"It's the greatest professional disappointment of my career," Bruce Growick told me recently without a trace of doubt in his voice. The former president of the International Association of Rehabilitation Professionals was referring to the Ticket to Work program, a 1999 outgrowth of Social Security Disability Insurance that was intended to funnel the nation's growing ranks of injured workers back into the workforce. In the 90s, Growick testified before the committees that would draft Ticket to Work and met with lawmakers to help shape it. Years before he became skeptical of its effectiveness, he was optimistic about what it might do for disabled individuals.
"Having a job is so much better than being paid to stay at home," he says. In his testimony, Growick said, "The role of government should be to assist and encourage persons with disabilities towards employment."
Getting even 5 percent more disability beneficiaries back to work would save the government billions of dollars in benefits payouts. Ticket to Work's mission was to accomplish just that. Under the program, most disability beneficiaries are sent "tickets," which they can take to local "employment networks," or ENs—businesses or organizations that help the ticket-holders with their job searches without collecting any fees up front. If the person finds and keeps a job, the EN would be paid for their services by the Social Security Administration. The ticket-holders could keep their disability benefits and their health insurance while they were looking for work, or if they didn't find it. Participation in the program was, and remains, completely voluntary.
Growick was there when Ticket to Work was signed in 1999 one bright December morning in front of the FDR Memorial in Washington—a location chosen because its honoree represents the triumphs people with disabilities can achieve.
"This is about more than jobs or paychecks," then-President Clinton said at the signing. "It's fundamentally about the dignity of each human being "¦ about recognizing that work is at the heart of the American dream."
But the program has struggled, and it's done little to address the vexing problem of how best to help the millions of people who collect disability benefits for years on end. A flawed incentive structure for both disability recipients and the ENs has limited the reach of Ticket to Work. An audit by the Government Accountability Office in 2011 revealed that less than 1 percent of all ticket-holders had assigned their tickets to ENs, and just 2 percent of all of the ENs participating in the program had helped the majority of the assigned ticket-holders. According to updated figures sent to me by the Social Security administration, 2.4 percent of the people eligible for the Ticket program are currently using their tickets.
In other words, most people who are eligible for free help to get off government benefits and back into jobs are saying, "No thanks." And this is in the era of Slack, Skype, and dictation software, in which some physically impaired people could likely do certain jobs remotely with greater ease than they could have when Ticket to Work originally passed.
"This did not help the [Social Security] trust fund as anticipated," Growick said recently. "It's not helping anyone get back to work. There is a greater likelihood that you will die or become old enough to be switched from disability to retirement than go back to work."
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Ubiquitous as it might be, the slur "welfare queen" is a misnomer: Most people who draw government benefits aren't actually on welfare. Thanks to reforms in the 1990s, welfare, or Temporary Assistance for Needy Families (TANF) as it's called now, props up just 3.5 million people with checks that amount to far less than the poverty level. As welfare has been eroded, most people who need government help these days turn to Social Security Disability Insurance. Nearly 9 million workers, not including spouses and children, now receive about $13,000 each in yearly disability benefits, having proven to the federal government that a physical or mental ailment prevents them from working.
Unlike with TANF or unemployment benefits, which have strict time limits, once people get on SSDI, they can collect benefits for years. This has made it a very attractive option for people who have few options left, and it's what's caused spending on the program to shoot up nine-fold in the past four decades. Even those who don't personally know anyone on disability will be affected by it: The SSDI fund is projected to go broke at the end of next year. One proposal lawmakers are considering in order to replenish it is to raid the regular Social Security fund, that shallow wave-pool where everyone's retirement money is currently sloshing around.
Many people who are on disability were born with severe mental or physical impairments that keep them from working. They need that money to survive. Still others suffered gruesome on-the-job injuries, as I've written, that make them unable to perform the kind of manual labor they were trained to do. SSDI, paltry as it might be, offers them a way to keep on living.
Few would argue that people on disability should be forced into jobs. But there are people on SSDI—some experts suggest a figure as high as 20 percent—who want to go back to work. Most people on disability are in their 40s and 50s, and they've finished high school. They might have thrown out their backs, for example, but they're still mentally sharp. They might be depressed, but they still speak three languages. They want to put their skills to use. "They're broke, bored, poor, and they're tired of it," as Susan Webb, who works for an EN in Phoenix, put it to me.
"Having a job is so much better than being paid to stay at home."
Though about 10 percent of disability beneficiaries are doing some work—often off the books—at any given point, only a tiny percentage earn enough to stop receiving benefits. (Estimates vary, but it's something like 1 to 5 percent.) People who had visual or hearing impairments were likelier to go back to work, but those who had back pain were least likely.
One reason for the low rates of work among disability recipients is that the task of enrolling in disability in the first place is rather daunting. Signing up for benefits requires, first, an in-depth review of medical records by state officials and sometimes doctors. Two-thirds of applicants are rejected at this step. From there, applicants can appeal, and an additional 11 percent get through at this point. Everyone else must endure a tense hearing before a judge. When all is said and done, years can pass between the moment the person is injured and the moment they hold a freshly cut check in their hands.
Disability recipients who go back to work and make more than about $1,000 per month risk losing their benefits. Many beneficiaries endure extreme financial hardships while they wind their way through the process. In southwest Virginia recently, I met one couple who almost lost their house while they were waiting for their applications to clear. It's the kind of ordeal that can spook a person away from returning to work.
"You apply, you wait and wait and wait," said Nicole Maestas, a senior economist at RAND who has studied SSDI. "It took you three years to get the benefits, and that whole time you couldn't work. Now someone comes to you and says, 'Hey, let's try and work.'"
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For the people it does help, Ticket to Work does exactly what it says: The ENs help their "ticket-holders" find jobs. That might sound easy—anyone who has Internet access can search Monster.com—but many SSDI recipients have yawning gaps in their resumes that raise eyebrows among employers.
"They might say, 'They haven't worked in the past few years, so what's going on?'" Maestas said.
The ENs, a collection of organizations who generally hope to do some good while turning a small profit, help ticket-holders build resumes and prepare for job interviews. Some even help them buy glasses or prosthetic limbs, Growick said. ENs typically can't afford to send people back to college, but they might put ticket-holders through quick certificate programs.
Webb, who works for an EN called Arizona Bridge to Independent Living in Phoenix, says she's had some luck placing ticket-holders, especially in recent months. Through the Workforce Innovation and Opportunity Act, ABIL received federal funding to train people for jobs that are facing worker shortages in the area. Four of Webb's ticket-holders are training to be web developers at a local community college. Local companies need at least 100 more developers, so if the ticket-holders pass the course, they're offered a job. Two other ticket-holders are learning project management, and their salaries will start at $55,000 when they graduate. Of the 153 ticket-holders ABIL has, 86 are working and 30 are in training, Webb said.
Besides being better off financially, Webb notices a mental-health boost among disability recipients who find jobs. "It's amazing how many of them do better when they go back to work," she said. "You have a social life, and you feel better about yourself."
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Then again, ABIL has some advantages that not every EN enjoys. First, it's in Phoenix, where "we have jobs coming out of our ears," Webb said.
ABIL also aggressively screens the disability beneficiaries who contact the organization for help. It only accepts about 14 percent of the callers, Webb said. The rest "don't have marketable skills, a high-school diploma, or a GED. Maybe they were convicted of a felony. Their work capacity isn't there."
ENs only get paid when their ticket-holders get off disability, so understandably, some of them target people who are easiest to coax off the couch and into the office. A high-school dropout who was mangled in a car wreck might have a hard time getting an EN's attention.
What's more, let's say the ticket-holder lives in Reno, where the unemployment rate is 10 percent, instead of Phoenix, where it's 5.8. Or say she is a single mom to three young children. Several experts said they didn't know of any ENs who would pay for relocation expenses or child care.
Growick said it's rare for ENs to provide a certificate program as extensive as ABIL's. Usually, the goal is to move people into a job—any job—as quickly as possible. "If I'm in Morgantown [West Virginia], the first thing I'm going to do is have that coal miner go back to work," he said. "There's not as much of an incentive for me to get someone to go back to school to be a court reporter and worry about getting them placed after that."
"Think about guaranteed benefits for life."
The 2011 GAO report found evidence of dubious practices among the ENs. Some would target ticket-holders who were already making enough money to make the leap off of disability, file for payment from the federal government for supposedly having helped those ticket-holders find jobs, and split the money they received with the ticket-holder. Then, they wouldn't track how the ticket-holder was using the cash. In 2009, this strategy accounted for a third of all government payments to ENs.
The GAO also slammed the Social Security Administration for not adequately monitoring the progress of the ticket-holders as they dealt with their ENs. A recording on the phone line of one EN advised beneficiaries that they could avoid losing their disability checks by working part-time, rather than full-time, indefinitely. And becoming an EN was seemingly much easier than getting into community college—or on disability, for that matter: As of 2010, the GAO found, only 11 EN hopefuls had ever been denied a contract, and there were about 1,600 ENs contracted with the agency.
The Social Security Administration told me that it has stopped allowing ENs to split payments with ticket-holders without providing services, and that it's going to check to ensure that the ENs are following the new rules. It also said it now has stricter requirements for becoming an EN, and it has only approved 157 out of 185 proposals in the past two years, representing a much higher rejection rate than before. It has stepped up its monitoring of ticket-holders, it added. In February, the agency said 7,619 ticket-holders who used ENs found work and didn't receive benefits as a result.
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The problem might not be that the Ticket to Work program is ineffective, but that it comes too late in each worker's personal-injury saga. For the roughly two-year stretch between the day someone decides they want to join disability to the day they actually start collecting benefits, there's no one encouraging them to work. In fact, they aren't allowed to earn more than a small amount.
"There's no requirement to try to get back to work prior to being declared disabled," Growick said. And furthermore, "There is nothing in the ticket that gives you an incentive to use it to go back to work unless you want to."
Once people are declared disabled, something happens, whether through medical deterioration or labor-market entropy, that seems to make it harder to start working again. People who finally get on disability might breathe a sigh of relief, look around, and survey the options around them. They might see a lot of low-wage work with scant labor protections. Nothing that comes with the kind of health insurance you get on disability. Would you trade a guaranteed check for a fast food job?
"Think about that decision," Maestas said. "Think about guaranteed benefits for life. The finances of the program are in favor of not trying to work. It's not surprise to me that takeup of [Ticket to Work] has never been big."
Talking to experts, I heard a lot of ways we could fix Ticket to Work, or disability more broadly. Webb recommended that, rather than lose their benefits as soon as they cross a certain income threshold, ticket-holders' benefits should taper out—say at a rate of $2 for every $1 they earn. "That's a way to recognize that you might not be able to work full-time, but you don't lose everything when you work as much as you can," she explained.
The Social Security Administration is currently running a study in 10 areas to see what happens when SSDI recipients are offered this kind of $2-to-$1 tapering of their benefits. Analyses of the experiment have so far showed that although participants did earn more and work more, they also received more in benefits, since those who would have fallen off their benefits under the old model stayed on them instead.
Growick thinks the Social Security Administration should do a better job filtering out beneficiaries who seem likeliest to work again, and focus their re-employment efforts on that group alone. "People who are severely developmentally disabled should not be lumped in with people who have a car accident," he said.
But experts say the easiest thing might be to introduce Ticket to Work, or some other rehab program, earlier in the disability application process—possibly even before people apply.
"It would be best if there were something in place that got them early before they applied for benefits," said Gina Livermore, an expert in employment policy with Mathematica Policy Research. For example, someone who begins experiencing twinges of back pain could receive support to help them work comfortably, even if their condition was not severe enough for SSDI. "For a lot of people with disabilities, their injuries weren't sudden. They were slow. In the years before [joining the program], people are getting sicker and sicker and working less and less. You could catch them earlier and try to intervene."
Most people agree that joining the disability rolls shouldn't mean withdrawing from working life forever. Republicans and Democrats alike think changes need to be made to the program, but legislation on disability insurance doesn't exactly tend to sail through Congress. Plus, reform introduces the nerve-wracking possibility that, by fiddling with SSDI, policymakers will inadvertently leave disabled workers even worse off than before.
"The political environment is such that everyone is afraid that when it all comes out in the wash, you'll wind up with a program that does not provide support for disabled people," Maestas said. "That the program will become dismantled if anyone does any more than tinkering."
So for the time being, the best we can do for disabled people, apparently, is make them prove beyond a shadow of a doubt that they absolutely can't work, and then spend years trying to convince them that they should. No wonder so many of them don't believe it.