job that is physically demanding. Think of the lifelong construction worker whose injuries prevent him from hauling materials, lifting beams or similar work. His future is in construction; he needs the time to get better.
By conducting more frequent eligibility reviews, there may be some people identified who no longer meet the definition of disabled, and in that case, a termination is proper. But getting eligible for SSI or SSDI is not a simple process.
There are many verifications and materials to be submitted, and missing one deadline can derail the process. So one must wonder just how many ineligible people are actually receiving benefits.
Moreover, people who are wrongly terminated from the programs are often not people who can advocate for themselves. They don’t know where to turn to get help in appealing decisions made in error.
Perhaps most troublesome about the change is the way in which it was announced and the rush to implement it. The Federal Register announcement would have one believe this is simply an administrative adjustment to the regulations, not an action that will result in the wholesale removal of individuals from eligibility.
To read the comments posted on the draft regulation in the Federal Register is to get a window into the world of some of these individuals. Anybody who thinks that these beneficiaries are cheats or layabouts should take a look. It is difficult to read some of these hard-luck stories.
With the comment period now closing, implementation is imminent, unless the Social Security Administration listens to Congress and delays it. There are legitimate questions about this change, not only about fairness but about the cost of this change to taxpayers, which may negate the vast majority of any savings on benefit payments.
It is time to stand up for people who cannot always advocate for themselves and demand fairness from an administration that seems to relish harm rather than healing.
Gerard A. Vitti is the founder and CEO of Healthcare Financial Inc., a Boston-area company that assists individuals in obtaining health care benefits.
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