Testimony

Before the Subcommittee on Social

Security, Committee on Ways and

Means, House of Representatives

United States General Accounting Office

GAO

For Release on Delivery

Expected at 10:00 a.m.

Thursday, July 11, 2002 SSA DISABILITY

PROGRAMS

Fully Updating Disability

Criteria Has Implications

for Program Design

Statement of Robert E. Robertson, Director

Education, Workforce, and Income Security Issues

GAO-02-919T
Page 1 GAO-02-919T

Mr. Chairman and Members of the Subcommittee:

Thank you for inviting me here to testify during your hearing on the

definition of disability used by the Social Security Administration (SSA) in

the Disability Insurance (DI) and Supplemental Security Income (SSI)

programs. Since these programs began, much has changed and continues

to change in the arenas of medicine, technology, the economy, and

societal views and expectations of people with disabilities. These changes

have generally enhanced the potential of people with disabilities to work

as well as the kinds of jobs that are available. Moreover, these programs

have grown. In 2001, SSA provided $73.2 billion in cash benefits to 8.8

million working-age adults. With such an extensive cash outlay and such a

large beneficiary population, it is important to use updated scientific and

economic information to evaluate claims for disability benefits.

Today I will discuss the results of our examination of SSA’s efforts to

update the disability criteria the agency uses to make eligibility decisions

for DI and SSI benefits. I will focus my remarks on (1) the scientific

advances, economic changes, and social changes that have occurred in

recent years that relate to the disability criteria used in DI and SSI

eligibility decisions, (2) the extent that DI and SSI disability criteria have

been updated to reflect these changes, and (3) the implications of fully

incorporating scientific advances, economic changes, and social changes

into the DI and SSI disability criteria and program design. To develop this

information, we reviewed agency documents, SSA’s advisory board

reports, our prior reports, and other literature. In addition, we interviewed

agency officials and several experts in the field.

In summary, first we found that scientific advances, changes in the nature

of work, and social changes have generally enhanced the potential for

people with disabilities to work. Medical advancements, such as organ

transplantations, and assistive technologies, such as advances in

wheelchair design, have given more independence to some individuals. At

the same time, a service- and knowledge-based economy has opened new

opportunities for people with disabilities, while social changes, reflected

in the Americans with Disabilities Act, have fostered the expectation that

people with disabilities can work and have the right to work. Second, we

found that DI and SSI disability criteria have not kept pace with these

advances and changes. Depending on the claimants’ impairment, decisions

about an individual’s eligibility for disability benefits can be based on both

medical and labor market criteria. SSA is in the midst of an effort to

update the medical portion of the disability criteria, but the pace is slow.

However, even if the criteria were fully updated, the program as currently
Page 2 GAO-02-919T

designed does not require SSA employees to consider the possible effect

that treatments or assistive technologies could have on a claimant’s ability

to work, unless a physician has already prescribed the treatment.

Moreover, with respect to the labor market portion of the disability

criteria, SSA is using outdated information about the types and demands

of jobs in the economy.

Finally, regarding the implications for incorporating the advances and

changes into the programs’ disability criteria, some steps can be taken

within the existing program design and some would require more

fundamental changes. Within the context of the current statutory and

regulatory framework, SSA will need to continue to update the medical

portion of the disability criteria and vigorously expand its efforts to

examine labor market changes. However, in addition, policymakers and

agency officials could look beyond the traditional concepts that underlie

the DI and SSI programs to re-examine the core of federal disability

programs—including eligibility standards, the benefits structure, and

return-to-work assistance—with a focus on taking advantage of the

medical, economic, and social changes. This would include maximizing

opportunities to work in today’s environment, while providing financial

support when and where it is needed. To do so, they need critical

information on various policy options, including what works, what needs

to be fundamentally re-oriented, and the cost of such changes. To this end,

approaches taken from the private disability insurers and other countries

offer useful insights.

Established in 1956, DI is an insurance program that provides benefits to

workers who are unable to work because of severe long-term disability. In

2001, DI provided $54.2 billion in cash benefits to 6.1 million disabled

workers.1

 Workers who have worked long enough and recently enough are

insured for coverage under the DI program. DI beneficiaries receive cash

assistance and, after a 24-month waiting period, Medicare coverage. Once

found eligible for benefits, disabled workers continue to receive benefits

until they die, return to work and earn more than allowed by program

rules, are found to have medically improved to the point of having the

ability to work, or reach full retirement age (when disability benefits

 1

 Included among the 6.1 million DI beneficiaries are about 1.1 million beneficiaries who

were dually eligible for SSI disability benefits because of the low level of their income and

resources.

Background
Page 3 GAO-02-919T

convert to retirement benefits).2 To help ensure that only eligible

beneficiaries remain on the rolls, SSA is required by law to conduct

continuing disability reviews for all DI beneficiaries to determine whether

they continue to meet the disability requirements of the law.

SSI, created in 1972, is an income assistance program that provides cash

benefits for disabled, blind, or aged individuals who have low income and

limited resources. In 2001, SSI provided $19 billion in federal cash benefits

to 3.8 million disabled and blind individuals age 18-64. Unlike the DI

program, SSI has no prior work requirement. In most cases, SSI eligibility

makes recipients eligible for Medicaid benefits. SSI benefits terminate for

the same reasons as DI benefits, although SSI benefits also terminate when

a recipient no longer meets SSI income and resource requirements (SSI

benefits do not convert to retirement benefits when the individual reaches

full retirement age). The law requires that continuing disability reviews be

conducted for some SSI recipients for continuing eligibility.

The Social Security Act’s definition of disability for adults under DI and

SSI is the same: an individual must have a medically determinable physical

or mental impairment that (1) has lasted or is expected to last at least 1

year or to result in death and (2) prevents the individual from engaging in

substantial gainful activity.3

 Moreover, the definition specifies that for a

person to be determined to be disabled, the impairment must be of such

severity that the person not only is unable to do his or her previous work

but, considering his or her age, education, and work experience, is unable

to do any other kind of substantial work that exists in the national

economy.

SSA regulations and guidelines provide further specificity in determining

eligibility for DI and SSI benefits. For instance, SSA has developed the

Listing of Impairments (the Medical Listings) to describe medical

conditions that SSA has determined are severe enough ordinarily to

prevent an individual from engaging in substantial gainful activity. SSA has

also developed a procedure to assess applicants who do not have an

 2

 Fewer than one-half of 1 percent of DI beneficiaries, and about 1 percent of SSI

beneficiaries, leave the rolls each year because they are working.

3

 Regulations currently define substantial gainful activity for both the DI and SSI programs

as employment that produces countable earnings of more than $780 a month for nonblind

disabled individuals. The substantial gainful activity level is indexed to the annual wage

index. The level for DI blind individuals, set by statute and also indexed to the annual wage

index, is currently defined as monthly countable earnings that average more than $1,300.
Page 4 GAO-02-919T

impairment that meets or equals the severity of the Medical Listings. The

procedure helps determine whether an applicant can still perform work

done in the past or other work that exists in the national economy. While

not expressly required by law to update the criteria used in the disability

determination process, SSA has stated that it would update them to reflect

current medical criteria and terminology. Over the years, SSA has

periodically taken steps to update its Medical Listing. The last general

update to the Medical Listing occurred in 1985.

In 2000, the most common impairments among DI’s disabled workers were

mental disorders and musculoskeletal conditions (see fig.1). These two

conditions also were the fastest growing conditions since 1986, increasing

by 7 and 5 percentage points, respectively.

Figure 1: Percentage Distribution of DI Disabled Workers by Impairment Categories,

2000

Source: Annual Statistical Supplement to the Social Security Bulletin, 2001.

In 2000, the most common impairments among the group of SSI blind and

disabled adults age 18-64 were mental disorders and mental retardation

(see fig. 2). Mental disorders was the fastest growing condition among this

population since 1986, increasing by 9 percentage points.
Page 5 GAO-02-919T

Figure 2: Percentage Distribution of SSI Adult Disabled Recipients by Impairment

Categories, 2000

Source: Annual Statistical Supplement to the Social Security Bulletin, 2001

Scientific advances, changes in the nature of work, and social changes

have generally enhanced the potential for people with disabilities to work.

Medical advancements and assistive technologies have given more

independence to some individuals. Moreover, the economy has become

more service- and knowledge-based, presenting both opportunities and

some new challenges for people with disabilities. Finally, social changes

have altered expectations for people with disabilities. For instance, the

Americans with Disabilities Act fosters the expectation that people with

disabilities can work and have the right to work.

Recent Advances and

Changes in Science,

Work, and Society

Have Enhanced

Potential among

People with

Disabilities
Page 6 GAO-02-919T

Recent scientific advances in medicine and assistive technology and

changes in the nature of work and the types of jobs in our national

economy have generally enhanced the potential for people with disabilities

to perform work-related activities. Advances in medicine have led to a

deeper understanding of and ability to treat disease and injury. Medical

advancements in treatment (such as organ transplantations), therapy, and

rehabilitation have reduced the functional limitations of some medical

conditions and have allowed individuals to live and work with greater

independence. Also, assistive technologies—such as advanced wheelchair

design, a new generation of prosthetic devices, and voice recognition

systems—afford greater capabilities for some people with disabilities than

were available in the past.

At the same time, the nature of work has changed in recent decades as the

national economy has moved away from manufacturing-based jobs to

service- and knowledge-based employment. In the 1960s, earning capacity

became more related to a worker’s skills and training than to his or her

ability to perform physical labor. Following World War II and the Korean

Conflict, advancements in technology, including computers and automated

equipment, reduced the need for physical labor. The goods-producing

sector’s share of the economy—mining, construction, and

manufacturing—declined from about 44 percent in 1945 to about 18

percent in 2000. The service-producing industry’s share, on the other

hand—such areas as wholesale and retail trade; transportation and public

utilities; federal, state and local government; and finance, insurance, and

real estate—increased from about 57 percent in 1945 to about 72 percent

in 2000.

Although there may be more an individual with a disability can do in

today’s world of work than was available when the DI and SSI programs

were first designed, today’s work world is not without demands. Some

jobs require standing for long hours, and other jobs, such as office work,

require social abilities. These characteristics can pose particular

challenges for some persons with certain physical or mental impairments.

Moreover, other trends—such as downsizing and the growth in contingent

workers—can limit job security and benefits, like health insurance, that

most persons with disabilities require for participation in the labor force.

Whether these changes make it easier or more difficult for a person with a

disability to work appears to depend very much on the individual’s

impairment and other characteristics, according to experts.

Medical and Technological

Advances Lead to Better

Understanding and

Treatments

Changes in the Nature of

Work and Economy

Expand Opportunities
Page 7 GAO-02-919T

Social change has promoted the goals of greater inclusion of and

participation by people with disabilities in the mainstream of society,

including adults at work. For instance, over the past 2 decades, people

with disabilities have sought to remove environmental barriers that

impede them from fully participating in their communities. Moreover, the

Americans with Disabilities Act supports the full participation of people

with disabilities in society and fosters the expectation that people with

disabilities can work and have the right to work. The Americans with

Disabilities Act prohibits employers from discriminating against qualified

individuals with disabilities and requires employers to make reasonable

workplace accommodations unless it would impose an undue hardship on

the business.

The disability criteria used in the DI and SSI disability programs to help

determine who is qualified to receive benefits have not been fully updated

to reflect these advances and changes. SSA is currently in the midst of a

process that began around the early 1990s to update the medical criteria

they use to make eligibility decisions, but the progress is slow. Moreover,

some changes resulting from treatment advances and assistive

technologies are not fully incorporated into the decision-making process

due to program design. In addition, the disability criteria have not

incorporated labor market changes. In determining the effect that

impairments have on individuals’ earning capacity, SSA continues to use

outdated information about the types and demands of jobs in the

economy.

SSA’s current effort to update the disability criteria began in the early

1990s. Between 1991 and 1993, SSA published for public comment the

changes it was proposing to make to 7 of the14 body systems in its

Medical Listings.

4

 By 1994, the proposed changes to 5 of these 7 body

systems were finalized. The agency’s efforts to update the Medical

Listings were curtailed in the mid-1990s due to staff shortages, competing

priorities, and lack of adequate research on disability issues.

 4

 Our analysis excludes SSA’s changes to the childhood-related Medical Listings.

Social Changes Promote

Inclusion of People with

Disabilities

SSA Has Not Fully

Updated Disability

Criteria to Reflect

These Advances and

Changes

Slow Process to Update

Medical Criteria

Jeopardizes Progress

Already Made
Page 8 GAO-02-919T

SSA resumed updating the Medical Listings in 1998.5 Since then, SSA has

taken some positive steps in updating portions of the medical criteria it

uses to make eligibility decisions, although progress is slow. As of early

2002, SSA has published the final updated criteria for 1 of the 9 remaining

body systems not updated in the early 1990s (musculoskeletal) and a

portion of a second body system (mental disorders). SSA also plans to

update again the 5 body systems that were updated in the early 1990s. In

addition, SSA has asked the public to comment on proposed changes for

several other body systems. After reviewing the schedule and timing for

the revisions, SSA recently pushed back the completion date for

publishing proposed changes for all remaining body systems to the end of

2003.6

 The revised schedule does not list target dates, with one exception,

for submitting changes for final clearance to the Office of Management

and Budget.

SSA’s slow progress in completing the updates could undermine the

purpose of incorporating medical advances into its medical criteria. For

example, the criteria for musculoskeletal conditions—a common

impairment among persons entering DI—were updated in 1985. Then, in

1991, SSA began developing new criteria and published its proposed

changes in 1993 but did not finalize the changes until 2002; therefore,

changes made to the musculoskeletal criteria in 2002 were essentially

based on SSA’s review of the field in the early 1990s. SSA officials told us

that in finalizing the criteria, they reviewed the changes identified in the

early 1990s and found that little had taken place since then to warrant

changes to the proposed criteria. However, given the advancements in

medical science since 1991, it may be difficult for SSA to be certain that all

applicable medical advancements are in fact included in the most recent

update.

 5

 To conduct the current update, SSA gathers feedback on relevant medical issues from

state officials who help the agency make disability decisions. In addition, SSA has in-house

expertise to help the agency keep abreast of the medical field and identify aspects of the

medical criteria that need to be changed. SSA staff develop the proposed changes and

forward them for internal, including legal and financial, review. Next, SSA publishes the

proposed changes in the Federal Register and solicits comments from the public for 60

days. SSA considers the public comments, makes necessary adjustments, and publishes the

final changes in the Federal Register.

6

 Social Security Administration, “Semiannual Unified Regulatory Agenda,” Federal

Register 67, no. 92 (13 May 2002): 34016 – 34038.
Page 9 GAO-02-919T

SSA has made various types of changes to the Medical Listings thus far.

As shown in table 1, these changes, including the proposed changes

released to the public for comment, add or delete qualifying conditions;

modify the criteria for certain physical or mental conditions; and clarify

and provide additional guidance in making disability decisions.

Table 1. Types of Changes Made (or Proposed) to SSA’s Medical Listings during Current Update

Type of Change Examples Rationales

Revise qualifying conditions Remove peptic ulcer.a

Add inflammatory bowel

disease by combining two

existing conditions already

listed: chronic ulcerative and

regional enteritis.

Advances in medical and surgical management have

reduced severity.

Reflect advances in medical terminology.

Revise evaluation and diagnostic criteria Expand the types of

allowable imaging

techniques.

Reduce from three to two in

the number of difficulties that

must be demonstrated to

meet the listings for a

personality disorder.b

The Medical Listings previously referred to x-ray evidence.

With advancements in imaging techniques, SSA will also

accept evidence from, for example, computerized axial

tomography (CAT) scan and magnetic resonance imaging

(MRI) techniques.

Specific rationale not mentioned.

Clarify and provide additional guidance Remove discussion on

distinction between primary

and secondary digestive

disorders resulting in weight

loss and malnutrition.

Expand guidance about

musculoskeletal “deformity.”

Distinction not necessary to adjudicate disability claim.

Clarify that the term refers to joint deformity due to any

cause.

a

A condition removed from the Medical Listings means that SSA no longer presumes the condition to

be severe enough to ordinarily prevent an individual from engaging in substantial gainful activities.

However, an individual with a condition removed from the Medical Listing could still be found eligible

under other considerations in the evaluation process.

b

The criteria for a personality disorder are met when (a) the individual has certain behaviors defined in

the Medical Listings and (b) those behaviors result in at least two of the following: (1) marked

restriction of activities in daily living; (2) marked difficulties in maintaining social functioning; (3)

marked difficulties in maintaining concentration, persistence, or pace; or (4) repeated episodes of

decompensation (as specified in the Medical Listings).

Source: GAO analysis of SSA publications appearing in the Federal Register.

Despite these changes, program design issues have limited the extent that

advances in medicine and technology have been incorporated into the DI

and SSI disability decision-making criteria. The statutory and regulatory

Although Changes Have

Been Made, Treatment

Advances and Assistive

Technologies Are Not Fully

Considered in DecisionMaking
Page 10 GAO-02-919T

design of these programs limits the role of treatment in deciding who is

disabled. Unless an individual has been prescribed treatment,7

 SSA does

not consider the possible effects of treatment in the disability decision,

even if the treatment could make the difference between being able and

not being able to work. Thus, treatments that can help restore functioning

to persons with certain impairments may not be factored into the disability

decision for some applicants. For example, medications to control severe

mental illness, arthritis treatments to slow or stop joint damage, total hip

replacements for severely injured hips, and drugs and physical therapies to

possibly improve the symptoms associated with multiple sclerosis are not

automatically factored into SSA’s decision making for determining the

extent that impairments affect people’s ability to work. Additionally, this

limited approach to treatment raises an equity issue: Applicants whose

treatment allows them to work could be denied benefits while applicants

with the same condition who have not been prescribed treatment could be

allowed benefits.

As with treatment, the benefits of innovations in assistive technologies—

such as advanced prosthetics and wheelchair designs—have not been fully

incorporated into DI and SSI disability criteria because the design of these

programs does not recognize these advances in disability decision making.

For example, SSA does not require an applicant who lost a hand to use a

prosthetic before the agency makes its decision about the impact of this

condition on the ability to engage in substantial gainful activities.

For an applicant who does not have an impairment that meets or equals

the severity of the Medical Listings, SSA evaluates whether the individual

is able to work despite his or her limitations. Specifically, an individual

who is unable to perform his or her previous work and other work in the

labor market is awarded benefits. SSA relies upon the Department of

Labor’s Dictionary of Occupational Titles (DOT) as its primary database to

help make this determination. However, Labor has not updated DOT since

1991 and does not plan to do so.

 7

 SSA’s regulations require that in order to receive benefits, claimants must follow

treatment prescribed by the individual’s physician if the treatment can restore his or her

ability to work. SSA, however, does not consider the effects of treatment that has been

prescribed but not received under certain circumstances, such as when the treatment is

contrary to the established teaching and tenets of the individual’s religion.

Disability Criteria Not

Updated to Reflect Labor

Market Changes
Page 11 GAO-02-919T

Although Labor has been working on a replacement for the DOT called the

Occupational Information Network (O*NET) since 1993, Labor and SSA

officials recognize that O*NET cannot be used in its current form in the DI

and SSI disability determination process. The O*NET, for example, does

not contain SSA-needed information on the amount of lifting or mental

demands associated with particular jobs. The agencies have discussed

ways that O*NET might be modified or supplemental information

collected to meet SSA’s needs, but no definitive solution has been

identified. Absent such changes to the O*NET, SSA officials have indicated

that an entirely new occupational database could be needed to meet SSA’s

needs, but such an effort could take many years to develop, validate, and

implement. Meanwhile, as new jobs and job requirements evolve in the

national economy, SSA’s reliance upon an outdated database further

distances the agency from the current market place.

In order to incorporate the medical, economic, and social advances and

changes into the programs’ disability criteria, some steps can be taken

within the existing program design, while others would require more

fundamental changes. Within the context of the current statutory and

regulatory framework, SSA will need to continue to update the medical

portion of the disability criteria and vigorously expand its efforts to

examine labor market changes. However, in addition, policymakers and

agency officials could look beyond the traditional concepts that underlie

the DI and SSI programs to re-examine the core elements of federal

disability programs. This broader approach would raise a number of

significant policy issues, and more information is needed to address them.

To this end, approaches taken by private disability insurers offer useful

insights.

Within the context of the programs’ existing statutory and regulatory

design, SSA will need to further incorporate advances and changes in

medicine and the labor market. That is, SSA should continue to update the

criteria used to determine which applicants have physical and mental

conditions that limit their ability to work. As we noted above, SSA began

this type of update in the early 1990s, although the agency’s efforts have

focused much more on the medical portion than labor market issues. In

addition to continuing the medical updates, SSA will need to vigorously

expand its efforts to more closely examine labor market changes. SSA’s

results could yield updated information used to make decisions about

whether or not applicants have the ability to perform their past work or

any work that exists in the national economy.

Incorporating

Advances and

Changes into the

Disability Criteria

Could Have Profound

Implications

Some Disability Criteria

Could Be Updated Within

Program Design
Page 12 GAO-02-919T

More fundamentally, the recent scientific advances and labor market

changes discussed earlier raise issues about the programs’ basic design,

goals, and orientation in an economy increasingly different from that

which existed when these programs were first designed. Whereas the

programs currently are grounded in assessing and providing benefits

based on individuals’ incapacities, fully incorporating recent advances and

changes could result in SSA assessing individuals with physical and mental

conditions with a focus on their capacity to work and then providing them

with, or helping them obtain, needed assistance to improve their capacity

to work. Moreover, reorienting programs in this direction is consistent

with increased expectations of people with disabilities and the integration

of people with disabilities into the workplace, as reflected in the

Americans with Disabilities Act. We have recommended in prior reports

that SSA place a greater priority on work, design more effective means to

more accurately identify and expand beneficiaries’ work capacities, and

develop legislative packages for those areas where the agency does not

have legislative authority to enact change. However, for people with

disabilities who do not have a realistic or practical work option, long-term

cash support would remain the best option.

In reexamining the fundamental concepts underlying the design of the DI

and SSI programs, approaches used by other disability programs may offer

some valuable insights. For example, our prior review of three private

disability insurers shows that they have fundamentally reoriented their

disability systems toward building the productive capacities of people with

disabilities, while not jeopardizing the availability of cash benefits for

people who are not able to return to the labor force.8

 These systems have

accomplished this reorientation while using a definition of disability that is

similar to that used by SSA’s disability programs.9

 However, it is too early

 8

 U.S. General Accounting Office, SSA Disability: Other Programs May Provide Lessons

for Improving Return-to-Work Efforts, GAO-01-153 (Washington, D.C.: Jan. 12, 2001). This

report also addresses the reorientation of the social insurance systems of Sweden and The

Netherlands toward a return-to-work focus. In addition, this report addresses the German

social insurance system, which has had a long-standing focus on the goal of rehabilitation

before pension.

9

 In general, for the three private insurers that we studied, claimants are initially considered

eligible for disability benefits when, because of injury or sickness, they are limited in

performing the essential duties of their own occupation and they earn less than 60 to 80

percent of their predisability earnings, depending upon the particular insurer. After 2 years,

this definition generally shifts from an inability to perform one’s own occupation to an

inability to perform any occupation for which the claimant is qualified by education,

training, or experience. It is this latter definition that is most comparable to the definition

used by SSA.

Fully Incorporating

Advances and Changes

Has Profound Implications

on Program Design
Page 13 GAO-02-919T

to fully measure the effect of these changes. In these private disability

systems, the disability eligibility assessment process evaluates a person’s

potential to work and assists those with work potential to return to the

labor force. This process of identifying and providing services intended to

enhance a person’s productive capacity occurs early after disability onset

and continues periodically throughout the duration of the claim. In

contrast, SSA’s eligibility assessment process encourages applicants to

concentrate on their incapacities, and return-to-work assistance occurs, if

at all, only after an often lengthy process of determining eligibility for

benefits. SSA’s process focuses on deciding who is impaired sufficiently to

be eligible for cash payments, rather than on identifying and providing the

services and supports necessary for making a transition to work for those

who can. While cash payments are important to individuals, the advances

and changes discussed in this testimony suggest the option to shift the

disability programs’ priorities to focus more on work.

Reorienting the DI and SSI programs would have implications on their

core elements—eligibility standards, the benefits structure, and the access

to and cost of return-to-work assistance. We recognize that re-examining

the programs at the broader program level raises a number of profound

policy questions, including the following:

• Program design and benefits offered - Would the definition of

disability change? Would some beneficiaries be required to accept

assistance to enhance work capacities as a precondition for benefits

versus relying upon work incentives, time-limited benefits, or other

means to encourage individuals to maximize their capacity to work?

What can SSA accomplish through the regulatory process and what

requires legislative action?

• Accessibility and cost - Are new mechanisms needed to provide

sufficient access to needed services? In the case of DI and SSI, what is

the impact on the ties with the Medicare and Medicaid programs? Who

will pay for the medical and assistive technologies and will

beneficiaries be required to defray costs? Would the cost of providing

treatment and assistive technologies in the disability programs be

higher than cash expenditures paid over the long-term? Will net costs

show that some expenditures could be offset with cost savings by

paying reduced benefits?

Critical information, including various policy options, needs to be

collected to address these and other issues. SSA’s current research efforts

could help begin to address some of these broader policy issues. SSA is
Page 14 GAO-02-919T

beginning to conduct a number of studies that recognize that medical

advances and social changes require the disability programs to evolve. For

instance, the agency has funded a project to design a study that would

assess the extent to which the Medical Listings are a valid measure of

disability and has began to design a study of the most salient job demands

in comparison to applicants’ ability to perform work that exists in the

national economy.10 Such research projects could provide insight into

ways that medical and technological advances can help persons with

disabilities work and live independently. Nevertheless, these studies do

not directly or systematically address many of the implications of factoring

in medical advances and assistive technologies more fully into the DI and

SSI programs. More research on the cost and outcomes of various

program changes that bring up-front help to individuals receiving or

applying for disability benefits would be needed.

Mr. Chairman, this concludes my prepared statement. I would be pleased

to respond to any questions you or members of the subcommittee may

have.

For further information regarding this testimony, please contact Robert E.

Robertson, Director, or Kay E. Brown, Assistant Director, Education,

Workforce, and Income Security at (202) 512-7215. In addition, Barbara H.

Bordelon, Brett S. Fallavollita, Carol Dawn Petersen, and Daniel A.

Schwimer made key contributions to this testimony.

 10 In addition, SSA has (1) sponsored a project intended to enable SSA to estimate how

many adults live in the United States who meet the definition of disability used by SSA and

to better understand the relationship between disability, work, health care, and community

and (2) funded a study to examine the impact and cost of assistive technology on

employment of persons with spinal cord injuries and the associated costs.

GAO Contact and

Staff

Acknowledgments

(130179)