TABLE OF CONTENTS

INTRODUCTION ...................................................................................................................1

I. Background of the Board’s Examination of Disability .............................................3

II. Trends in Disability Expenditures and Number of Benefi ciaries ............................6

III. Return to Work Demonstration Project and Ticket to Work Program ..................9

 

IV. Vision for the 21st Century .......................................................................................10

V. A Model Disability System for Adults ......................................................................12

VI. An Integrated Disability System Model for Youth ................................................ 18

VII. Incentives to Make Work Pay ...................................................................................21

VIII. Health Care .................................................................................................................23

IX. Suggestions for Longer-Term Program Enhancements .........................................26

X. Administrative Responsibility ..................................................................................28

XI. Conclusion ..................................................................................................................31

APPENDIX .............................................................................................................................34

BIBLIOGRAPHY ..................................................................................................................44

SOCIAL SECURITY ADVISORY BOARD ........................................................................47
A Disability System for the 21st Century

INTRODUCTION

 In the October 2003 report, The Social Security Defi nition of Disability, the Social 

Security Advisory Board observed that, “The original Social Security disability programs were...

designed to serve those who had no realistic expectation of a return to the workforce because of 

a combination of severity of disability and attainment of near-retirement age.” At that time we 

also raised the question of whether or not the Social Security defi nition of disability facilitates an 

appropriate approach to supporting and enabling persons with disabilities.

During the past 3 years a major activity of the Board has been a review of our Nation’s 

approach to disability. We have been aided in this task by the many thoughtful parties who 

have generously shared their perspectives and expertise with us. We have learned a great deal 

about the strengths and weaknesses of the disability system. The result has been to confi rm 

our belief that a defi nition based on inability to work collides with the goals of the Americans 

with Disabilities Act, which proclaimed that “the Nation’s proper goals regarding individuals 

with disabilities are to assure equality of opportunity, full participation, independent living, and 

economic self-suffi ciency for such individuals.”

 The Board believes we must fi nd a way to revise the Social Security defi nition of 

disability in a way that does not undermine the protections afforded by the last resort programs 

administered by the Social Security Administration but does support an integrated approach that 

provides and emphasizes an alternate path — one directed to self-support, independence, and 

contribution that can help those who might, by taking that path, avoid, delay, or minimize their 

need for dependence on the programs of last resort. We should, in fact, question the idea that 

there is such a thing as a single “defi nition of disability.”

...the Nation’s proper goals regarding individuals with disabilities are 

to assure equality of opportunity, full participation, independent living, and 

economic self-suffi ciency for such individuals...

Americans with Disabilities Act

 We continue to view the Social Security disability programs as vital supports that must 

continue to be available. And we congratulate the Social Security Administration on undertaking 

important administrative reforms within the adjudication process that will help to address some 

of the delays, backlogs, and quality issues that needed serious attention. At the same time, 

we believe that the existing defi nition of disability that emphasizes inability to work does not 

represent the proper central approach to providing support to persons with signifi cant mental 

or physical limitations. An overall uniformly applicable and systematic approach needs to be 

adopted in which the initial focus is on assessing what individuals can do and helping them 

to obtain the support services, both fi nancial and nonfi nancial, that are needed to maintain 

or increase expectations that return to work (or, as appropriate, starting work) is a realistic 

possibility. The determination that an individual cannot work should be the option of last resort, 

not the fi rst option.

1
 The Board believes that increasing expectations about the ability to work is consistent 

with the Americans with Disabilities Act (ADA) and the desires of most persons with disabilities 

and their families. The challenge is how to implement a strategy that meets the aspirations of 

the ADA, fulfi lls the needs of persons with disabilities, maintains the protections provided by the 

Social Security disability programs, and is fi scally responsible and sustainable.

2
I. Background of the Board’s Examination of Disability

 Fifty years ago—in August of 1956—Congress expanded the Social Security program to 

include benefi ts for workers age 50 and over who had mental or physical impairments of a long 

lasting nature and a severity suffi cient to preclude them from engaging in any substantial gainful 

activity. Subsequent amendments broadened the scope of this program to include younger 

disabled workers and to add benefi ts for disabled widows and for individuals who became 

disabled prior to age 22 and whose working parent died or became eligible for Social Security 

benefi ts. The original requirement of a disability of long lasting and indefi nite duration was 

modifi ed to allow benefi ts for impairments lasting as little as a year, and health insurance under 

Medicare was added for those on the disability rolls for 2 years or more. In 1972, a needs-based 

program of Supplemental Security Income (SSI) was created making available cash assistance, 

accompanied in nearly all cases by Medicaid eligibility, for both disabled adults and disabled 

children.

 These Social Security disability programs provide important supports for the basic needs 

of income and health care for millions of America’s most vulnerable men, women, and children. 

As shown in Table 1, as of June 2006, the Social Security Administration is providing monthly 

benefi ts to 6.6 million disabled workers along with 1.7 million dependent spouses and children 

of such workers. Benefi ts also are paid to 0.2 million disabled widows, and 0.8 million disabled 

adult children. Some 5.2 million individuals under age 65 receive Supplemental Security Income 

based on disability (including 1.4 million who also receive Social Security benefi ts). As of 2004, 

federal benefi t payments under these provisions totaled $112 billion.

Table 1 Social Security Disability Benefi ciaries 

June 2006 Thousands

 Disabled workers 6,630

Spouses of disabled workers 155

Children (under 18) of disabled workers 1,523

Student children (age 18-19) of disabled workers 51

 Disabled widow(er)s 213

Disabled adult children 772

 SSI disabled under 18 1,058

 SSI disabled 18-64 4,117

 (1.384 million of the above receive both SSI and 

 Social Security benefi ts)

Sources: SocialSecurity.gov (OASDI Monthly Statistics, SSI Monthly 

 Statistics, Monthly Statistical Snapshot) and unpublished SSA data.

3
 According to SSA statistical reports on the Disability Insurance (DI) and Supplemental 

Security Income (SSI) programs, 28 percent of DI worker benefi ciaries depend on those benefi ts 

for 100 percent of their income; 47 percent of working age (18-64) SSI recipients get 100 percent 

of their income from SSI. In both programs, the benefi ts represent more than three quarters of 

total income for a majority of such beneficiaries. (See Chart 1.)

50

40

30

20

10

0

Chart 1 Program Benefits as Percentage

of Personal Income

Disability 

Insurance (worker)

SSI Recipient 

(age 18-64)

Percent of Individuals

Under 25 25-49 50-74 75-99 100

Percent of Income

Source: Annual Statistical Report on the Social Security Disability Insurance Program, 2004 and 

 the SSI Annual Statistical Report, 2004.

 The importance of these Social Security programs and their impact on the lives of people 

with disabilities led the Board to focus much of its attention on disability over the ten years since 

it fi rst began to carry out its mandate to examine the Nation’s Social Security systems. In our 

reviews, we found many administrative issues that needed attention, and many of the Board’s 

reports contain recommendations about how the operations of the program can be strengthened. 

We expressed concerns about the lengthy processing times in many parts of the program, the 

unexplained geographical inconsistencies in disability determinations as well as at different 

levels of adjudication. The need for stronger quality management and policy development 

capabilities has been noted as well. But, as we examined these essentially administrative and 

resource issues, we were continually confronted with questions about how well the programs 

were aligned with the Nation’s fundamental disability policy goals as enunciated over 15 years 

ago in the Americans with Disabilities Act. We also discovered that there is something about 

these programs that was antithetical to another basic need—the need to pursue independence and 

a sense of contributing to one’s own self support and to the good of society.

 In examining these apparent conflicts, the most obvious and frequently cited suspect 

was the Social Security defi nition of disability. The Social Security Act equates disability with 

inability to do any substantial work. This core defi nition is as old as the program itself. It was 

adopted at a time when attitudes about the capabilities of people with disabilities were markedly 

different than they are today. As the Board pointed out in the 2003 report, The Social Security 

Defi nition of Disability, the defi nition was adopted for a program that was limited to individuals 

approaching retirement age, and the program was explicitly viewed as representing a kind of 

early retirement. It was adopted by a Congress that could not have foreseen the great advances 

that would take place over the next fi fty years in medical science, adaptive technology, and 

rehabilitative practice and therapy. 

4
 In looking at the Social Security defi nition of disability, many of those with whom 

the Board consulted pointed out the apparent contradictions between a program defi nition 

that rewards applicants for proving that they cannot work and a national disability policy that 

emphasizes independence and encourages individuals with signifi cant limitations to make as 

much of a contribution to society and their own self support as possible. A 2003 Government 

Accountability Offi ce report placed the Social Security and other federal disability programs 

on the GAO “high risk” list. In doing so, it characterized them as “mired in concepts from 

the past and...poorly positioned to provide meaningful and timely support for Americans with 

disabilities.”

Most of our public policy was originally developed on the assumption 

that disability was life-long, helpless, hopeless and eternal dependency. And I 

am sorry to tell you that model is very much alive and well...

Roundtable participant, Washington, D.C. 

 Still, in the extensive study the Board has undertaken since 2003, the Board has also 

heard concerns expressed about what it would mean to modify the defi nition of disability used 

for Social Security programs. Changing the defi nition could result in narrowing eligibility in 

ways that would exclude individuals who have no alternative but to depend upon the benefi ts 

those programs provide or could result in broadening eligibility so as to increase the costs of the 

program and provide benefi ts to individuals beyond the currently intended scope. We recognize 

the validity of these concerns. It is our purpose in this report to suggest neither that the existing 

disability programs should provide coverage more broadly nor that they should be contracted to 

prevent individuals who are unable to engage in substantial work from receiving their benefi ts. 

The problem that we see is in the way in which those programs are, or rather are not, integrated 

into an overall approach to disability that supports the aspirations of people with disabilities to 

achieve their maximum potential. Correcting this problem will require a statutory change to 

defi ne disability in a way that encompasses such an integrated approach.

 The Social Security disability programs have been described by many as “programs of 

last resort.” This seems to us to be an appropriate description. It will, of course, remain true 

that many of those with severe impairments may need access to those programs on a virtually 

immediate basis, and such access must remain available. However, the fi rst alternative to be 

explored must be how to enable persons with work incapacities to avoid, postpone, or minimize 

their need for dependence on the programs of last resort while assuring that those programs 

and the important protection they provide remain in place. The fi rst question society poses to 

those with signifi cant impairments should not be, “Can you prove you cannot work?” The fi rst 

question should be, “What type of assistance do you need in order to achieve your maximum 

possible contribution to your own well being and to the good of the community?” If we do 

not fi nd a way to make that the fi rst question, we will be endorsing and fostering a culture of 

pessimism and dependency.

 In the remainder of this report, we will describe our vision of a 21st century disability 

system that is founded on a culture of encouraging and supporting economic self-suffi ciency, 

independence, and the personal rewards that come from being able to make a contribution. We 

acknowledge that the implementation of such a vision will involve much detailed planning that 

5
is beyond the scope of this report. In our work over the past few years, we have found that a 

great deal of thought and study that could support such a vision is already underway by many 

individuals and organizations. Policymakers will, therefore, fi nd a wealth of thoughtful material 

to work with.

 As will be discussed in more detail later in the report, we are aware that the budgetary 

situation constrains the ability of policymakers to adopt new spending initiatives. However, 

we have heard widespread agreement that the current overall approach to disability is harmful 

to people with disabilities, is contrary to basic societal values, and, in particular, contradicts the 

policies and values of the Americans with Disabilities Act. We concur in that judgment. We 

believe that it is necessary to establish a clear, if broadly drawn, vision of what our national 

disability system should look like and to take whatever steps we now can to move toward that 

goal. The new system will be a foundation for a national culture that integrates people with 

disabilities into society as important and contributing members.

II. Trends in Disability Expenditures and Number of Benefi ciaries

 Not only is there impetus for change because the existing national approach to disability 

is antithetical to both the interest of the disabled population and to basic American societal 

values, there are also very strong economic reasons why the approach to disability needs to 

be reexamined. We are, as a Nation, already spending a huge amount of public dollars on 

programs for people with disabilities, the great bulk of which is being expended for those who 

are currently dependent upon Social Security’s disability programs. A recent Cornell University 

study estimates that federal and state spending on programs for the working-age disabled came 

to $276 billion in 2002 or 2.7 percent of the Gross Domestic Product. Ninety-six percent of 

those expenditures were for income security and health care and three-quarters of the total 

expenditures were for cash and health benefi ts for benefi ciaries of the Social Security disability 

programs 

 These costs, however, are not static, but growing. As Chart 2 shows, the number of 

disabled workers drawing Social Security Disability Insurance has more than doubled since 1990 

from 3 million to 61⁄2 million. In the past 15 years, the working-age population of our Nation has 

grown by 18 percent. During that same period, the number of persons receiving Social Security 

Disability Insurance benefi ts has increased by 117 percent, and the number of disabled workingage SSI recipients has grown by 66 percent.

8

6

4

2

0

Chart 2 Working Age Disability Beneficiaries

1990 and 2006

1990

2006

Social Security Supplemental 

Disability Security

Insurance Income

Sources: SSA Monthly Statistical Snapshot, July 2006; 2006 Annual Report of the Supplemental 

 Security Income Program, 2006 OASDI Trustees’Report

6
 The projected long-range costs of the Disability Insurance program grew by over 38 

percent during the last 15 years. Benefi t costs in constant (2005) dollars have increased since 

1990 from $42 billion to $86 billion and the Disability Insurance Trust Fund is already paying 

out more than its statutory share of program tax income and is projected to reach exhaustion in 

less than 20 years. If we can fi nd ways to keep enough individuals in productive employment 

to reduce long-range disability insurance costs by as little as 10 percent, the present value of 

reduced benefi ts would be $555 billion. This would eliminate roughly two-thirds of the 75- 

year defi cit in the DI program, reducing it from 0.33 percent of payroll to about 0.1 percent. 

Moreover, facilitating the ability to remain in active employment can enhance an individual’s 

own well-being and can provide an improved standard of living. Add to this the contribution 

such individuals would make to economic productivity and tax receipts, and it becomes clear that 

a national cohesive disability policy offers important opportunities for constructive change.

 Even apart from their impact on the growing cost of the disability programs themselves, 

the coming demographic shifts will place severe pressure on our economy’s ability to maintain 

standards of living for the working-age and retired population. Our society has entered the era 

where the aging baby boom generation is concentrated in its disability-prone years. Since 2000, 

there has been a steady increase in the disability incidence rate in the baby boom population, 

and it is expected to continue to grow over the next several years. It is therefore crucially 

important that we do not needlessly increase program costs and waste human capital by failing 

to enable individuals with impairments to make some contribution to our national workforce. 

Unfortunately, there is a lack of strong research that would permit reliable estimates of how 

much added productivity and reduced benefi t costs might be attainable. We recognize that in 

the absence of such evidence, the argument can be made that it is impossible to know if longterm savings will offset short-range costs that can accompany change. The Board recognizes the 

uncertainty inherent in any new bold initiative, but we believe that there are strong arguments 

in favor of acting now. The long-range costs of failure to act are clear from the continuing 

growth of the programs under existing policy and the meager results of current efforts to 

support work activity. We fi nd broad agreement on some of the major reforms that would be 

necessary to transform the system in ways that can reduce the growth of dependency and provide 

the necessary encouragement and support to achieve a substantial increase in the economic 

contributions that people with disabilities can make.

 As the Board examined the issue of whether the Social Security disability programs are 

appropriately aligned with national disability policy, we found broad agreement that they are not. 

However, concern was also expressed that our focus on this lack of alignment may be interpreted 

as a signal to cut back on the support provided through the programs administered by the Social 

Security Administration. We do not intend such a result, nor do we believe that direct reductions 

in the assistance provided by these programs are either feasible or desirable. However, we are 

convinced that the absence of a coordinated and integrated national system to support increased 

participation of people with disabilities in the workforce has contributed substantially to the 

continuing rapid growth of the costs and caseloads of the Social Security disability programs. 

And we believe that, in the long run, the adoption of such a coordinated and integrated system 

will not only enable people with disabilities to have a life that is more fulfi lling and more 

economically rewarding but will also lessen the overall level of dependence on—and therefore 

the cost of—those programs.

7
 One question that might arise is whether such decreased expenditures or possible savings, 

or much of them, could be achieved by doing a better job of screening applicants for disability 

benefi ts so that those who have the ability to work do not become benefi ciaries in the fi rst place. 

Similarly, will doing a better job of rehabilitating those on the rolls so that they stay on for a 

shorter period result in large savings? Although these are logical questions, the answer to both is 

no. Certainly, every effort should be made to make initial eligibility determinations accurately. 

And, certainly it is worthwhile to try to support and encourage rehabilitation efforts by those 

who do fi nd themselves on the disability benefi t rolls. However, past experience has shown 

that these approaches are largely ineffective and are likely to remain so. The reason is that by 

the time an individual applies for disability benefi ts and, even more so, by the time he or she is 

actually placed on the benefi t rolls, the best opportunity for restoring or retaining the capacity 

for self-support has already been lost. In the absence of a disability system designed to manage 

toward self suffi ciency, the realistic possibilities of someone with a work limitation remaining 

productive begin to fade. The process itself tends to make an individual who might have been 

able to work at an earlier point in time less and less capable of doing so. Attachment to an 

employer, the maintenance and improvement of skills, the sense of belonging to the workforce, 

the mindset that work is possible—the loss of all of these factors, combined with the passage of 

time and with the program requirements that reward inability to work, conspire to transform a 

person from an “impaired individual” with potential into an individual who, in fact, has come to 

meet the defi nition “unable to work.”

 The Board does not believe there is a single magic answer. There has been research on 

ways to encourage return to work done in the past; however, much of it has been inconclusive, 

and certainly there is no substantial body of evidence-based research that shows clearly what 

specifi c changes would work with what population. Additional research has been undertaken 

recently by the Social Security Administration but the implementation of such research and 

demonstration projects has proceeded slowly. It is impossible to predict in advance how 

signifi cant the results will be. And, in any case, usable results will not be available possibly for 

several years. While the Board strongly believes that this evidence-based research is important, 

it does not preclude rethinking the approach to disability supports and services now.

 While disability policy differs in many respects from welfare policy, there are certain 

parallels. Prior to the development of welfare reform, the then current programs created 

widespread dissatisfaction on the part of both the public and those they aimed to serve. Program 

costs and caseloads were on the rise. Attempts to improve the standard of living and create 

incentives to work were largely ineffective. Evidence-based research demonstrated, however, 

that effective change could be made, but only when there was a fundamental cultural shift away 

from a presumption that work was out of the question and toward a presumption that recipients 

did have the ability to work. While the disability program has not been subjected to the extent 

of experimental research that AFDC had been, the research that has been done thus far shows 

that our current disability system presumes that work is not feasible and thus, effectively locks 

benefi ciaries onto the rolls once they get past the initial disability determination.

 The Board is aware that existing budgetary processes impose constraints that make it 

difficult to fund near-term investments which have the potential of achieving signifi cant savings 

in the longer run. Nonetheless, we believe it is our responsibility to make the recommendations 

in this report because we are convinced that the current lack of an integrated disability system is 

a disservice to all members of society. The models we propose in this report can serve as a goal 

to be discussed and adopted now and to be fulfi lled as resources allow.

8
III. Return-to-Work Demonstration Projects and the 

Ticket to Work Program

 Over the past 20 years SSA has engaged in a variety of research and demonstration 

projects designed to increase employment of benefi ciaries. These activities began in 1985 with 

the Transitional Employment Training Demonstration, which tested new methods of delivering 

vocational rehabilitation services to SSI benefi ciaries with IQs in the 40-70 range. Project 

NetWork, in 1991, was SSA’s fi rst large-scale interaction with private rehabilitation providers 

and marked the fi rst time that the agency provided services directly to benefi ciaries to help 

them enter the labor force. The State Partnership Initiative, which focused predominantly on 

providing benefi ts counseling, was fi elded in 11 states from 1998-2004. These large-scale 

voluntary programs targeted specifi c populations and had participation rates averaging only in the 

4-5 percent range. This should not be too surprising, given that the programs were offered after 

benefi ciaries had proven satisfactorily to SSA that they could not work.

 The projects all had some valuable lessons. The more successful programs had the 

fl exibility to tailor services to the needs of the individual and offered an array of services, 

including benefi t planning and counseling, work assessments, psychological counseling, physical 

and occupational therapy, job training and search assistance, and other employment services. The 

fi ndings from the most recent of these demonstration projects, the State Partnership Initiative, 

indicate that benefi ts counseling and employment services increased employment rates among 

the benefi ciaries who participated in the program. Other demonstrations, as well, showed some 

positive impact on employment rates (and earnings), but these effects were small and seemed to 

diminish over time.

 SSA also established other employment programs that targeted disability applicants. 

Research demonstration projects were funded in the mid-80s that offered rehabilitation services 

to SSDI applicants (rather than to those whose claims had already been approved). Disability 

research experts have suggested that the outcomes from these demonstrations provide some 

indication that higher participation may be possible if the intervention is targeted to applicants. 

They also conclude that the strongest predictor of program participation is recent work experience.

 While these demonstration projects had some positive outcomes that encouraged and 

supported steps toward economic self-suffi ciency, focusing all of the return-to-work efforts inside 

the structure of the disability program seems to be too late for many individuals. In order for 

the intervention to be effective, it needs to occur before the individual comes to SSA, before he 

applies for SSDI or SSI, and before the attachment to the workforce is lost. What is strikingly 

clear is that the policy of waiting until an individual has established entitlement to SSDI or SSI 

and has effectively removed himself from the workforce for at least 12 months seems to be at odds 

with optimal timing for return to work interventions.

Ticket to Work Program

 In the legislation adopted in 1999 that created the Ticket to Work and Self Suffi ciency 

Program, Congress noted that individuals with disabilities have greater opportunities for 

employment than ever before, yet despite such opportunities and the motivation of disability 

recipients to work and support themselves, fewer than one-half of one percent of SSDI and SSI 

benefi ciaries return to work and leave the benefi t rolls. The Ticket program has been designed 

9
to address that lack of participation in return to work efforts by improving benefi ciary access to 

rehabilitation and employment services and by improving the quality of those services. It has 

incorporated several features from earlier demonstrations, most notably benefi ts counseling and 

the use of private service providers as an alternative to state vocational rehabilitation services. 

The legislation also creates a different payment for services plan that is meant to induce more 

providers to enter the return-to-work market and create more choice for benefi ciaries.

 Tickets are offered to most beneficiaries, with a notable exception – individuals who 

have impairments that are expected to medically improve in a year and have not gone through 

the continuing disability process are not eligible for a Ticket.1 The program was phased in for 

current benefi ciaries between February 2002 and September 2004; Tickets to new benefi ciaries 

have been mailed out monthly since then. As of August 2006, of the 10 million Tickets that 

have been mailed out, approximately 144,000 benefi ciaries have entered the program. The most 

recent available data on the number of Ticket participants who are actually working is from 

the 2004 National Benefi ciary Survey, which is part of the Ticket program evaluation. This 

early data from the fi rst phase of the Ticket rollout, showed that 10,000 of the 21,000 Ticket 

holders were working. Participation rates in the Ticket program have been found to be higher 

for benefi ciaries who were allowed at the initial determination level. This seems to suggest that 

those individuals with a more recent attachment to the labor force may be more likely to respond 

to return to work initiatives.

 Even though the Ticket to Work program has helped some individuals regain 

employment, its success, when measured against the number of people coming onto the disability 

rolls, is quite limited and the reason is clear. The intervention process comes too late in the 

process – after the individual’s connection to employment has been severed and frequently after 

that individual has undergone a lengthy process of proving inability to work.

IV. Vision for the 21st Century

 Throughout the Board’s existence, we have spent many hours studying the disability 

programs, talking to consumers, employers, and disability experts. In all of these conversations, 

there have been many recurring themes about the shortcomings of the current system. We 

heard that current public policy is based on the concept that disabilities are lifelong and 

hopeless and that society still has barriers in place that constrain self-fulfi llment. The country’s 

disability programs do not, generally, recognize the cyclical nature of some disabilities and 

the concomitant impacts on work capacity. Navigating the hundreds of programs which are 

frequently uncoordinated can often be an insurmountable challenge. Moreover, confl icting rules 

for eligibility among the programs can often lead to unintended consequences. The current 

disability program provides a vital aspect of our country’s social protection system but it has 

remained basically the same for more than 50 years, even though the environment in which 

it operates has changed signifi cantly. Scientifi c advances and economic and social changes 

have redefi ned the relationship between impairments and the ability to work. Advances in 

medicine and technology have reduced the limitations imposed by some medical conditions and 

individuals experience greater independence and function more productively. Social and legal 

changes have promoted the goals of inclusion and participation by people with disabilities into 

1SSA published a notice of proposed rule making on September 30, 2005 that seeks to eliminate this exception.

10
the mainstream of society. The labor market has changed as the national economy has moved 

toward service and knowledge-based employment.

 At a minimum, a 21st century disability system should be one that is responsive to the 

changing demographics that will shrink the labor force. Over the next 45 years, the over age40 population will dramatically increase. More people will be entering their disability prone 

years and could potentially exit the labor force. The Nation’s disability system needs to continue 

to provide essential support to those who need it, but it must also establish a mechanism that 

maintains a worker’s ability to stay in active employment.

 We believe that it is time to set aside old paradigms and look more broadly at what is 

possible. Clearly, a shift in public policies is needed to sustain the employment of people with 

disabilities. It is time to reexamine our national disability programs with a view to investing in 

human capital – our most valuable asset. A new disability system must incorporate elements that 

embrace change and:

• provide assistance and support to individuals and strive to maximize employment 

outcomes to the extent of each individual’s capabilities;

• facilitate a culture shift within society to establish the expectation that individuals 

with disabilities can and should work to the extent of their capabilities and that 

society should assist individuals with disabilities in that endeavor;

• recognize and accommodate the dynamic nature of disability and its sometimes 

cyclical impact on work capacity; and

• facilitate rehabilitation and employment by coordinating and integrating the various 

sources of assistance and support that are now inconsistently provided by multiple 

uncoordinated programs.

 The new system would recognize that it is not inconsistent to receive supports and work. 

It will accommodate the continuum of individual abilities and readiness to contribute to one’s 

self suffi ciency. It will strengthen and support choice, making the consumer an active partner in 

designing appropriate services and 

supports. The interventions will lead 

to independence, productivity, and 

community inclusion.

 In order for these changes 

to be effective, there needs to be a 

larger systemic change that facilitates 

coordination and integration of services and supports. There needs to be, as someone described 

it to the Board, a “front end on the stove pipes.” This front end is not a barrier to SSDI or SSI, 

but instead represents a real chance to access tailored services that can enhance return to work 

efforts. It provides timely intervention before the attachment to the work force is totally lost and 

the societally imposed culture of having to prove inability to work before benefi ts and services 

are offered takes over.

 The current disability programs remain in place, and for some people will remain the path 

of fi rst choice. However, for many others, a coordinated and supported environment in which 

to access rehabilitation programs and to acquire training and skills that will lead to a productive 

return to work will be the path of fi rst choice.

11

Nobody knows better than me about 

me and how I can achieve my goals.

Roundtable participant, Washington D.C.
 As we refl ected on the features of prior employment programs and demonstrations and 

on best practices from public programs and private industry, it seemed that there were some 

real lessons learned that should be used in designing a new “front end.” The features of this 

new “front end” include focused case management or service coordination. Working with 

the individual, the service coordinator arranges for a multidimensional evaluation that will 

result in a tailored assessment of work potential and the development of a return-to-work plan 

that is specifi c to the situation of the individual. This “prescription” or plan will ultimately 

lead to improved employment readiness and outcomes. Moreover, because there is the 

acknowledgement that signifi cant limitations can be episodic, the return-to-work prescription 

needs to be fl exible.

 Drawing on the fi ndings 

in research and in employment 

literature, as well as the extensive 

experience of private disability 

insurance providers, we are 

convinced that people – especially 

those with recent work history– 

will participate and will benefi t 

from a coordinated system 

that provides incentives rather 

disincentives to work. Providing a process that facilitates transition from employment through 

retraining and rehabilitation and back into the work place is the place to start.

The private health industry has incentives

to get their claimants back to work and 

therefore they will move mountains to make 

that work.

Roundtable participant, Kansas City

V. A Model Disability System for Adults

 The population of persons with signifi cant impairments is certainly anything but 

homogeneous. There are individuals who are born with serious disabilities. There are people 

who experience their fi rst encounter with serious mental or physical impairment at various 

stages in their life from childhood through advanced age. Some have strong educational or 

vocational backgrounds. Others have lower educational levels and limited work histories prior 

to experiencing a disabling event. Some experience disability as a sudden traumatic event. 

For others the degree of impairment gradually progresses and becomes more severe over time. 

Still others have disabilities that are cyclical in nature. A national disability system needs to 

be fl exible enough to appropriately address all of those with disabilities. In this part of the 

report, we will discuss a basic model for adults, starting with those who experience the onset of 

disability during the course of an otherwise “typical” work life.

 Under current practices, an individual with a disability which is or becomes severe is 

likely to encounter the national disability system fi rst through a contact with the Social Security 

12
Administration by calling the 800 number, going to a fi eld offi ce, or visiting the SSA website. 

What such a person will hear can be illustrated by how the Disability Insurance program is now 

described on the website:

The defi nition of disability under Social Security is 

different than other programs. Social Security pays only 

for total disability. No benefi ts are payable for partial 

disability or for short-term disability. 

Disability under Social Security is based on your inability 

to work. We consider you disabled under Social Security 

rules if you cannot do work that you did before and we 

decide that you cannot adjust to other work because of your 

medical condition(s). Your disability must also last or be 

expected to last for at least one year or to result in death. 

This is a strict defi nition of disability. Social Security 

program rules assume that working families have access 

to other resources to provide support during periods of 

short-term disabilities, including workers’ compensation, 

insurance, savings and investments.

 This information is accurate, but it clearly sends a message that does not encourage, 

much less offer support for, attempting to work. If the individual does proceed to apply for 

benefi ts, he or she is entering into a system that clearly provides its rewards for proving that 

doing any substantial work is beyond the applicant’s capacity. The eligibility determination 

process, therefore, is likely to take place only after the applicant has accepted a mindset that 

signifi cant work is no longer feasible. And the determination process itself has a similar negative 

objective of establishing inability to work.

The “all or nothing” concept is 

inherently discouraging to work. People 

should not be told that you get benefi ts only 

if you can do nothing. The program should 

provide support for people to do as much as 

they can. 

Roundtable participant, Kansas City

13
One Size Does Not Fit All

Chart 3 diagrams a model that we propose as an alternative to the present system. In 

that model, the fi rst contact that an impaired individual would have with the “disability system” 

would involve an assessment that focuses on what resources he or she, and society, have 

available to make it possible for that individual to retain or regain capacity for self support. 

This would typically involve some type of functional testing and evaluation to ascertain what 

residual capabilities the individual has retained and what kinds of supports will be needed to 

maximize those capabilities.

The model assumes that this assessment would take place very quickly after the onset 

of the impairment. Depending upon the circumstances and the nature of the impairment, 

a full assessment might need to be delayed somewhat until the condition stabilizes, but the 

model assumes that it would take place much earlier than the point at which individuals tend 

to encounter a disability determination as part of the Social Security application process. 

For adults who become disabled while employed, the assessment should take place, if at all 

possible, while the employment relationship is still active.

While the assessment is not envisioned as a Social Security style eligibility 

determination, it would necessarily involve some elements of triage. Some individuals would 

be easily categorized as having obviously temporary or minor impairments needing little or 

nothing in the way of supports beyond what may already be readily available through existing 

employer health and leave programs. Others may have such clearly severe or traumatic 

conditions that the logical step would be immediate application for benefi ts under the existing 

“last resort” programs, although even those individuals could elect the rehabilitation path, if 

they chose. They should be assured that doing so would in no way preclude or delay their entry 

into the Social Security disability programs if or when they fi nd that alternative necessary.

Triage

assessment

SSDI/SSI

Chart 3 Adult Model

Little or no Substantial work history work

history

Flexible program Current work re-entry and exit rule; Exit to employment incentive rules; differential work current incentive rules reinstatement rules and waivers (e.g., EPE easy-on)

Transition program participant maintains loose program attachment. Can re-enter transition program or 

apply for SSDI/SSI without “penalty.” Participation in traditional program is governed by current work 

incentive and reinstatement rules.

Transition program

• develop work Rx 

• coordinate supports

14
 For those who cannot be immediately triaged as being appropriate for immediate referral 

to the current disability programs or as having temporary or minor impairments, there would 

be a comprehensive assessment. The nature of the assessment would be essentially the reverse 

of the Social Security adjudication process which fi rst takes a highly medical approach to see if 

the severity of the impairment or lack thereof allows a quick decision that the individual is or is 

not unable to work and, only if that screening process fails, looks to see if a more functional and 

vocational approach can separate those who are able to work from those who are not. 

 Under the model that we propose, the objective would be to measure an individual’s 

functional abilities and determine how those abilities could be maximized through an appropriate 

support environment. This multidisciplinary assessment would be carried out through a 

nationwide network of public and private medical and vocational experts. This essential 

expertise exists in many organizations around the country and would be readily available 

at the local community level. The Social Security Administration has begun to develop a 

foundation for such a network of medical and vocational experts as part of its Disability Service 

Improvement plan.

 Unlike the Social Security disability determination, the assessment this model envisions 

is not a “yes/no” eligibility decision. Rather it needs to result in a plan of action prescribing 

the steps and supports needed to keep the individual on a track to resumption of employment. 

These can, depending on individual circumstances, include such elements as medical treatment, 

counseling, transitional income support, rehabilitation therapy, retraining, and other such 

treatments and services that can facilitate the restoration of self support capabilities.

 This type of positive assessment of abilities would go a long way to correcting the culture 

of inability and hopelessness that is engendered by the existing process. However, a truly 

effective system should also assist the individual in implementing the plan of action by providing 

continuing guidance and coordination of the identifi ed support services. Currently, the chances 

of individuals with signifi cant impairments being appropriately connected with needed supports 

are haphazard at best. Ongoing access to a coordinator or planner who can monitor the progress 

of a rehabilitation or self-support plan, put the individual in contact with available supports, and 

suggest reassessments and course corrections as needed is an essential element in the success of 

such a plan.

 The objective of this model is not to put obstacles in the way of those who need the 

benefi ts of the existing Social Security disability programs, but rather to assure that those who 

have the ability to retain or regain a life of productivity and self support are not unnecessarily 

abandoned to dependency on those programs. We see this model as ordinarily coming into play 

at an earlier stage than the point of application for Social Security benefi ts. Participants in this 

model would not be barred from applying for Social Security benefi ts at whatever point they 

determine that such action is necessary. The outcomes from the assessment and subsequent 

rehabilitation programs should, if anything, facilitate the eligibility determination for longer-term 

benefi ts, since the information developed in the assessment process would be readily available 

for any subsequent benefi ts application. While we are convinced that many participants in the 

model approach will be able to avoid or signifi cantly defer the need for dependence on the Social 

Security disability programs, we believe that, even for those who ultimately fi nd it necessary to 

apply for those programs, their participation in the model approach may enable them to enjoy a 

higher level of independence and sense of contribution than would be the case otherwise.

15
Learning from Existing Efforts 

 We understand that some additional work would have to be done to develop the details of 

how such a model would actually operate. In our study of what now exists and our discussions 

with a variety of experts, we have found some helpful and impressive examples of existing 

efforts. These innovative programs could be expanded, coordinated, and utilized to create a 

culture that clearly states that the contributions of people with disabilities are important and 

that independence is possible. For example, many businesses participate in programs such as 

the Business Leadership Network that promotes an understanding by businesses of how they 

can tap into an underutilized important human capital resource by actively seeking to employ 

people with disabilities. The Workforce Investment Act (WIA) established a network of locallybased One-Stop Career Centers that bring together in one location public and private resources, 

including local, state, and federal programs that provide employment services to individuals 

seeking work, including those with disabilities. Business-led Workforce Investment Boards, 

funded through WIA, provide training and educational services that prepare workers to reenter 

the labor force. We also learned that some labor unions, such as the International Association of 

Machinists, have a long history of operating signifi cant programs to support the return to work of 

injured or disabled workers.

Employers in Partnership with Insurers

 One particular example that is closely aligned with the Board’s model is the support 

offered by private disability insurers. Many employers today provide disability benefi ts for their 

workers. While there are many different levels and types of private disability insurance, some 

of the major plans employ methods quite similar to the model the Board would recommend. A 

common approach is to provide separate short-term and long-term programs with both programs 

administered by the same insurer. As soon as an employee qualifi es for the short-term benefi ts, 

a process is set in motion to identify whether the disability is likely to be protracted and, if so, 

to provide an assessment of the employee’s functional capacity and the probable impact of the 

impairment on the employee’s ability to meet the functional demands of the workplace.

 If it appears feasible that the employee could eventually return to the previous job or 

to other work for the same employer or to other employment, a plan of action is developed to 

help that employee meet the appropriate employment goal. The work prescription will identify 

the kinds of supports needed to meet the identifi ed objective. Identifi ed supports could include 

workplace accommodations, adaptive equipment, rehabilitation services or therapies, and 

training. A case manager or coordinator is assigned to the individual to assure that the needed 

supports are provided and to track the progress of executing the plan of action. Greater contact is 

generally necessary in the early part of the plan, but the coordinator has continuing responsibility 

to monitor progress and provide any needed intervention. This approach benefi ts the employee 

who is enabled to return to productive employment, the employer who maximizes the retention 

of skilled employees, and the insurer who avoids unnecessary long-term benefi t liability.

 According to Bureau of Labor Statistics compensation surveys, close to 30 percent of all 

workers are enrolled in employer sponsored long-term disability programs. Not all of these have 

the type of early assessment and planning described here. Moreover, the availability of 

16
such plans, at this time, tends to be more likely for larger employers. However, this is a useful 

working example for the implementation of proposals along the lines the Board suggests as a 

model.

Bridging the Gap in the Public Sector

 The Board also notes that several states already operate short-term disability programs 

that provide benefi ts to individuals who have temporary disabilities or who have not yet met the 

Social Security Disability Insurance program’s “waiting period” requirements. In general, these 

are state-operated programs although some of them allow employers to utilize private insurance 

programs as an alternative. There is little federal involvement although most of these programs 

have some connection with the federal-state unemployment compensation program. The 

existence of these short-term programs is based on a recognition that the unemployment program 

does not provide coverage for those whose unemployment arises out of their disability.

 Except in the limited cases where these state short-term disability programs operate in 

conjunction with private insurance programs offering short-and long-term benefi ts, these state 

programs do not now incorporate the kind of model that the Board is proposing. Since states 

have no liability for long-term disability costs and the largest part of their caseload will, in fact, 

have temporary disabilities, there is no built-in incentive for the states to undertake the kind of 

assessment and coordination of services discussed here. If such incentives could be provided, 

these state-run programs could be an important element in developing a 21st century approach to 

disability.

 We believe that the development of specifi c proposals to implement the model that we are 

proposing should consider ways of providing such incentives. It should aim at taking advantage 

of the fact that there are already programs operated by businesses, nonprofi t employment and 

rehabilitation organizations, unions, private insurers, the Department of Veterans Affairs, the 

Department of Labor, state Vocational Rehabilitation agencies, and other state, local, and private 

agencies that are well positioned to be a part of such a model. Entities like these already have 

contact with impaired individuals early in their disability and at that crucial point where an 

employment relationship still exists. In particular, as we will discuss in more detail later, we 

believe a cooperative project with one or more states to merge short-term disability benefi ts with 

the necessary assessment and coordination could be used as a major pre-test of the model we 

propose.

 Such employment-based opportunities offer the most promising avenue for building 

a model that reaches individuals early in their disability and maintains their motivation and 

capacities for self support. However, the Board is aware that there are individuals with 

disabilities who do not have the substantial connection to an employment relationship that could 

be the basis for efforts to provide the kinds of assessment and supports that are envisioned in 

our adult model. Some individuals may have limited educational backgrounds and sporadic 

connection to the workforce. For others, the onset of disability may be early in adulthood while 

still engaged in education or during a period of unemployment. Still others may have decided to 

withdraw from the workforce temporarily.

 Our model envisions that adults who have a significant limitation but who do not have an 

ongoing employment relationship would nonetheless have access to assessment and supports that 

would facilitate the maintenance of their capacity for independent living. Moreover, it is 

17
important not only to have such elements available to those without strong employment 

relationships, but also to assure that affected individuals are made aware of these resources. An 

obvious source of such information and referral could be medical providers, but with the exception 

of occupational medicine, few physicians receive any training in disability assessment and 

management. This needs to change.

VI. An Integrated Disability System Model for Youth

 Disability, as it affects children, differs in many ways from disability in adults. The Social 

Security Disability Insurance program does not ordinarily provide benefi ts for children, and the 

Supplemental Security Income program uses a special defi nition that primarily looks at the child’s 

functional limitations rather than at the question of ability to work. But those who are disabled in 

childhood will ultimately move to the adult world and will be measured against the adult disability 

standards even though they may be at risk and ill prepared to assume adult responsibilities. Too 

often upon reaching adulthood, they lack education, work skills, and even life skills to fully 

participate in society. This defi cit aggravates the physical or mental limitations that affect their 

ability to work.

 Because children are different from adults, a different disability support model is necessary. 

Although the details of how such a model would operate will be different, the basic problems are 

the same. In our discussions with advocates, program administrators, youth with disabilities and 

their families, and experts on childhood disability, we heard clear messages, including:

• A need for an early, comprehensive, functional assessment.

• A need for a major culture shift that emphasizes expectations of independence, selfsupport, and participation.

• A need for continuing guidance and management that not only provides planning 

toward those expectations but also identifi es the necessary supports and coordinates the 

provision of those supports.

 We learned that some portion of these strategies exists in theory but either does not exist in 

practice or is inadequately carried out. Youth with disabilities, like other children, should spend 

their formative years learning, growing, and planning for a productive and independent future. 

To do this, families, educational systems, and providers of rehabilitation, training, and other 

supportive services need to forge an earlier and stronger alliance. And there must be a systematic 

coordination of these elements.

 The lack of an appropriate system for addressing the needs of disabled children can been 

seen in what happens as they transition to adulthood. The picture of SSI youth that emerges 

from the National Survey of SSI Children and Families (NSCF) is instructive. Less than half of 

the youth who are or were on SSI graduate from secondary school. For the young adults (ages 

19-23), who are on SSI, nearly 60 percent reported they were not working, going to school, 

or in vocational training. Of those who had left the SSI program as the result of the age-18 

redetermination or for other reasons, just over half were not in school, working, or in a training 

program. Clearly, the transition to adulthood was not seamless for these youth. This is even more 

apparent when looking at income. Those who remain on SSI after 18 as well as those who leave 

the rolls have incomes, on average, only slightly above the poverty line. Youth who come on the 

SSI rolls before age 18 spend, on average, 27 years on benefi ts over their lifetime. The 

18
fi rst term of entitlement averages 10 years. The cash benefi ts of SSI and access to Medicaid are 

clearly important to the children and their families. But these alone do not prepare the youth for 

adulthood.

 Students in special education, many of whom are SSI recipients, are required by the 

Individuals with Disabilities Education Act to have an Individualized Education Program (IEP). 

There are many aspects of the IEP system which represent an excellent approach to addressing 

the needs of children with disabilities. The IEP system is carried out by schools, which have 

continuing day-to-day contact with children and have a clear institutional interest in developing 

the full potential of students. States are required to identify, locate, and evaluate children with 

disabilities. Requirements include an evaluation designed to identify educational needs and 

services that will lead to the achievement of specifi c goals. Progress should be monitored, 

and the plan must be reviewed at least annually with a triennial reevaluation. Parents, the 

disabled children, regular and special education teachers, and additional individuals with 

special knowledge or expertise are expected to be involved in the process. Transition planning 

is required to be incorporated at least by age 14, and identifi ed transition services must be 

incorporated into the plan at least by age 16.

 Unfortunately, we have heard repeatedly from parents, young people, and disability 

experts that the quality of the planning as well as the content of the IEP are frequently 

insuffi cient or lack meaningful life-skill or knowledge-development benchmarks. The existence 

of the IEP system certainly is an important advance, and it undoubtedly does provide important 

help to many individuals. Too often, it appears to represent paper compliance with an ideal that 

is not actually carried out in a meaningful way. As was pointed out earlier this year in our annual 

Statement on the Supplemental Security Income Program, the Department of Education has 

found many states out of compliance with the content requirements for IEPs. Examples include 

schools which essentially used “boilerplate” IEPs with identical goals and objectives and IEPs 

which did not include goals and objectives to address identifi ed needs.

 Moreover, even where the IEP identifi es needed services, these services are frequently 

not in fact provided. The Board has heard, for example, that it is often diffi cult to get Vocational 

Rehabilitation agencies to provide services to transition age youth because those agencies are 

not well equipped to meet the needs of that population. Additionally, many agencies believe that 

services to such youth will not achieve the kinds of results for which the agencies receive credit, 

such as quick job placement at a signifi cant earnings level. As a result, an IEP that identifi es VR 

services as a transition need will often be “achieved” by the individual’s placement on a long 

waiting list.

 Our discussion with experts and others concerned with disabled children have also led 

us to conclude that the IEP system, even if well implemented, has signifi cant limitations. While 

it is helpful and useful to have evaluations of disabled children in the context of their school 

attendance, functional evaluations even earlier in life are likely to be able to identify corrective 

measures that will have major long-term payoffs. Within the IEP process, the provisions for 

transition planning by age 14 and identifi cation of transition services by age 16 are important, 

but many of those we consulted believe that planning for the future should generally begin even 

earlier, perhaps as early as age 8 to 12. Care, of course, needs to be taken not to inappropriately 

“track” children into vocational goals at the expense of developing and meeting appropriate 

academic objectives. Children need from an early age to learn the basic life skills and attitudes 

that will be important in any type of future work life.

19
Parents are still being told that their 

kids with severe disabilities will never be 

able to work. These explicit goals should 

be written on the wall of every classroom 

from kindergarten on: “independence,” 

“productivity,” “community inclusion.”

Roundtable participant, Washington, D.C.

 The Board heard time and 

again, and we concur, that it is 

essential for children from their 

earliest years to develop in a culture 

where the expectations are ones 

of maximum feasible self support 

and participation in the life of the 

community. As we reviewed the IEP 

guide published by the Department 

of Education, we see no emphasis—

indeed essentially no mention—of 

this important issue of fostering 

expectations.

 While the IEP system may be a good start, we believe that much more can and should 

be done. The current situation 

imposes large costs on the affected 

children in terms of undeveloped 

potential for a fulfi lling, productive 

life and on society in terms of 

foregone productive capacity, as 

well as signifi cant costs for benefi ts. 

Addressing the needs of disabled 

children is therefore a societal 

responsibility, regardless of where 

administrative responsibility may ultimately fall. It is a responsibility that needs to be fulfi lled 

not only for those children currently receiving benefi ts under the SSI program, but for all 

children with disabilities including those who, because of parental income, may be ineligible for 

SSI as children but may become eligible for SSI or other benefi ts later in life.

 Without some type of overarching program that embraces all children with disabilities 

early in their lives, these young adults may indeed be facing a life of unrealized potential and 

poverty. It is imperative that a 21st century, integrated disability system assist and support all 

individuals and that it strive to prepare each person to participate fully in society and maximize 

their employment outcomes to the extent of their capabilities.

From a taxpayer’s perspective, the 

program with the best return on investment 

is a timely or early intervention.

Roundtable participant, Washington, D.C. 

Integrating Services ─ Changing Lives

 We believe that it is time to develop a timely, coordinated, and purposeful approach to 

evaluating and developing a tailored “life-progression” plan. This should begin with functional 

assessments at the appropriate times in the child’s development. The assessments should be 

conducted by competent and well-trained professionals from a variety of disciplines. The 

child and the family would be referred to a service coordinator who would arrange for a multidimensional evaluation. For those children in special education, this evaluation could work 

in concert with the IEP process and would identify and provide access to the needed services, 

technologies, supports, education, and training that will help shape a meaningful developmental 

program. A major role for this system would be the coordination of these services which are now 

20
available on an inconsistent, “stove pipe” basis. The evaluation should not be just another “add 

on” to the already crowded, and often confl ictive, fi eld of required tests, development plans, and 

educational requirements. But rather, it should be the starting point for marshalling and arraying 

in a more systematic fashion all of the appropriate services and interventions that would benefi t 

the development of the child.

 The evaluation would result in a tailored assessment of abilities and a plan for 

maximizing the child’s potential and emphasizing expectations. As the child matures, the plan 

would also mature, shifting its focus over time to more adult-oriented life skills, education, and 

training. Participation in this additional program would not be conditioned on being enrolled in 

special education, would be voluntary, and the child would, if eligible, continue to receive any 

SSI payments and Medicaid coverage. For those who participate, there could be differential 

program rules. For example, perhaps access to services could be expedited, or periodic reviews 

could be deferred, or there could be greater fl exibility in exiting and reentering the SSI program.

 While (as we discuss in more detail in section X) we do not think the Social Security 

Administration should have administrative responsibility for the service-focused models we 

propose, it will necessarily have important coordinating responsibilities for the large number 

of disabled children who are on its SSI benefi t rolls. At a minimum, it can provide important 

medical information obtained in the eligibility determination and redetermination processes (and 

may participate, administratively, in the early functional assessment proposed). As we pointed 

out in our 2006 Statement on the Supplemental Security Income Program, SSA can also play an 

important role in making sure that parents of SSI recipient children are informed of the services 

available through the existing and proposed process and are aware of the differential eligibility 

requirements their children will face as adults.

VII. Incentives to Make Work Pay

 In the course of our study of this issue, we have heard many suggestions about how 

incentives might be improved to strengthen and encourage return-to-work efforts. While we are 

not attempting to endorse specifi c proposals and are aware of the constraints imposed by shortterm budgetary realities, we think it is worth pointing out a number of the areas in which better 

incentives for a work-friendly culture could be created.

Short-Term Benefi ts Systems and Tax Incentives

 One of the obvious needs during a period of transition from onset of impairment to 

resumption of self support is some sort of income support. Initially some persons will have 

private or state short-term disability benefi ts; others may need to rely on accumulated leave and 

savings. Development of public policy to bring about wider availability of short-term benefi t 

systems (with an employment connection where possible) would be very helpful. In assessing 

the possibilities of resuming employment, individuals with impairments will inevitably measure 

what they can expect to earn against what might be available if they can qualify for one of the 

major benefi t programs.

21
 Measures to help “make work pay” could contribute signifi cantly to deciding to attempt 

the self support option. The earned income tax credit (EITC) is designed to encourage work by 

providing an increasing credit as earnings increase up to a point where it begins to phase out. 

For workers with children, the EITC provides a signifi cant supplement to earnings that begins to 

phase down at an earnings level around $14,000 and phases out completely at around $35,000. 

For individuals without children (whether or not disabled) the credit is much smaller, grows only 

until earnings reach somewhat above $6,000, and is phased out completely at earnings levels 

around $12,000. Making a more generous schedule available for workers with disabilities could 

make work a more attractive alternative.

 The tax code already includes some other provisions designed to facilitate the 

employment of people with disabilities such as the full deductibility of impairment related work 

expenses (such as attendant care costs), business deductions for the costs of providing access 

as required by the Americans with Disabilities Act, and the work opportunity credit for hiring 

individuals participating in vocational rehabilitation programs through state VR agencies or the 

Department of Veterans Affairs. (Legislation to extend the work opportunity credit for persons 

hired after 2005 is currently pending in Congress.)

 The Board heard a number of suggestions for making tax incentives stronger, more 

effective, and more widely used. Ideas ranged from simplifi cation and efforts to increase 

awareness of existing provisions to proposals to provide credits in place of deductions for 

assistive devices and personal assistants. Additionally, suggestions were made to create new 

provisions such as tax-sheltered savings specifi cally designed to enable impaired individuals 

to accumulate assets that could be used to support employment efforts or new tax credits for 

employers with strong return-to-work programs.

It is important to look for those things that might 

infl uence or motivate an employer to get involved 

in managing disability. Maybe we should consider 

giving employers tax credits to intervene.

Roundtable participant, Kansas City

Simplify and Strengthen Work Incentives

 In this report, the Board has focused particularly on the need to provide early assessments 

and supports prior to the point of application for the Social Security disability programs. We are 

convinced that the primary issue with our national disability system is not to be found in how the 

current Social Security disability programs are designed and operated but rather in the absence of 

an adequate culture and methodology to guide and support impaired individuals into a more workoriented path that could avoid or delay their need to depend on those Social Security programs. 

We do, however, recognize that there are also changes that could be made in those programs to 

better encourage work activity. We recognize that there are some ongoing efforts such as the 

proposed regulatory changes to the Ticket to Work program and the Benefi t Offset demonstration 

project that may lead to somewhat better success in the area of return to work. As we suggested in 

our 2005 Statement on the Supplemental Security Income Program, it should be possible to make 

changes that would simplify that program and at the same time provide stronger work incentive 

features.

22
Social Security has got work incentives 

for people who are on SSDI to go back to 

work. Have y’all read those? Have you 

actually sat down and read them? Because 

they are so complicated. I am a lawyer, 

and I looked at them and I said, huh, I 

don’t know; I don’t really know if I get 

this.

Public hearing participant, Dallas

 We also believe that the adoption of a pre-Social-Security assessment and work incentive 

program along the lines of the model we are proposing might also provide an opportunity to 

eliminate some of the barriers to 

work activity for those who do later 

become eligible for Social Security 

disability benefi ts. For example, 

one of the barriers to attempting a 

return to work on the part of current 

benefi ciaries is the fear that an attempt 

to work might result in a benefi t 

termination that would be diffi cult to 

reverse if the individual subsequently 

needed to return to the rolls. While 

Congress has attempted to reduce these 

disincentives through provisions aimed 

at maintaining technical eligibility 

that would allow a quick return to the 

rolls and extended Medicare eligibility, 

many of those the Board has talked with have indicated the fear that benefi ts will not be available 

if needed remains a major deterrent to attempting a return to work. The adoption of a system such 

as we are recommending might make it feasible within reasonable cost constraints to provide a 

special status for those who participated in the early assessment program and subsequently found it 

necessary to seek disability benefi ts such persons might be granted permanent technical entitlement 

subject only to benefi t reduction and payment of Medicare premiums appropriate to their 

earnings level. Provisions like these could provide strong incentives for participation in the early 

assessment program and appropriately address the cyclical nature of some disabling conditions.

VIII. Health Care

 We are addressing the issue of health care separately because it is in many respects both 

the most important and most diffi cult part of any model for supporting individuals with severe 

impairments in their attempt to pursue or return to employment.

 In the 1960s and 1970s, Congress 

extended health insurance coverage to 

disabled individuals under the Medicaid 

and Medicare programs in recognition 

of the fact that this population has a 

critical need for medical and hospital 

care. In general, eligibility for these 

health insurance programs is directly 

tied to eligibility for cash benefi ts under 

the Social Security or SSI disability programs. In the case of Medicare, eligibility is established 

after fulfi lling a 24-month waiting period. However, this waiting period begins after the 5-month 

waiting period for Disability Insurance Benefi ts, thus DI benefi ciaries must wait up to 29 months 

before receiving Medicare coverage.

 The tie-in to the cash benefits programs and the waiting period provision refl ect 

understandable administrative and fi scal concerns. Only one eligibility determination is needed 

How do you encourage people to 

continue working if they can’t get health 

insurance unless they are found disabled?

Roundtable participant, Kansas City

23
for both cash benefi t and health insurance coverage. The Medicare waiting period avoids 

the need for complex reimbursement calculations for the large number of cases where the 

adjudication period is protracted.2 In addition, this waiting period also eliminates the need for 

public health insurance expenditures during a period when some benefi ciaries may still have 

ongoing group or individual coverage.

 While there is some logic for tying health coverage to benefit programs, as well 

as for the waiting period, this process has resulted in an unintended consequence. Many 

individuals are driven to establish entitlement to cash benefi ts in order to obtain what they really 

seek─health insurance. They apply very quickly for cash benefi ts in order to begin serving 

the lengthy waiting period because they want to minimize the gap (and cost) between the end 

of any employer-sponsored coverage through COBRA or similar plans, and the beginning of 

Medicare eligibility. Those workers who had employer-sponsored health benefi ts can continue 

to participate in those plans for up to 18 months under the COBRA law. However, they may 

be required to pay the full costs of such coverage. Workers who are found eligible for Social 

Security disability benefi ts can qualify for an additional 11 months of COBRA coverage but may 

be charged 150 percent of the plan costs for those added months.

 Many large employers do offer health insurance. However, a Kaiser Family Foundation 

survey noted that for small fi rms with fewer than 200 employees, the percentage offering health 

benefi ts has declined from 68 percent in 2000 to 59 percent in 2005. Despite the coverage that 

may be available through COBRA, there remains for a signifi cant number of workers the need 

to maintain a continuous connection to healthcare coverage at an affordable cost. Establishing 

eligibility for cash benefi ts in the hope of obtaining Medicare can be a prime motivator for 

individuals who are out of work and have signifi cant impairments.

 In our discussions with interested groups, program administrators, and academic experts, 

the Board has heard that securing health insurance coverage is far more important than cash 

benefits to children and adults with disabilities and their families. The most frequently repeated 

word in our conversations about this issue is “fear.” When thinking about the possibilities of 

working as opposed to receiving benefi ts, the fear of losing healthcare coverage is likely to carry 

the most weight.

Improving Access to Health Coverage

 There is an overwhelming concern on the part of individuals with disabilities to assure 

access to health care. It also frequently plays a very substantial role in making it possible 

for them to engage in employment. We are convinced that any model of a national system 

to encourage individuals with impairments to view work as a viable alternative to benefi t 

dependency must fi nd an effective way to address the need to access adequate and secure health 

insurance protection. At the same time, we recognize that for the national budget as for private 

employers, the increasing costs of health benefi ts are already a huge challenge.

 Congress has taken an important step in the direction of addressing this issue by 

establishing the Medicaid buy-in process. This allows states to provide Medicaid coverage to 

disabled individuals who would be eligible for Supplemental Security Income (and therefore 

2Retroactive Medicare reimbursement may be required if the processing of the disability claim extends beyond 29 months from 

the fi rst month for which disability benefi t entitlement is established.

24
Medicaid) but for the fact that their earnings take them above the SSI eligibility limits. (For such 

individuals, states can also waive or increase the asset and unearned income limits.) In providing 

Medicaid to such individuals, states are able to charge premiums related to income. 

This general approach of providing health benefit coverage to individuals with disabilities on 

a cost-sharing basis and utilizing other coverage that may be available to them through employment 

or post-employment provisions (e.g., COBRA coverage) provides an appropriate model for 

assuring that health care is available while limiting program costs to feasible levels. However, at 

this point, the Medicaid buy-in is quite limited in scope. There are 32 states participating and 

rules differ from state to state. Some states have only a few participants and nationally the number 

of participants was just under 80,000 as of March 2005. (See Table 2, which is based on CMS 

data.) 

Table 2 — Enrollments in Medicaid Buy-In

Programs – March 2005

States Participating

(32)

Number of enrollees

(79,140)

Alaska 214

Arizona 683

Arkansas 444

California 1263

Connecticut 3617

Illinois 700

Indiana 5811

Iowa 8098

Kansas 865

Louisiana 529

Maine 681

Massachusetts 7414

Michigan 176

Minnesota 6339

Mississippi 1460

Missouri 18654

Nebraska 83

Nevada 11

New Hampshire 1319

New Jersey 1436

New Mexico 1241

New York 2864

North Dakota 275

Oregon 585

Pennsylvania 5007

South Carolina 52

Utah 283

Vermont 553

Washington 495

West Virginia 118

Wisconsin 8265

Wyoming 5

25 
 One major issue with the current Medicaid buy-in approach is that eligibility is limited to 

individuals who are disabled under the Social Security programs’ current defi nition of disability. 

This means that eligibility depends on going through the existing process of proving inability to 

engage in any substantial work activity. To keep costs within bounds, eligibility would necessarily 

be limited according to some standard of signifi cant functional limitation, but it should not be tied 

in this way to the Social Security disability defi nition.

 An appropriate new national disability system should include measures that convincingly 

assure adults and children with disabilities and their families that secure and continuing adequate 

health care coverage would not depend on their establishing and maintaining eligibility for Social 

Security or SSI disability benefi ts. In addition, the assurance should be there that such coverage 

would be available as necessary to enhance their efforts to seek independence and self support.

IX. Suggestions for Longer-Term Program Enhancements

 Over the course of our discussions with experts, through our public hearings and 

roundtables, we have heard many ideas that may indeed help realign the current program and set 

the stage for a 21st century disability system that truly supports the goals of the ADA. Those 

suggestions include:

• Revise work, earnings, and asset rules

Research shows strong evidence that some benefi ciaries substantially restrain their 

earnings in order to stay below the SSDI and SSI thresholds. Exceeding these 

limits threatens program attachment and access to health coverage.

 Current asset test rules constrain a working benefi ciary’s ability to save money that 

 can be vital for sustaining employment and maintaining independence.

• Provide lifetime certifi cation for health coverage for benefi ciaries with lifelong 

conditions

We have heard repeatedly that the biggest barrier to work is the fear of losing health 

coverage. Exploration of access to healthcare coverage that could potentially 

include public/private partnership should be considered. Assuring people with 

lifelong conditions access to health care would remove one of the disincentives to 

work.

Exploration of continued attachment to the program in order to maintain continued 

eligibility for healthcare benefi ts through an enhanced buy-in program should be 

considered.

• Refocus the criteria for the SSI age-18 redetermination of disability

The current criteria assume that there is a bright line between functional limitations 

that qualify a young person for disability and those that would qualify an adult. 

Expanding the age-18 assessment criteria to include an overall evaluation that 

addresses medical, functional, and life-skills readiness should be considered.

26
• Address the disincentives to employment in an integrated fashion through the creation 

of system-wide buy-in programs

For many people with disabilities, their ability to work is made possible through 

the support that they receive from a variety of public programs. As their income 

increases, they often lose eligibility for some public benefi ts such as supported 

housing and medical assistance. These expenses, which have been covered in 

all or part by these programs, cannot always be completely paid for out of the 

worker’s current earnings.

As a result, individuals will often limit earnings or withdraw entirely from the 

workforce in order to remain eligible for these essential services. The creation of 

system-wide sliding scale buy-in programs would allow the person to continue to 

work and to receive the public services and supports that they need, while at the 

same time contributing toward the costs of those services.

• Create job preparation trust funds

The SSI program generally limits eligibility to those whose assets are below 

relatively small thresholds ($2000 for an individual, $3000 for a couple) and 

counts as income, for purposes of calculating benefi ts, any type of income that is 

not specifi cally excluded. The law does include limited exceptions for amounts 

placed in trust (such as trusts established by family members to provide for 

special needs). Such trusts can be complicated to establish, are subject to varying 

state trust laws, and to somewhat different rules between the SSI and Medicaid 

programs.

The Board supports a more simplifi ed approach that would allow recipients or 

their families to set up accounts that are dedicated to accumulating the kinds 

of resources that would support their attempts to undertake employment or self 

employment.

• Establish lifelong certifi cation for disabled worker’s tax credit

Similar to the earned income tax credit, establishment of an appropriate schedule 

for workers with disabilities could make work a more attractive alternative.

• Encourage the expansion of community-based services such as those created by the 

New Freedom Initiative of 2001

These programs (e.g., “cash and counseling”) facilitate community living, 

consumer choice, and employability.

27
• Educate physicians on their role in disability assessment

Few doctors, outside of a few specialties, ever receive training in disability 

assessment and management. Yet, they are routinely asked to determine a 

patient’s ability to participate in the workforce. Training doctors to properly 

assess functional abilities will allow them to better understand the relationships 

between physical and mental fi ndings and work related tasks. Furthermore, such 

enhanced training may reinforce for medical providers the gains that a patient 

may achieve by going through a rehabilitation program soon after the onset of the 

work limiting impairment.

• Consider an educational/rehabilitation “sabbatical”

For workers with signifi cant work history, an opportunity to create their own 

education and rehabilitation plan could be afforded as an alternative to disability 

benefi ts. This could be available, for example, to persons who exhausted 

unemployment benefi ts prior to applying for disability or who were denied such 

benefi ts solely because of their inability to work. Similar to the concepts of “cash 

and counseling,” the worker would receive a lump sum stipend that could be used 

for income replacement, training, education, etc.

• Consider a partial disability program

One concept that has been brought to our attention is that of establishing 

eligibility criteria for “partial disability.” An example is the program 

administered by the Department of Veterans Affairs which provides a level of 

benefi ts based upon the applicant’s degree of impairment.

X. Administrative Responsibility

 The Board does not view this report as a detailed blueprint for change, but rather as 

the establishment of a basic framework that can, we hope, shape the future of a 21st century 

disability system. When the development of a new structure for integrating and delivering 

services begins, the issue of administering the new structure will necessarily be a major 

consideration.

 We recognize that there are obvious reasons why the Social Security Administration 

is likely to be viewed as the appropriate seat of major responsibility in whatever structure is 

created. It is the agency that has the broadest contact with adults and children with signifi cant 

limitations. Its workloads and costs will be significantly impacted by the success or failure of a 

new disability system that offers people with disabilities an alternative path to self suffi ciency 

and independence. And it is an agency that has a well deserved reputation for outstanding public 

service and excellent administration of the programs entrusted to it.

 However, SSA would not be the appropriate entity for implementing the model we 

are proposing in this report. SSA’s primary responsibility is that of processing applications, 

adjudicating whether or not individuals meet a strict defi nition of disability that emphasizes the 

yes/no question of ability to do any substantial gainful activity, and maintaining benefi t rolls. 

28
These are, and will continue to be complex administrative tasks. These are tasks that are quite 

different from the models that we propose. The agency is just beginning to implement a new 

Disability Service Improvement initiative that offers much promise of addressing the existing 

backlogs and delays in the disability adjudication process.

 Our proposal is based upon creating a national culture shift that emphasizes continuing 

employment and contribution before the Social Security Administration provides benefi ts to 

those eligible applicants who have left the workforce. In our model an “early intervention” 

step emphasizes, where feasible, (re)training and employment. After this initial step (and for 

some the last step), SSA would, as it does now, make the ultimate decision on whether or not 

individuals meet the strict defi nition of disability. It would be inappropriate and misdirected 

public policy to add a triage and case management approach to a claims processing organization. 

SSA will, of course, need to carefully coordinate its role with that of a new and integrated 

system, and there will need to be extensive sharing of information and data.

 The model we are recommending requires a coordinating entity for the early intervention 

step. There are many existing government agencies that currently have a “piece of the action.” 

For example, the Department of Education has oversight of the Vocational Rehabilitation system 

that is primarily administered by state governments; the Department of Labor is responsible 

for state workforce agencies (including “One Stops”). In fact, the Government Accountability 

Offi ce has (as shown in Table 3 below) identifi ed 192 different programs operated or overseen 

by some 20 different federal departments or independent agencies that are designed to provide 

supports for people with disabilities. In fi scal year 2003, more that $120 billion in federal 

funds were spent on programs serving people with disabilities. It is especially noteworthy and 

disheartening that only 2 percent was spent on employment related programs.

29
Table 3 – Federally Sponsered Disability Programs 

Agencies Total Number of Programs 

Supporting People with Disabilities 

Department of Health and Human 

Services 40

Department of Education 33 

Department of Veterans Affairs 32 

Department of Labor 22 

Department of Housing and Urban 

Development 16

Social Security Administration 10 

Department of Agriculture 9 

Department of Transportation 6 

Department of Justice 5 

Equal Employment Opportunity 

Commission 3

Office of Personnel Management 3 

Department of Commerce 2 

Department of Treasury 2 

Library of Congress 2 

Access Board 1 

Committee for Purchase from 

People Who are Blind or Severely 

Disabled 1

Department of Defense 1 

Department of Energy 1 

Department of the Interior 1 

Railroad Retirement Board 1 

Small Business Administration 1 

Total number of programs 

(GAO survey) 192

Source: GAO analysis of survey data from GAO-05-626 Federal Disability Assistance 

 Again and again, the Board has heard that this uncoordinated, “stove pipe” approach is 

itself a major part of the problem. To develop a 21st century system for persons with disabilities, 

there should be a new, single and integrated center of responsibility that can offer people with 

disabilities a clear and uniform path to fi nding the support they may need to pursue a path to 

independence and self support. On the benefi t side, we currently have such a clear cut, uniform 

structure; on the employment support side we have something close to chaos. There are, of 

course, many different kinds of supports including training, medical care and therapy, assistive 

technology, counseling and more. A variety of providers refl ecting different disciplines will need 

to be involved, but persons with disabilities should have a single point of entry that can help 

them, as needed, attain and stay on the path to the supports they need.

30
XI. Conclusion

In our October 2003 report, The Social Security Defi nition of Disability, we raised the 

question of whether or not the Social Security defi nition of disability facilitates an appropriate 

approach to supporting and enabling persons with disabilities. Since we issued that report, 

we have, as described in detail in the Appendix, completed 3 years of additional study of our 

national approach to disability. This study has included regional hearings, public forums, 

roundtable discussions with experts, administrators, and advocates, and a series of meetings 

with an expert panel we convened to help us better understand the issues and develop our 

recommendations. 

This study has been very instructive. We have learned much about the strengths and 

weaknesses of the disability system. Most importantly, we have confi rmed our concern that 

a defi nition based on inability to work is inconsistent with the goals of the Americans with 

Disabilities Act. That Act proclaims that “the Nation’s proper goals regarding individuals with 

disabilities are to assure equality of opportunity, full participation, independent living, and 

economic self-suffi ciency for such individuals.”

 

The current Social Security statutory defi nition represents a powerful symbol of a 

national approach to disability that collides with the policy objectives enunciated in the ADA 

legislation. We need to replace that defi nition, but must do so in a way that does not undermine 

the protections afforded by the programs administered by the Social Security Administration. 

A new system must support an integrated approach providing an alternate path directed to 

economic self-suffi ciency, independence, and community inclusion.

In reshaping our statutory standards for supporting persons with disabilities, we need 

to recognize all the changes that have taken place over the past 50 years. The nature of work 

itself has changed substantially as we have moved away from an economy largely dependent 

on manufacturing jobs. The medical and pharmacological sciences have radically changed the 

impact of many conditions. There have been great strides made in rehabilitation therapy and 

the availability of adaptive technology. And, most importantly, there has been a sea change in 

the attitudes of and about persons with disabilities and their capabilities and rightful aspirations. 

This has been accompanied by recognition that disability is not a single state but a process—a 

process that may be inconsistent with the misleading precision of a single defi nition.

Call for Action

We have attempted in this report to present some general models for what we believe 

is a more appropriate structure. We have developed these models by drawing on what we 

have learned about the experience of many existing efforts including those of private disability 

insurers, state and local programs, the approach of other countries, and the many private and 

nonprofi t organizations that have taken on responsibility for providing supportive services to 

persons with disabilities. We do not expect or intend that these efforts should be replaced, much 

less eliminated. Rather we see the need for a better and integrated system to assure that people 

with disabilities receive timely assessments and coordinated access to the supports they need to 

maximize their capabilities.

31
The Board recognizes that disability affects individuals in widely differing ways, and we 

have accordingly attempted to draw our models broadly and with a view to assuring fl exibility. 

We do not assume that these models answer all questions or can be used as detailed blueprints, 

but we present them as a goal and vision of a 21st century approach to a new disability sysem. 

This is a call for action.

Unifi ed Vision and Management

Our Nation’s policymakers need to acknowledge that the current disability programs, 

though well intentioned, are badly fractured and disjointed. A unifying point of vision, oversight, 

and management is desperately needed. To rectify this, consideration should be given to the 

creation by the Administration and the Congress of an entity or entities that can develop and 

implement detailed legislative proposals for managing and integrating the supports available 

to people with disabilities in a way that truly offers a coordinated path to achieving community 

inclusion, independent living, and economic self suffi ciency. Detailed legislative proposals to 

build a 21st century system could include, where appropriate, a realignment of functions and 

responsibilities that are currently carried out by numerous entities. It is now a decade and a half 

since our Nation declared its adherence to a disability policy that encourages and supports people 

with disabilities in their quest to achieve independence and self-support that is within their 

capabilities. It is time to begin to make the necessary administrative and statutory changes that 

can make that policy a reality.

We recognize that moving from our broad conceptual models to an actual legislative 

proposal that can in fact be implemented will require substantial work and coordination by the 

Administration and the Congress. We believe, however, that the diffi culty of that task, while 

daunting, must not be viewed as a reason for avoiding action. We believe, in particular, that 

there already exists an important opportunity for carrying out a major pre-test of parts of the 

adult model we propose in a way that could help to sort out the details of how to make the model 

work.

Untapped Opportunity: State Short-term Disability Programs

Short-term disability insurance programs currently exist in 5 states and Puerto Rico.3 

As was discussed earlier in this report, these programs provide benefi ts to individuals with 

temporary disabilities or to those workers who have not yet fulfi lled the 5-month waiting period 

for SSA disability benefi ts. Generally, these programs do not include any type of assessment or 

provide rehabilitation or training services.

 It seems to us that there is potential here for working with one or more of these states 

(or other states that might be willing to implement such a program) to develop a pre-test 

that incorporates the concepts described in the adult model. These programs would afford 

the opportunity to determine when and how to intervene in order to return people to work. 

The states would continue to pay their usual benefi ts. In addition, through a public/private 

partnership, a wrap-around program that included a multidimensional assessment which leads to

3 California, Hawaii, New Jersey, New York, Rhode Island, and Puerto Rico.

32
the tailored work “prescription” and access to services would be incorporated. Such a pre-test 

would help determine how the type of intervention that is suggested in this paper can result in 

a better integrated disability system and whether it can be done in a cost effective way. Greater 

insight into and understanding of the prospective SSDI applicant pool would be gained as well.

 We urge the Congress to seriously consider establishing such a pre-test of a model 

disability system that can enable our Nation to show that it was serious when it adopted the 

Americans with Disabilities Act. We acknowledge that many questions remain to be answered, 

but they will still remain to be answered fi fty years from now unless we undertake a serious 

effort to attain those answers through a real world test such as the Board proposes here.

33
APPENDIX

How the Board Studied This Issue

Throughout the last 10 years, the Board has devoted considerable time and careful 

attention to the study of the issues facing the disability programs administered by the Social 

Security Administration (SSA). Our study took several forms:

• regular monthly meetings at which we have discussed disability policy issues with 

disability experts in both the public and private spheres,

• research and discussion forums convened by the Board, 

• public hearings,

• commissioned studies and other work.

All of these activities shaped our thinking and led to the present report.

Most recently, in 2006 we convened a panel of disability experts to work intensively 

with a working group of the Board to help inform our development of this report. The combined 

knowledge, experience and advice of the members of that Disability Expert Panel was also of 

great assistance to the Board in studying these issues. The Board would like to thank the Panel 

for its invaluable insights and contributions. We would also like to thank David Barnes, who 

served as facilitator for the Panel’s discussions. This report, however, was produced by the 

Social Security Advisory Board, and we are solely responsible for its content.

The Early Years: 1996-2002

 During the early years of the Board’s existence, we began, as mandated by our 

authorizing statute, to undertake a broad examination of and develop recommendations about the 

Nation’s retirement and disability systems. These are the charges which the Congress has given 

us:

• analyzing the Nation’s retirement and disability systems and making 

recommendations with respect to how the OASI, DI, and SSI programs, supported by 

other public and private systems, can most effectively assure economic security;

• studying and making recommendations relating to the coordination of programs that 

provide health security with SSA’s programs;

• making recommendations with respect to policies that will ensure the solvency of the 

OASDI program, both in the short term and the long term;

• making recommendations with respect to the quality of service that SSA provides to 

the public;

• making recommendations with respect to policies and regulations regarding the 

OASDI and SSI programs;

• increasing public understanding of the Social Security system;

• making recommendations with respect to a long-range research and program 

evaluation plan for the Administration;

• reviewing and assessing any major studies of Social Security as may come to the 

attention of the Board; and

• making recommendations with respect to such other matters as the Board determines 

to be appropriate.

34
 As we began examining each of these issues in depth, the Board met with SSA offi cials 

both in headquarters and in the fi eld. We met with representatives from the state Disability 

Determination Services (DDS) and Vocational Rehabilitation (VR) systems, community leaders 

and consumer advocates, representatives from the private and nonprofi t sectors, and program 

benefi ciaries. The Board traveled throughout the Nation, visiting SSA offi ces, state offi ces, and 

demonstration project sites to learn about what works and what does not work. In addition, the 

Board held a number of public hearings throughout the country to hear directly from experts and 

the benefi ciaries of SSA’s programs.

 As a result of these many meetings in Washington, D.C., and across the Nation, it 

quickly became apparent to the Board that high among the signifi cant challenges facing SSA 

were the administrative and policy-making burdens placed on the agency by the SSDI and 

SSI disability programs. The Board was growing increasingly concerned that the disability 

programs—originally envisioned to be small in comparison to SSA’s retirement program—were 

now dominating SSA’s workloads, resources, and management capacity. About two-thirds of the 

agency’s annual administrative budget and a growing portion of the time and attention of SSA 

management and staff at all levels of the agency are spent on disability-related workloads.

 Between 1996 and 2002, the Board wrote extensively on issues it encountered in its 

review of the SSDI and SSI disability programs. We have issued a number of reports in which 

we raised concerns and made recommendations with respect to:

• timely adjudication and service to the public,

• consistency of decision making,

• work measurement and quality assurance, and

• disability policy development.

 The Board also met regularly with the Commissioner of Social Security and with 

representatives of SSA and the DDSs in order to keep abreast of the many efforts that SSA was 

undertaking to improve the operation, integrity, and management of these programs—including 

the design of a new disability adjudication process, a new quality assurance process, and a new 

budget formulation process focused on service delivery.

 While many issues were related to administrative processes and resource constraints, it 

became increasingly clear to the Board that there also were more fundamental problems with 

these programs that needed to be addressed. During these early years, we issued a number of 

reports that continually brought the Board’s attention back to the basic question of whether or 

not the defi nition of disability—established nearly a half a century ago when the program was 

fi rst created—continues to be appropriate in a 21st century environment. In our January 2001 

report, Charting the Future of Social Security’s Disability Programs: The Need for Fundamental 

Change, the Board raised the question of whether or not Social Security’s defi nition of disability 

was appropriately aligned with national disability policy as refl ected, for example, in the 

Americans with Disabilities Act.

2003

 As the Social Security Administration worked to develop a new process to improve the 

adjudication of disability claims, the Advisory Board in 2003 simultaneously undertook a more 

earnest and in-depth look at the issues facing SSA’s disability programs that require more than 

35
administrative or regulatory remedies—issues that will require statutory change in order to 

address them adequately. The Board devoted about three-quarters of its monthly meetings to the 

study of SSA’s disability programs. We met with disability experts and adjudicators, including 

outside experts, representatives from the Government Accountability Offi ce (GAO), and 

numerous offi cials from SSA. In May of 2003, the Board made a fi eld visit to Boston where it 

met with SSA offi cials from the Boston Region and with representatives from the Massachusetts 

DDS. In June, we met with representatives from the Council of State Administrators of 

Vocational Rehabilitation (CSAVR) in Washington, D.C.

 As a result of everything the Board heard and discussed in its many meetings and 

consultations on disability policy to date—and the Board’s growing sense that perhaps 

the disability programs administered by the Social Security Administration needed to be 

modernized—in October of 2003 the Board released a report entitled, The Social Security 

Defi nition of Disability. This report examined the background of SSA’s disability programs 

and how they have changed, the growing diffi culty of appropriately determining who can and 

cannot work, and the various attempts to build in work incentives. While recognizing that 

these programs are a large and important part of our national income security system, the Board 

concluded that the Nation must face up to the contradictions created by the existing defi nition 

of disability. The report briefl y catalogues some of the alternative approaches that might, in 

some combination, be incorporated into revised programs while noting that any such changes 

must be made carefully and with due regard for the importance of these programs to the lives of 

America’s disabled citizens and to their impact on other elements of national income security. 

The Board issued this report to focus attention on that issue, and indicated its intent to do 

additional work in this area in the future.

Disability-Related Board Publications in 2003:

Introducing Nonadversarial Government Representatives to Improve the Record for Decision in 

Social Security Disability Adjudications, May 2003.

The Social Security Defi nition of Disability, October 2003.

2004

 The Board’s 2003 report on the defi nition of disability led, in April of 2004, to a 

discussion forum exploring the Social Security defi nition of disability and whether or not it 

is consistent with a national goal of supporting maximum self-suffi ciency. At its discussion 

forum, the Board convened a group of disability experts and these invited experts presented and 

discussed papers presenting a wide range of views on the future of the disability programs. In 2 

separate sessions, the presented papers examined: (1) whether or not the current Social Security 

disability programs are consistent with a 21st century national vision of disability policy—

integrating benefi ts, services, civil rights, and employment for people with disabilities; and (2) 

what would be the necessary features of a consistent national disability benefi ts/supports system 

should reform be necessary.

 The presenters and discussants who participated in the fi rst series of discussions were: 

David Stapleton of Cornell University; Virginia Reno of the National Academy of Social 

Insurance; Marilyn Howard, a social policy analyst from the United Kingdom; Robert Anfi eld 

of UnumProvident Corporation; Bobby Silverstein of the National Center on Workforce and 

Disability; Peter Blanck of the University of Iowa; and Tony Young of NISH and the Consortium 

for Citizens with Disabilities. Gerben DeJong of the University of Florida was the moderator for 

36
this session. The presenters and discussants who participated in the second series of discussions 

were Monroe Berkowitz of Rutgers University; Bruce Growick of the Ohio State University; 

Eugene Steuerle of the Urban Institute; Michael O’Brien of the Washington Department of 

Vocational Rehabilitation; William Kiernan of the Institute for Community Inclusion; and Mark 

Dakos of BTE Technologies, Inc. Richard Burkhauser of Cornell University was the moderator 

for this session. David Walker, Comptroller General of the United States, gave the keynote 

address stressing the large and growing fi nancial impact of the Nation’s disability programs and 

the need for reform.

 The presentations and discussion at this all-day forum highlighted the importance, broad 

scope, and extreme complexity of the problem identified by the Board’s report on the Social 

Security defi nition of disability. In addition, the forum revealed a range of views on the severity 

and scope of the problem; the underlying causes; and possible solutions. At the conclusion of the 

forum, the Board pledged its continued active involvement in this policy arena.

 In keeping with its promise, throughout the remainder of 2004 the Board continued to 

devote considerable time and attention to its examination of the disability programs and the 

appropriateness of a definition of disability that may not be aligned with 21st century policy 

and may, in fact, present barriers for people with disabilities in their efforts to contribute to their 

own economic well being. At its regular monthly meetings, the Board met with representatives 

from SSA, the GAO, the Department of Veterans Affairs (VA), the Department of Labor (DOL), 

experts, researchers, and disability advocates. In addition, the Board traveled to Vallejo, 

California in June of 2004 where it met with representatives of and participants in the California 

Bridges to Youth Self Suffi ciency pilot project designed to provide assistance for youth with 

disabilities as they transition to adulthood.

2005

 Early in 2005, the Board began to outline a specifi c project to explore these disability 

issues and develop a set of recommendations. The Board’s meeting and research agenda for 2005 

was planned in support of this project. Early in the year, the Board met with a group of disability 

experts to discuss their joint proposal to improve the disability programs. This group consisted of: 

Deborah Kaplan, Disability Consultant; Bonnie O’Day, Senior Research Associate at the Cornell 

University Institute for Policy Research; Susan Parker, Director of Policy Program Research in 

the Offi ce of Disability Employment Policy at the Department of Labor; Sallie Rhodes, External 

Relations Director for CSAVR; and David Stapleton, Director of the Cornell University Institute 

for Policy Research. The Board met with representatives from SSA’s Offi ce of Disability and 

Income Security Programs to discuss, among other topics, the defi nition of disability. The Board 

met with representatives from the Centers for Medicare and Medicaid Services (CMS) and with 

representatives from SSA to discuss current and proposed grant and demonstration projects under 

the Ticket to Work and Work Incentives Improvement Act. The Board also met with members and 

staff of the Ticket to Work and Work Incentives Advisory Panel to discuss the future directions of 

the Ticket program.

 In November of 2005, the Board traveled to Dallas, Texas where it met with SSA managers 

and staff from the Dallas Region, as well as with representatives from the Texas DDS. On 

November 15, 2005, the Board held a public hearing in Dallas to hear additional expert opinions 

on whether or not the defi nition of disability required modernization. At this hearing, the Board 

heard from: Dallas Regional SSA Commissioner Ramona Schuenemeyer; Wayne Pound, Vice 

President of Community Services for the Lighthouse for the Blind of Fort Worth, Texas;

37
Mary Wolfe, Assistant Commissioner for the Texas DDS; Elise Mitchell, Senior Regional 

Attorney for Advocacy, Inc.; Carol Schaper, Advocate and Claimant Representative for the 

National Alliance for the Mentally Ill (NAMI); and Charlotte Stewart, Executive Director of 

Reach Independent Living Center.

Disability-Related Board Publications in 2005:

Retirement Security: The Unfolding of a Predictable Surprise, March 2005

Board Comments on Ticket to Work Regulations, December 2005

2006

 In February of 2006, the Board convened a panel of disability experts in an effort to 

further the Board’s study of the national disability system and assist us in our attempt to lay out, 

broadly, the parameters that would be necessary for a modernized disability system that better 

meets the goals of the American people and better serves people with disabilities. This Disability 

Expert Panel consisted of: Richard Burkhauser from Cornell University; Martha Ford from 

Disability Policy Collaboration; Allen Heinemann from the Rehabilitation Institute of Chicago; 

Andrew Imparato from the American Association of People with Disabilities; Kenneth Mitchell 

from UnumProvident Corporation; and the late Eileen Sweeney from the Center for Budget and 

Policy Priorities. The Disability Expert Panel met monthly from February through August of 

2006, often consulting with additional experts from both the public and private sectors where 

needed, including MDRC, Virginia Commonwealth University, and Maryland Rehabilitation 

Services.

 In June of 2006, the Board traveled to the Kansas City Region in an effort to further 

its study of the Nation’s disability system. While in Kansas City, the Board met with SSA 

executives and staff and the Director of the Kansas DDS. Also during this fi eld visit, the 

Board held a half-day roundtable discussion to learn the views of a diverse cross section of 

knowledgeable individuals from the Kansas City Region, including university researchers, 

community and business leaders, legal advocates for people with disabilities, rehabilitation 

specialists, providers of other services to persons with disabilities, representatives from state 

and local government programs, and a state legislator. (See table at end of this Appendix.) The 

roundtable sessions were designed to draw on the wisdom that these individuals have gained 

in their many years of experience with the Social Security disability programs and the other 

programs that make up our country’s disability system.

 Roundtable participants were divided into 5 small groups—each table was hosted by a 

member of the Social Security Advisory Board. Each table was asked to examine 4 questions 

and then summarize their discussion back to the larger group. These 4 questions were:

• Our major national disability programs (SSDI and SSI) apply a complex set of 

evaluation standards in an attempt to separate those who can work from those who 

cannot work. The questions are: “Does this approach achieve the desired result?” 

Would a better alternative be a system that attempts to:

 evaluate each individual’s potential to maintain, attain, or regain the 

 capacity for self support,

 provide the encouragement, incentives, accommodations, and supports 

 necessary to achieve that self support, and

 ultimately determine eligibility for long term income support on the 

 success or failure of that attempt?

38
• Assuming the need for change, there is wide acceptance that effective intervention 

should be “timely,” for example, while the individual still has a connection to the 

workforce and, if possible, an employment relationship. What could be done to assure 

that such timely intervention occurs routinely when an individual suffers a signifi cant 

impairment? When is “timely” intervention for youth with disabilities?

• There exist in our society a large number of entities providing a variety of 

supports and services and employment opportunities to individuals with signifi cant 

impairments, but there is a perception that these are largely uncoordinated and the 

likelihood of a given individual fi nding the appropriate combination of supports and 

opportunities is haphazard. Is this a correct perception and, if so, what would remedy 

the situation?

• If we need a signifi cant course correction in how we implement our national disability 

policies, then what major changes not addressed in the above 3 questions would the 

roundtable participants like to bring to the Board for consideration?

 As a result of the Kansas City roundtable discussions, the Board was able to focus on a 

more narrow set of issues and questions and begin framing a broad outline for a new approach 

to disability—with one set of parameters specifi cally designed for adults with disabilities and 

another set of parameters for youth with disabilities. And in an effort to further refi ne its outline, 

on July 19, 2006, the Board held a second all day roundtable discussion forum in Washington, 

D.C. to examine the Nation’s disability system with a view toward developing a description 

of a disability system that maximizes economic self suffi ciency at a reasonable standard of 

living. The new system would be consistent with the Americans with Disabilities Act and would 

facilitate equal opportunity, independent living, and full participation in the labor force to the 

extent of an individual’s abilities.

 Participants for this second set of roundtable discussions included, once again, a broad 

cross section of public and private sector experts on the Nation’s disability system, including 

representatives from: The Ticket to Work Advisory Panel; Mathematica Policy Research; the 

American Council of the Blind; Webility Corporation; the Association of University Centers 

on Disability; Easter Seals; Abt Associates; the National Council on Disability; the Cornell 

University Institute for Policy Research; Griffi n Hammis Associates, LLC; the Anixter 

Center; the Offi ce of Students with Disabilities at Gallaudet University; AFL CIO; Daniels 

and Associates; the Center for the Study and Advancement for Disability Policy; the National 

Organization of Social Security Claimants’ Representatives; the Integrative Pain Center 

of Arizona; America’s Health Insurance Plan; the Kennedy Krieger Institute, the Virginia 

Department of Rehabilitative Services; the National Disability Rights Network; Community 

Legal Services, IMX Medical Management; ENDependence Center of Northern Virginia; the 

National Alliance on Mental Illness; and McLendon and Associates. (See table at the end of this 

Appendix.)

 Roundtable participants were divided into 4 groups. Each group discussion was hosted 

by a member of the Social Security Advisory Board and a member of the Disability Expert 

Panel. Participants were provided with the broad parameters, as outlined by the Board, for a 

hypothetical adult model and a hypothetical youth model. As in Kansas City, 

39
each group was asked to examine and discuss a series of questions for each of the models. These 

questions were:

For Adults with Disabilities:

• Is this model worth pursuing?

• What would the initial evaluation look like, when would it happen, and who would do 

it?

• Should there be a temporary program that provides services before an individual is 

determined eligible for the Social Security disability benefi ts and, if so, what would it 

look like?

• How should existing programs be improved or strengthened to assure successful 

outcomes?

• What other issues or concepts need to be considered?

For Youth with Disabilities:

• Is this model worth pursuing?

• What would the initial evaluation look like, when would it happen, and who would do 

it?

• What would the transition-to-adulthood phase look like, when would it begin, what 

would be the incentives, and how would it be fi nanced?

• Would there be a post-transition phase and, if so, what would it look like and how 

would it be fi nanced?

• How should existing programs be improved or strengthened to assure successful 

outcomes?

• What other issues or concepts need to be considered?

 This present report represents the culmination of all that the Board has learned about the 

Nation’s disability system, and how it can be improved, over the past decade.

Other Disability-Related Board Publications in 2006:

Disability Decision Making: Data and Materials, revised edition, May 2006

40
SOCIAL SECURITY ADVISORY BOARD

DISABILITY ROUNDTABLE PARTICIPANTS

41
Participants at the roundtable in

Kansas City, Missouri June 21, 2006

David Barnes, Advanced Policy Solutions

Clay Berry, Alphapointe Association for the Blind

Martha Blue-Banning, University of Kansas

William Craig, Lakemary Center

Shannon Crane, Kansas Legal Services

Janis DeBoer, Kansas Department on Aging

Gary Enyard, Full Employment Council

Jean Hall, University of Kansas

Jerry Henry, Kansas State Representative, Achievement Services of Northeast Kansas

Susan Herrin, The Whole Person Independent Living Center

Jack Hillyard, University of Iowa Health Care

Robert Hull, Cerebral Palsy Research Foundation

Alen Ighedosa, Osalen Services

Shannon Jones, Statewide Independent Living Center of Kansas

Leonard Matheson, Washington University

Jeanine Schieferecke, Kansas Department of Social and Rehabilitation Services

Teresa Nianga, Missouri Vocational Rehabilitation Services

Theresa Shively, Kansas Legal Services

Kelly Sloan, Jewish Vocational Services

Sheila Stoeckel, Iowa Workforce Development

Jessica Sulzern, The Helping Hand of Goodwill Industries

Jeff Wilson, Missouri Business Partnership Initiative

Chris Zuercher, Prairie View Hospital

42
Participants at the roundtable in 

Washington, D.C. July 19, 2006

Day Al-Mohamed, American Council of the Blind

Berthy De La Rosa Aponte, Ticket to Work Advisory Panel

David Barnes, Advanced Policy Solutions

Stephen Bell, Abt Associates

Allan Bergman, Anixter Center

Richard Burkhauser, Cornell University

Winthrop Cashdollar, America’s Health Insurance Plan

Tom Croghan, Mathematica Policy Research

Susan Daniels, Daniels and Associates

Marty Ford, The Arc and UCP Disability Policy Collaboration

Elizabeth Genovese, IMX Medical Management

David Hammis, Griffi n-Hammis Associates, LLC

Cheryl Bates-Harris, National Disability Rights Network

Allen Heinemann, Rehabilitation Institute of Chicago

Jill Houghton, Ticket to Work Advisory Panel

Andrew Imparato, American Association of People with Disabilities

John Lancaster, National Council of Independent Living

Eric Levey, Kennedy Krieger Institute

Brad Turner-Little, Easter Seals

Gina Livermore, Cornell University Institute for Policy Research

David Long, Abt Associates

Michael McLendon, McLendon and Associates

Djuna Parmley Mitchell, ENDependence Center of Northern Virginia

Katherine Beh Neas, Easter Seals

Bonnie O’Day, Cornell University Institute for Policy Research

Edgar Palmer, Gallaudet University

Jane McDonald-Pines, AFL-CIO

Jeff Rosen, National Council on Disability

James Rothrock, Virginia Department of Rehabilitative Services

Rhoda Schulzinger, Association of University Centers on Disabilities

David Siktberg, Webility Corporation

Randy Soohoo, Integrative Pain Center of Arizona

Andrew Sperling, National Alliance on Mental Illness

Craig Thornton, Mathematica Policy Research

Richard Weishaupt, Community Legal Services

David Wittenburg, Mathematica Policy Research

Ethel Zelenske, National Organization of Social Security Claimants’ Representatives

43
BIBLIOGRAPHY

Autor, David, and Mark Duggan. “The Growth in the Social Security Disability Rolls: A Fiscal 

Crisis Unfolding.” NBER Working Paper 12436, August 2006. www.nber.org/papers/

w12436

Center for Workers with Disabilities. Transition for Youth with Disabilities: A Look at State 

Programs, Progress, and Promising Practices. The American Public Human Services 

Association, July 2006.

Christian, Jennifer, and others. “Preventing Needless Work Disability by Helping People Stay 

Employed.” A White Paper on the Stay-at-Work/Return-to-Work Process (Draft Manuscript). 

April 2006.

deJong, Philip, Maarten Lindeboom, and Bas van der Klaauw. “Screening Disability Insurance 

Applications.” Tinbergen Institute Discussion Paper, TI 2006-018/3, February 2006.

Goodman, Nanette, and David C. Stapleton. “Program Expenditures for Working-age People 

with Disabilities in a Time of Fiscal Restraint.” Rehabilitation Research and Training 

Center for Economic Research on Employment Policy for Persons with Disabilities, 

November 2005.

Jensen, Allen, and Robert “Bobby” Silverstein. “Gradual Reduction Choice Option and Related 

Policy Outcomes.” SSA Grant No. 10 P-98360-5-047, 14 December 2005.

Lengnick-Hall, Mark L., Philip Gaunt, and Jessica Collison. Employer Incentives for Hiring 

Individuals with Disabilities. Society for Human Resource Management, April 2003.

Loprest, Pamela, and Elaine Maag. “The Relationship Between Early Disability Onset and 

Education and Employment.” The Urban Institute, September 2003.

MacDonald, Bryon, and Megan O’Neill. “Being American: The Way Out of Poverty.” World 

Institute on Disability, June 2006.

Ruiz-Quintanillo, S. Antonio, Robert R. Weathers II, Valerie Melburg, Kimberly Campbell, and 

Nawaf Madi. “Participation in Programs Designed to Improve Employment Outcomes for 

Persons with Psychiatric Disabilities: Evidence from the New York WORKS Demonstration 

Project.” Social Security Bulletin, 66 (2006/2006): 2, 49-79.

Rupp, Kalman, and Charles G. Scott. “Trends in the Characteristics of DI and SSI Disability 

Awardees and Duration of Program Participation.” Social Security Bulletin, 59 

(Spring 1996): 1, 3-21.

Rupp, Kalman, and others. “A Profi le of Children with Disabilities Receiving SSI: Highlights 

from the National Survey of SSI Children and Families.” Social Security Bulletin, 66 

(2005/2006): 2, 21-48.

Stapleton, David C., Bonnie O’Day, Gina A. Livermore, and Andrew J. Imperato. “Dismantling 

the Poverty Trap: Disability Policy for the 21st Century.” Rehabilitation Research and 

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July 2005.

Thornton, Craig, and others. “Evaluation of the Ticket to Work Program: Implementation 

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to the Individualized Education Program. July 2000.

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Programs Need to be Examined in Light of 21st Century Challenges. GAO-05-626, 

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U.S. National Council on Disability. The Social Security Administration’s Efforts to 

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20 November 2005.

U.S. National Council on Disability. The State of 21st Century Long-Term Services and Supports: 

Financing and Systems Reform for Americans with Disabilities. 15 December 2005.

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45
46
Social Security Advisory Board

Establishment of the Board 

In 1994, when the Congress passed legislation establishing the Social Security 

Administration as an independent agency, it also created a 7-member bipartisan Advisory 

Board to advise the President, the Congress, and the Commissioner of Social Security on 

matters relating to the Social Security and Supplemental Security Income (SSI) programs. 

The conference report on the legislation passed both Houses of Congress without opposition. 

President Clinton signed the Social Security Independence and Program Improvements Act of 

1994 into law on August 15, 1994 (P.L. 103-296). 

Advisory Board members are appointed to 6-year terms, made up as follows: 3 appointed 

by the President (no more than 2 from the same political party); and 2 each (no more than 1 from 

the same political party) by the Speaker of the House (in consultation with the Chairman and 

the Ranking Minority Member of the Committee on Ways and Means) and by the President pro 

tempore of the Senate (in consultation with the Chairman and Ranking Minority Member of the 

Committee on Finance). Presidential appointees are subject to Senate confi rmation. 

Board members serve staggered terms. The statute provides that the initial members of 

the Board serve terms that expire over the course of the fi rst 6-year period. The Board currently 

has 2 vacancies. The Chairman of the Board is appointed by the President for a 4-year term, 

coincident with the term of the President, or until the designation of a successor.

The Chairman of the Board is appointed by the President for a 4-year term, coincident 

with the term of the President, or until the designation of a successor.

Hal Daub, Chairman

Hal Daub is currently a partner in the law fi rm of Blackwell Sanders Peper Martin in 

Omaha, Nebraska and Washington, D.C. Previously, he was President and Chief Executive 

Offi cer of the American Health Care Association and the National Center for Assisted Living. 

He served as Mayor of Omaha, Nebraska from 1995 to 2001, and was an attorney, principal, 

and international trade specialist with the accounting fi rm of Deloitte & Touche from 1989 to 

1994. Mr. Daub was elected to the U.S. Congress in 1980, and reelected in 1982, 1984, and 

1986. While there he served on the House Ways and Means Committee, the Public Works 

and Transportation Committee, and the Small Business Committee. In 1992, Mr. Daub was 

appointed by President George H.W. Bush to the National Advisory Council on the Public 

Service. From 1997 to 1999, he served on the Board of Directors of the National League of 

Cities, and from 1999 to 2001, he served on the League’s Advisory Council. He was also elected 

to serve on the Advisory Board of the U.S. Conference of Mayors, serving a term from 1999 

to 2001. From 1971 to 1980, Mr. Daub was vice president and general counsel of Standard 

Chemical Manufacturing Company, an Omaha-based livestock feed and supply fi rm. A former 

U.S. Army Infantry Captain, he is a Distinguished Eagle Scout, 33rd Degree Mason, is active 

in the Salvation Army, Optimists International and many other charitable and philanthropic 

organizations. He is the current chairman-elect of the Community Health Charities of America. 

Mr. Daub is a graduate of Washington University in St. Louis, Missouri, and received his law 

degree from the University of Nebraska. Term of offi ce: January 2002 to September 2006.

47
Dorcas R. Hardy

Dorcas R. Hardy is President of DRHardy & Associates, a government relations and public 

policy fi rm serving a diverse portfolio of clients. After her appointment by President Ronald 

Reagan as Assistant Secretary of Human Development Services, Ms. Hardy was appointed 

Commissioner of Social Security (1986 to 1989) and was appointed by President George Bush 

to chair the Policy Committee for the 2005 White House Conference on Aging. Ms. Hardy has 

launched and hosted her own primetime, weekly television program, “Financing Your Future,” 

on Financial News Network and UPI Broadcasting and “The Senior American,” an NET political 

program for older Americans. She speaks and writes widely about domestic and international 

retirement fi nancing issues and entitlement program reforms and is the co-author of Social 

Insecurity: The Crisis in America’s Social Security System and How to Plan Now for Your Own 

Financial Survival, Random House, 1992. A former CEO of a rehabilitation technology fi rm, 

Ms. Hardy promotes redesign and modernization of the Social Security, Medicare and disability 

insurance systems. Additionally, she has chaired a Task Force to rebuild vocational rehabilitation 

services for disabled veterans for the Department of Veterans Affairs. She received her B.A. 

from Connecticut College, her M.B.A. from Pepperdine University and completed the Executive 

Program in Health Policy and Financial Management at Harvard University. She is a Certifi ed 

Senior Advisor and serves on the Board of Directors of Wright Investors Service Managed 

Funds, and First Coast Service Options of Florida. First term of offi ce: April 2002 to September 

2004. Current term of offi ce: October 2004 to September 2010.

Barbara B. Kennelly

Barbara B. Kennelly became President and Chief Executive Offi cer of the National 

Committee to Preserve Social Security and Medicare in April 2002 after a distinguished 23-

year career in elected public offi ce. Mrs. Kennelly served 17 years in the United States House 

of Representatives representing the First District of Connecticut. During her Congressional 

career, Mrs. Kennelly was the fi rst woman elected to serve as the Vice Chair of the House 

Democratic Caucus. Mrs. Kennelly was also the fi rst woman to serve on the House Committee 

on Intelligence and to chair one of its subcommittees. She was the fi rst woman to serve as Chief 

Majority Whip, and the third woman in history to serve on the 200-year-old Ways and Means 

Committee. During the 105th Congress, she was the ranking member of the Subcommittee on 

Social Security. Prior to her election to Congress, Mrs. Kennelly was Secretary of the State 

of Connecticut. After serving in Congress, Mrs. Kennelly was appointed to the position of 

Counselor to the Commissioner at the Social Security Administration (SSA). As Counselor, 

Mrs. Kennelly worked closely with the Commissioner of Social Security, Kenneth S. Apfel, and 

members of Congress to inform and educate the American people on the choices they face to 

ensure the future solvency of Social Security. Mrs. Kennelly served on the Policy Committee for 

the 2005 White House Conference on Aging. Mrs. Kennelly received a B.A. in Economics from 

Trinity College, Washington, D.C. She earned a certifi cate from the Harvard Business School on 

completion of the Harvard-Radcliffe Program in Business Administration and a Master’s Degree 

in Government from Trinity College, Hartford. Term of offi ce: January 2006 to September 2011.

David Podoff

David Podoff was a senior advisor to the late Senator Daniel Patrick Moynihan on Social 

Security and other issues while serving as Minority Staff Director and Chief Economist for 

the Senate Committee on Finance. While on the Committee staff he was involved in major 

legislative debates with respect to the long-term solvency of Social Security, health care reform, 

the constitutional amendment to balance the budget, the debt ceiling, plans to balance the budget, 

and the accuracy of infl ation measures and other government statistics. Prior to serving with 

48
the Finance Committee he was a Senior Economist with the Joint Economic Committee and 

directed various research units in the Social Security Administration’s Offi ce of Research and 

Statistics. He has taught economics at the Baruch College of the City University of New York, 

the University of Massachusetts and the University of California in Santa Barbara. He received 

his Ph.D. in economics from the Massachusetts Institute of Technology and a B.B.A. from the 

City University of New York. Term of offi ce: October 2000 to September 2006. 

Sylvester J. Schieber

Sylvester J. Schieber is Vice President/U.S. Director of Benefi ts Consulting at Watson Wyatt 

Worldwide, where he specializes in analysis of public and private retirement policy issues and 

the development of special surveys and data fi les. From 1981 to 1983, Mr. Schieber was the 

Director of Research at the Employee Benefi t Research Institute. Earlier, he worked for the 

Social Security Administration as an economic analyst and as Deputy Director at the Offi ce 

of Policy Analysis. Mr. Schieber is the author of numerous journal articles, policy analysis 

papers, and several books including: Retirement Income Opportunities in An Aging America: 

Coverage and Benefi t Entitlement; Social Security: Perspectives on Preserving the System

and The Real Deal: The History and Future of Social Security. He served on the 1994 - 1996 

Advisory Council on Social Security. He received his Ph.D. from the University of Notre Dame. 

First term of offi ce: January 1998 to September 2003. Current term of offi ce: October 2003 to 

September 2009.

Members of the Staff

Joe Humphreys, Staff Director

Katherine Thornton, Deputy Staff Director

Joel Feinleib

Beverly Rollins

George Schuette

Jean Von Ancken

David Warner

49