Disability Insurance Program Research Articles

The effects of paid maternity leave: Evidence from Temporary Disability Insurance

This paper investigates the effects of a large-scale paid maternity leave program on birth outcomes in the United States. In 1978, states with Temporary Disability Insurance (TDI) programs were required to start providing wage replacement benefits to pregnant women, substantially increasing access to antenatal and postnatal paid leave for working mothers. Using natality data, I find that TDI paid maternity leave reduces the share of low birth weight births by 3.2 percent, and the estimated treatment-on-the-treated effect is over 10 percent. It also decreases the likelihood of early term birth by 6.6 percent. Paid maternity leave has particularly large impacts on the children of unmarried and black mothers.

Return-to-Work Outcomes Among Social Security Disability Insurance Program Beneficiaries

We followed a sample of working-age Social Security Disability Insurance (DI) program beneficiaries for 5 years after their first benefit award to learn how certain factors are associated with achievement of four return-to-work milestones: enrollment for employment services provided by a state vocational rehabilitation agency or employment network, start of a trial work period (TWP), completion of TWP, and suspension or termination of benefits because of work. We found that younger beneficiaries are more likely than are older beneficiaries to achieve the milestones and that there exists substantial variation across impairment types. In addition, the probability of achieving the milestones is higher for individuals with more years of education, for Blacks, and for individuals residing in states with low unemployment rates at the time of award. It is lower for beneficiaries with a high DI benefit amount at award, an award decision made at a higher adjudicative level, and/or Supplemental Security Income or Medicare benefits at the time of DI award. We also found large variation in the relationships of both state of residence and award month to these return-to-work outcomes. We attribute these variations to unobserved factors at the state-level, policy changes, and trends in unobserved beneficiary characteristics.

Return to Work of Disability Insurance Beneficiaries Who Do and Do Not Access State Vocational Rehabilitation Agency Services

This study examines the relationship between services provided by state vocational rehabilitation agencies (SVRAs) and return-to-work outcomes of Social Security Disability Insurance (DI) beneficiaries. DI beneficiaries who enrolled in SVRA services were compared with matched and unmatched comparison groups of beneficiaries who did not enroll in these services. We examined the progression to substantial employment milestones for DI beneficiaries over a 10-year period beginning with their entry into the DI program. Employment outcomes of the SVRA enrollee group are substantially better than those of their matched and non-matched non-enrollee counterparts, and the timing of their employment outcomes is strongly associated with the timing of vocational rehabilitation (VR) enrollment. These findings indicate that differences in employment outcomes between DI beneficiaries who received VR services and those who did not are not simply due to observable differences.

Understanding the Increase in Disability Insurance Benefit Receipt in the United States.

The share of working-age Americans receiving disability benefits from the federal Disability Insurance (DI) program has increased significantly in recent decades, from 2.2 percent in the late 1970s to 3.6 percent in the years immediately preceding the 2007–2009 recession and 4.6 percent in 2013. With the federal Disability Insurance Trust Fund currently projected to be depleted in 2016, Congressional action of some sort is likely to occur within the next several years. It is therefore a good time to sort out the competing explanations for the increase in disability benefit receipt and to review some of the ideas that economists have put forth for reforming US disability programs.

Economic Conditions and SSI Applications

The Supplemental Security Income (SSI) program provides federally-funded income support for individuals with disabilities, and has become one of the most important means-tested transfer programs in the United States. Previous studies have examined the effects of economic conditions on growth in disability caseloads, but most focus on the Social Security Disability Insurance (SSDI) program. Most work on SSI dates from before welfare reform, which had both direct and indirect effects on the composition of the population at risk for SSI participation. In this paper we examine the relationship between SSI application risk and economic conditions between 1996 and 2010, using data from the Survey of Income and Program Participation (SIPP) linked to the Social Security Administration’s 831 file, which includes monthly data on SSI (and SSDI) application and receipt. Results from hazard models suggest that higher state unemployment rates have a large, positive effect on the risk of SSI application among jobless individuals, and our evidence suggests that female potential applicants may be more responsive to local economic conditions than men. State-level TANF policies have no effect on SSI application risk but state fiscal distress significantly increases application risk. Given the continued growth of the SSI program, understanding these relationships is increasingly important and policy-relevant.

Disability Insurance and the Great Recession.

The US Social Security Disability Insurance (SSDI) program is designed to provide income support to workers who become unable to work because of a severe, long-lasting disability. In this study, we use administrative data to estimate the effect of labor market conditions, as measured by the unemployment rate, on the number of SSDI applications, the number and composition of initial allowances and denials, and the timing of applications relative to disability onset. We analyze the period of the Great Recession, and compare this period with business cycle effects over the past two decades, from 1992 through 2012.

Earnings, Disposable Income, and Consumption of Allowed and Rejected Disability Insurance Applicants

Two key questions in thinking about the size and growth of the disability insurance program are to what extent it discourages work, and how valuable the insurance is to individuals and families. These questions motivate our paper. We begin by describing the earnings, disposable income, and consumption of awarded and rejected DI applicants, before and after the disability onset and the allowance decision. Next, we discuss how these descriptive results can be interpreted through the lens of alternative empirical approaches. Our analysis uses a Norwegian population panel data set with detailed information about every individual and household.

The use of VA Disability Compensation and Social Security Disability Insurance among working-aged veterans

BackgroundAlthough there is substantial disability among veterans, relatively little is known about working-aged veterans' uptake of Department of Veterans Affairs (VA) Disability Compensation and Social Security Disability Insurance (DI). ObjectivesThis study identifies levels of veteran participation in VA disability and/or DI benefit programs, examines transitions into and out of VA and DI programs among veterans, and estimates the size and composition of the veteran population receiving VA and/or DI benefits over time. MethodsData from the 1992, 1993, 1996, 2001, 2004, and 2008 Survey of Income and Program Participation (SIPP) are used to describe VA and DI program participation among veterans under the age of 65. ResultsThe majority of working-aged veterans do not receive VA or DI benefits and joint participation is low, but use of these programs has increased over time. A higher percentage of veterans receive VA compensation, which ranges from 4.9% in 1992 to 13.2% in 2008, than DI compensation, which ranges from 2.9% in 1992 to 6.7% in 2008. The rate of joint participation ranges from less than 1% in 1992 to 3.6% in 2008. Veterans experience few transitions between VA and DI programs during the 36–48 months they are observed. The number of veterans receiving benefits from VA and/or DI nearly doubled between 1992 and 2008. There have been substantial shifts in the composition of veterans using these programs, as cohorts who served prior to 1964 are replaced by those who served after 1964. ConclusionsThe findings suggest potential gaps in veterans' access to disability programs that might be addressed through improved coordination of VA and DI benefits.

Overview and Summary: Emotional Health: Strategies for Nurses.

challenges associated with mental illness and the care of persons with mental disorders have been traced through time since 400 B.C. as Hippocrates treated mental illness as a disturbance of physiology, parting ways from the belief systems of his contemporaries that attributed these disorders to demonic possession (PBS. 2014). One way to look to the advances in psychiatric nursing practice is to reflect upon where we have been.The mentally ill have suffered maltreatment from the time of Hippocrates into the present day, treated as criminals, delinquents, and defectives; burdened by atrocities of social and personal abuse. Champions mark these dark years, among which our authors march in their good company. Some I am sure are familiar to you: Dorothea Dix (1801-1887) advocate for humane treatment; Clifford Beers (1876-1943), an early founder of the client-advocate movement; and President Truman (1946) who established the National Mental Health Act and the National Institutes for Mental Health which promotes research in the field (PBS. 2014: Dix, n.d.). Along with the discovery of antipsychotic medications in the mid-1950s, the number of hospitalized mentally ill persons peaked, and by 1961, sociologist Erving Goffman identified the effects of institutionalization upon psychotic symptoms (Goffman. 1961). By the mid-1960s de-institutionalization begins, in large part because of psychopharmacological treatments. Trans-institutionalization, another cycle back into prisons begins, as the promise of community resources fails (Lamb & Weinberger. 2005). In 1979, the National Alliance for the Mentally III is formed, and by the early 1980s one-third of the homeless population is considered to have a mental disorder. Although a new generation of anti-psychotics becomes available in the early 1990s, society's tolerance for homeless persons with mental disorders has reached its limit. Over seven percent of jail intakes are persons with serious mental illness, and of those, 25% were held without charges (Lamb & Weinberger. 2005).Advocacy in mental health care has shifted toward policy initiatives since the 1990s. Mental Health Parity Act, which broke down some of the discrimination against mental health care has been under consideration by congress since the mid-1990s (National Alliance on Mental Illness fNAMU. 2014). Americans with Disabilities Act, which took effect in 1992, supported parents and consumers in the workplace and with public accommodations (Frank & Glied. 2007). Participation in public disability insurance programs, such as Medicare, Medicaid, Social Security Disability Insurance (SSDI) and its sister program, Supplemental Security Income (SSI), provide a stable, though often minimal, source of income for people disabled by mental illness. More recently, the Affordable Care Act promises improved access to care and parity protection through expanded insurance coverage for mental illness and substance abuse disorders (Beronio. Po. Skooec. & Glied. 2013). Today, mental health care for most people with severe mental illnesses is paid for by one or more of these programs. Mental health policymakers have come to recognize that changes in these programs can have powerful effects on the well-being of the population with mental illness and their families.Our authors for this OJIN topic recognize the effects of these policy changes upon the well-being of the mentally ill in their bracing discussion of the contemporary issues confronting mental health providers and persons with mental disorders today. changes that author Kane highlights in her article, The 2014 Scope and Standards of Practice for Psychiatric Mental Health Nursing: Key Updates are cross-cutting themes repeated in the articles submitted by the following authors, giving credence to their significance. In particular, these cross-cutting topics focus upon consumerism and recovery as an achievable goal in mental health care; the need for nurse contributions in psychiatric treatment research; and the importance of and difficulties associated with achieving prevention strategies in care at the individual or systems level. …

A European postdoc for the family.

In the spring of 2011, I started a 2-year Whitaker International postdoctoral scholarship in bioengineering. My husband, an experienced mechanical engineer who is fluent in German, left his job in the United States and found a new one in Vienna. The next year, I learned I was pregnant. We didn't go to Europe to start a family—our goal was to experience a new culture and remain competitive in our fields—but we recognized almost immediately the advantages of Austria's support for young professionals pursuing careers and a family. ![Figure][1] “The parental-leave advantages that Europe can offer postdocs are worth considering.” ILLUSTRATION: ROBERT NEUBECKER Austria is far ahead of the United States in providing options for both women and men to take time off from work for birth and child care. First there is Mutterschutz , a mandatory paid maternity leave and job protection period of 8 weeks before and 8 weeks after the birth of a child. Then there is Elternkarenz , up to 36 months of financial support with allowances of as much as 80% of your monthly wage. Parents frequently opt for 14 months, with the father taking 2 months. Other European countries offer similar benefits. Dutch employment law, for example, entitles working women to 16 weeks of paid zwangerschapsverlof , men to 2 days of paid vaderschapsverlof , and both parents to 6 months of additional unpaid leave with job protection. In the United Kingdom, statutory maternity pay (SMP) is granted for up to 39 weeks, and employers often supplement these benefits with occupational maternity pay. Under the SMP program, fathers can receive 2 weeks of paid leave, with an additional 26 weeks if the mother returns to work. Specific restrictions vary, but non-E.U. nationals can qualify as long as they have an employment contract and an appropriate visa. A science Ph.D. makes it easier to secure the required credentials. According to a Pew Research Center report covering 38 countries around the world, the United States is the only one that does not mandate paid leave for new mothers. California is one of a few states to offer paid family leave, available to workers who have contributed to the state disability insurance program. But in most of the country, the postdoc parenting experience is institution dependent. After our son was born, I took 5 months off and my husband took 3 months. We wanted to share parenting responsibilities equally, as much as nature allowed. He planned to take off 5 months, too, but job opportunities in the United States brought us back sooner than expected. Still, my husband was able to experience caring for our son full time while I worked; they bonded in a way that is hardly possible for working fathers in the United States, where paid paternity leave is rare. Being the primary caregiver for 3 months allowed my husband time to find his own way of parenting while I got back to work. I wanted to stay connected during my leave, so I worked remotely when I could and often brought my son to lab meetings, which my colleagues were kind enough to schedule around naps. My immediate team of male colleagues did not seem to mind the infant intrusion—it helped that he was a calm baby—and meetings were productive. This flexibility, and the absence of pressure to return to work, allowed ample time to connect with my son as I learned to be a mom. Work was secondary when it needed to be. In the United States, the pool of qualified postdocs has grown and postdocs have gotten longer. There's now a greater likelihood than ever that training will overlap with starting a family. The decision when and where to have children is personal and depends on many factors; there's something to be said, for example, for having your mother nearby. But in deciding where to train, postdocs should consider the whole experience of working and living, not just time spent in the lab. Add to the mix Europe's ample opportunities for professional enrichment, and the parental-leave advantages that Europe can offer postdocs are worth considering. [1]: pending:yes

Sicker and Poorer: The Consequences of Being Uninsured for People With Disability During the Medicare Waiting Period.

Purpose:Disabled individuals younger than 65 years are entitled to Medicare coverage through the Social Security Disability Insurance (DI) program, but only if they have completed a 2-year waiting period. This is the first study that uses longitudinal panel data, the Health and Retirement Study, and examines whether and to what extent the health and economic status are affected among disability beneficiaries who are uninsured during the Medicare waiting period.Methods:In a quasiexperiment research design, using a difference-in-difference (diff-in-diff) estimator, we compare changes in health and economic outcomes pre-/postentering the DI program for disability beneficiaries with alternative public health insurance and those without.Results:The adjusted diff-in-diff estimates suggest that disability beneficiaries who are uninsured during the waiting period, compared to those who are insured, are 13.6 percentage point more likely to report poor health, 6.3 percentage point less likely to be in excellent health, declare more difficulties in activities of daily living, and 30% higher medical expenditures from out of pocket.Conclusions:The findings highlight punitive health and economic effects of the Medicare waiting period for uninsured disability beneficiaries. We also discuss the implications of the findings for the Affordable Care Act reform.

Long term earnings and disability program participation outcomes of the Bridges transition program

BACKGROUND: The Bridges from School to Work (Bridges) program provides job placement and supports for youth with disabilities. Operating in nine sites across the country, over 18,000 youth have received job placement services through Bridges. OBJECTIVE: The paper presents long-term outcomes of youth who participate in the study to determine if previously documented short-term outcomes continue into adulthood. METHODS: We examine the earnings of Bridges participants up to age 30. We present longitudinal statistics on the earnings and Supplemental Security Income (SSI) and Social Security Disability Insurance (DI) program participation of youth placed by Bridges into a job. A comparison with similarly aged youths receiving SSI who did not participate in Bridges is also made. RESULTS: At age 30, almost three quarters of youth placed by Bridges have earnings. We also find that SSI participation declines through age 30 and DI participation increases. Among placed youth who received SSI at the time of Bridges enrollment, half have earnings at age 30 and less than half received SSI payments; however, over one quarter receive DI benefits. CONCLUSIONS: Bridges participation potentially helps create a higher earnings capacity for participants; however, more research is necessary to establish a causal effect.

Employee Health and Employer Incentives

In the past two decades the OECD has regularly voiced concern about the labor market exclusion of people with disabilities and about the cost of disability insurance programs. This paper examines whether the fundamental disability insurance reforms that were implemented in the Netherlands have helped or hindered employment opportunities of workers with health problems or disability. An important component of the Dutch reforms was to enhance employer incentives, which was done by making them responsible for paying sickness benefits and by strengthening their sickness monitoring obligations. These employer incentives may stimulate preventive and reintegration activities by firms, thereby improving the employment opportunities of disabled workers. However, the reforms also impose substantial costs on employers when an employee gets sick and may therefore reduce employme nt opportunities of disabled workers. We use data from the Dutch Labor Force Survey and rich administrative data from hospital admission records, social security records, and the municipality registers containing demographic information to examine whether the disability reforms have in fact improved the economic situation for the disabled. On balance, we conclude that the DI reforms implemented by the Dutch government have mainly protected those who already have a job, and may have inadvertently reduced the hiring opportunities of people with a disability.

Rejection from the Disability Insurance Program and Dependency on Social Support

Recent studies find that many workers do not return to the labor force after their applications for Disability Insurance (DI) are denied. It is, therefore, important to understand how this group funds their consumption. This paper uses the Survey of Income and Program Participation linked to administrative data to examine the social support participation behavior of rejected applicants. By following cohorts of individuals from 10 years before to 10 years after filing for DI, this paper shows that rejected DI applicants are at most 10 percent more likely to depend on social support programs than healthy workers. More general models show that at the time of application rejected applicants are 25 percent more likely to depend on social support programs than healthy workers. These effects decrease across time, but up to 10 years after filing, rejected DI applicants are still up to 12 percent more likely to depend on social support programs. These are the same levels of social support participation exhibited by DI beneficiaries. While rejecting more DI applicants may reduce DI outlays, these results suggest that rejected applicants are more likely to depend on other federally funded assistance programs to fund their (very) early retirement.

The Social Security Disability Insurance Program

The Social Security Disability Insurance (SSDI) was added to Social Security in the 1950s and has grown into a large and complex institution in its own right that interacts with several other government and employer-provided benefit programs. It provides income replacement to the 8.9 million disabled workers and their families. SSDI is currently funded by a 1.8% Federal Insurance Contributions Act payroll tax on earned income up to $117,000 per year (indexed). That has not been enough, and the Disability Insurance (DI) trust fund will be depleted in 2016. There are indications that the solution is at hand. A proposal within the Office of the Chief Actuary of the Social Security Administration would shunt money from the Old Age and Survivors Insurance to the DI trust funds, thus postponing the “day of reckoning” for the combined Old Age, Survivors, and Disability Insurance trust funds to 2033. It is imperative that Congress address this problem soon. The longer we wait, the harder it will be.

Reconciling findings on the employment effect of disability insurance.

Over the last 25 years, the Social Security Disability Insurance Program (DI) has grown dramatically. During the same period, employment rates for men with work limitations showed substantial declines in both absolute and relative terms. While the timing of these trends suggests that the expansion of DI was a major contributor to employment decline among this group, raising questions about the targeting of disability benefits, studies using denied applicants suggest a more modest role of the DI expansion. To reconcile these findings, we decompose total employment changes into population and employment changes for three categories: DI beneficiaries, denied applicants, and non-applicants. Our results show that during the early 1990s, the growth in DI can fully explain the employment decline for men only under an extreme assumption about the employment potential of beneficiaries. For the period after the mid-1990s, we find little role for the DI program in explaining the continuing employment decline for men with work limitations.

Edward D. Berkowitz and Larry DeWitt. The Other Welfare: Supplemental Security Income and U.S. Social Policy.

Edward D. Berkowitz and Larry DeWitt have spent their careers honing a portrait of the centerpiece of the New Deal welfare state—the Social Security Act. Together, they have pulled its previously unknown architects into the limelight, illuminated lesser-known elements of the system, drawn connections to insurance expansions like disability and Medicare, and provided scholars and students with access to primary sources crucial to its historical development. From DeWitt's position as chief historian of the Social Security Administration and Berkowitz's perch as professor of history and public policy and public administration at George Washington University in Washington, D.C., they have modeled generous, cooperative scholarship. In their second collaboration, they bring their knowledge and experience to bear on a distant relation of Social Security in a much later period—the Supplemental Security Income Program (SSI). In the last quarter of the twentieth century, SSI emerged as a large, vital component of the welfare state, but its history, nevertheless, has been little-understood. SSI is a means-tested income-support program for the elderly and disabled who are not otherwise eligible for the larger federal disability insurance program, Social Security Disability Insurance. Created in 1972, SSI has come to serve over nine million Americans and continues to grow annually. Its architects in the Social Security Administration and Congress intended to include elderly and disabled adults as part of a more respectable, federally controlled welfare program—one more generous and more uniform than the previous Old Age Assistance program or the despised Aid to Families with Dependent Children, serving single mothers. In practice, however, the program fell short of those goals. Berkowitz and DeWitt demonstrate how SSI quickly evolved into a system as variable, vulnerable, and unpopular as many of the other means-tested “welfare” programs. Though policymakers desired a truly national program, compromises in the legislative and administrative processes left SSI at the mercy of state and congressional meddling. SSI paid radically different benefits from state to state as a result. The authors also track how shifting target populations generated hostility from lawmakers and the media. Though SSI initially aimed to provide support to the “respectable” elderly and disabled, increasing numbers of mentally disabled, mentally ill, and addicted adults and children soon populated the program. None of them proved to be popular or politically influential clientele. From the moment of the program's birth through the 1990s, journalists and disgruntled members of Congress attacked SSI's recipients. Today, despite the aims of its architects, SSI hovers just above Temporary Assistance for Needy Families and the food stamp program in the eyes of its critics.

The Economic Burden of Disability in India: Estimates from the NSS Data

The paper estimates the economic cost to family when a household member loses job due to onset of disability. The cost measured in terms of loss in the ‘conversion handicap’ adjusted per capita household consumption and estimated using the Indian National Sample Survey (NSS) data. Estimates of the loss by state, by rural-urban place of residence, and by the type of disability are given. The paper recommends a publicly provided actuarially fair social disability insurance program that taxes workers while working and provides disability benefits close to their pre-disability earnings to improve social welfare by preventing large consumption losses.

The Accelerated Benefits Demonstration: Impacts on the Employment of Disability Insurance Beneficiaries.

We use data from the Accelerated Benefits demonstration to estimate the impacts of providing newly entitled disability insurance (DI) beneficiaries with health insurance and additional services during the DI program's 24-month Medicare waiting period. While health insurance alone did not increase employment, the additional employment services appeared to have positive short-term impacts on labor market activity. We find a statistically significant increase in employment and earnings in the second calendar year after random assignment; although these findings disappear in the third calendar year. Our results may have implications for disability reform proposals and provisions within the Affordable Care Act.

Social Security Reform and the Full-Funding Concept

Social Security, more accurately the Old-Age, Survivors, and Disability Insurance (OASDI) program, is woefully underfunded as measured by the long-term actuarial balance. Its reserves, on deposit with the U.S. Treasury Department, will be depleted in 2033, notwithstanding the fact that there is no money there. The surpluses that created them following the 1983 Amendments ended in 2010. The so-called reserves have long since been spent on other government programs and obligations. Yet the fiction endures. This article examines the origins of the full-funding standard and then analyses the real funding problems of OASDI and how they are measured. If the OASDI is seen as the pay-as-you-go system that it is, its problems would be more easily managed.