Material Hardship, Poverty, and Disability among Working-Age Adults

We use longitudinal data from the Survey of Income and Program Participation (SIPP) spanning the 1996 to 1999 period to estimate the prevalence of several types of material hardships among working-age people with and without disabilities. The hardships studied relate to: the ability to meet expenses; ability to pay rent or mortgage and utility bills; ability to obtain needed medical and dental care; and food security. Several alternative measures of disability are used, including distinctions between short and long-term disability. We find that, regardless of the disability measure used, people with disabilities experience various kinds of material hardship at substantially higher rates than their counterparts without disabilities. Hardship experiences did not differ dramatically between those with short and long-term disabilities. We estimate logit models of the likelihood of reporting material hardships to assess the importance of disability after controlling for income and other sociodemographic characteristics. We find that disability is an important determinant of material hardship even after controlling for these factors. All else constant, the odds of reporting hardship are 70 to 280 percent greater among people with disabilities compared with people without disabilities, depending on the measure of disability and the specific hardship considered. To illustrate the differences between those with and without disabilities from another perspective, we use the logit estimates to calculate the household income individuals with disabilities would need to attain the same likelihood of reporting a given material hardship as those without disabilities with household income at the official poverty level. We find that people with disabilities living alone would need annual incomes on the order of $18,000 to$38,000 to experience the same level of hardship, on average, as those without disabilities with incomes at the poverty level (about $10,000), depending on the nature of the disability and the hardship considered. We also estimate disability prevalence among working-age people with incomes at or below 200 percent of the federal poverty level and reporting hardships. A large majority of the low-income respondents reporting a material hardship in 1998 also reported a disability of some sort between 1996 and 1999. Among the hardships studied, people with disabilities made up the largest shares of those not getting needed medical care (64 percent) and those reporting food insecurity with hunger (72 percent). The findings suggest that comparisons of conventional poverty rates for people with and without disabilities may understate the differences in the relative economic well-being of these two populations. At a given level of income, people with disabilities will not, on average, achieve the same level of material well-being as those without disabilities. The findings provide support for policies that account for disability-related expenditures and needs when determining eligibility for means-tested assistance programs. The findings also highlight an important limitation of the official poverty measure; it overstates the economic relative well-being of a group that represents a large share of the low-income population, people with disabilities

A Review of Recent Evaluation Efforts Associated with Programs and Policies Designed to Promote the Employment of Adults with Disabilities

The purpose of this report is to provide a review of the recent evaluation activities being conducted for a number of state and federal programs, policies, and initiatives designed to promote the employment of people with disabilities. The review is intended to provide a single source for information on the nature of the initiatives and the evaluation efforts that have been recently completed or are currently under way and the findings to date related to the effectiveness of these initiatives. This broad review is also intended to provide some evidence of the progress we are making. The report also suggests avenues where further efforts and progress might be warranted. We identified 27 initiatives or programs and their associated evaluations that represent a federally sponsored program, policy, or initiative designed specifically to improve employment of the working-age adult population with disabilities. Because of resource constraints, we did not review initiatives designed to improve the adult employment outcomes of youth with disabilities, such as the Social Security Administration (SSA) sponsored Youth Transition Demonstrations. We also did not review small-scale studies evaluating the effectiveness of specific clinical, supported employment, or vocational rehabilitation (VR) approaches. We only looked at information related to the major federal programs serving people with disabilities, general legislation and policies, and initiatives that were fairly large-scale in nature

Costs and Benefits of Eliminating the Medicare Waiting Period for SSDI Beneficiaries

Examines how the two-year waiting period for Medicare eligibility affects disabled workers and how eliminating it would affect costs, private coverage crowd-out, and demand for Social Security Disability Insurance (SSDI). Considers broader implications

Policies and Programs Affecting the Employment of People with Disabilities - Policy Brief

The purpose of this brief is to summarize the wide range of federal programs and government policies that influence the employment and program participation decisions of people with disabilities and current research initiatives related to these programs and policies. The brief is organized by the following types of programs, policies, and initiatives: • federal programs that provide cash assistance, in-kind transfers (e.g., health insurance) and education, training, and rehabilitation support based on disability status and/or other characteristics (e.g., family structure); • federal tax policies that provide credits either directly to individuals with disabilities or to employers as an incentive to hire a person with a disability; • other employment-related programs and public policies that provide accommodation support and work incentives for people with disabilities; • recent policy changes that affect people with disabilities; and • some of the current research initiatives related to federal programs, tax policies, other employment programs and policies, and recent policy changes. We conclude with a summary of our program, policy, and research scan. This publication is based on The Economics of Policies and Programs Affecting the Employment of People with Disabilities, which provides a more comprehensive review of the policies and programs discussed here (as well as others) and analyzes the employment effects of these policies and programs within an economic framework

Dismantling the Poverty Trap: Disability Policy for the 21st Century. Policy Brief

Working-age Americans with disabilities are much more likely to live in poverty than other Americans and generally did not share in the economic prosperity of the late 1990s. At the same time, public expenditures to support them are growing at a rate that will be difficult to sustain when the baby boom generation retires and begins to draw Social Security Retirement and Medicare benefits. We argue that this discouraging situation will continue unless we can bring disability programs into line with more contemporary understanding of the capabilities of people with disabilities and successfully implement broad, systemic reforms to promote their economic self-sufficiency. This policy brief summarizes a larger paper (Stapleton, O’Day, Livermore & Imparato, 2005). It suggests principles to guide reforms and encourage debate. Future policy briefs will elaborate on some of these principles

The Health Care Financing Maze for Working-Age People with Disabilities

Much of the research on health care financing for people with disabilities has focused on the Medicaid and Medicare programs. The findings of this research often highlight the inadequacies of those programs in providing appropriate services to address the special needs of people with disabilities. A focus on these large programs, however, obscures the role of other public and private insurers, as well as the role of programs that provide many additional services to this population – all of which add complexity to the system. The purpose of this paper is to describe the health care financing system as a whole, including the large public programs, other public and private insurers, and the many other programs that provide additional services. The description of the system highlights structural problems that need to be addressed in order to substantially improve the delivery of health and related services to people with disabilities. In the next section, we describe each source of health care financing for working-age people with disabilities and highlight its implications for service delivery and quality of life. In the concluding section, we describe the key structural shortcomings of the current financing system, assess the extent to which current reform efforts are addressing these shortcomings, and discuss the implications for broader efforts to reform health care financing system

Dismantling the Poverty Trap: Disability Policy for the Twenty-First Century

Working-age people with disabilities are much more likely than people without disabilities to live in poverty and not be employed or have shared in the economic prosperity of the late 1990s. Today’s disability policies, which remain rooted in paternalism, create a “poverty trap” that recent reforms have not resolved. This discouraging situation will continue unless broad, systemic reforms promoting economic self-sufficiency are implemented, in line with more modern thinking about disability. Indeed, the implementation of such reforms may be the only way to protect people with disabilities from the probable loss of benefits if the federal government cuts funding for entitlement programs. This article suggests some principles to guide reforms and encourage debate and asks whether such comprehensive reforms can be successfully designed and implemented

The Economics of Policies and Programs Affecting the Employment of People with Disabilities

Over the last several decades, there has been a movement toward the inclusion of people with disabilities in mainstream social institutions. The 1990 Americans with Disabilities Act (ADA), which supports the full participation of people with disabilities in society and mainstream institutions, illustrates the shift in attitudes toward people with disabilities. Rather than being perceived as having a social or medical problem, individuals with disabilities are increasingly viewed as people with challenges that can be solved if appropriate policies and supports are available for addressing them