Nov 28, 2007

A Human Crisis Ignored

Our agency recently released a report regarding the huge backlog and denials for Social Security disability programs. While most of the report is based on the situation in Athens County, there is also evidence that the problem is pervasive throughout the state and the nation. The bottom line is sick and disabled people are not receiving the benefits they are entitled to, in a reasonable amount of time or, in many cases, not at all.

The majority of applications for Social Security disability or SSI are denied at the initial application. Upon requesting a review of their case by a hearing officer, those cases are then largely approved. In Ohio, the average length of time for a denied applicant to receive the opportunity for a hearing is almost two years. With a majority of those applying for disability assistance being denied, this clearly poses a huge challenge in protecting the well-being of our disabled population. One can not help but wonder why we are not able to do a better job determining eligibility accurately in the first place.

The Ohio Medicaid disability determination process utilizes the exact same criteria in determining disability as does the Social Security Administration, yet the majority of Medicaid initial applications are approved. While this process of determining eligibility takes an average of 120 days, they seem to be more likely to get it right than the Social Security Administration, which deals with their initial applications within 90 days. Perhaps if the Social Security Administration provided the same case management support and time frame utilized by Ohio’s Medicaid Program, we could take a step in the right direction to resolve this issue and cut down on unnecessary litigation.

It is of interest that a recent report issued by the USDA regarding Food Stamp recipients indicates that since 2000, the number of Food Stamp recipients with no income has more than doubled. Perhaps this has something to do with the disability applicants who are waiting years to get their benefits and living with no income in the meantime. It is difficult to do justice to the serious personal crisis that this poses for those sick and disabled people who not only wait months to get medical care, but perhaps years to get income support to meet their basic needs.

Is this the way we should or want to treat our sick and disabled people? Our federal and state representatives have known of this problem for years and yet nothing seems to be done to fix the situation.

We need to treat this as the human crisis that it is and react in much the same way as we do with natural disasters. We must use all the resources we can to fix this problem as soon as possible.

[where: Athens, Ohio 45701]


Anonymous said...

Posted: Friday, December 07, 2007
by: Bob Burgess

Increased funding, made necessary by three and a half decades of inconsistent, unrealistic decisionmaking, will never solve the fundamental problem of the program. As a 'technician' in the disability program from 1963 to 1998, I have watched the program spiral downhill since 1971 and the chickens are really coming home to roost now. Here is the background:
1) Two-thirds of all disability decisions require an assessment of what a claimant can do after subtracting the mental and/or physical limitations that the medical impairments impose.
2) Doctors that are impartial, equipped by academic training and clinical experience, are the only professionals that can guide that assessment.
3) From 1963 to 1971, knowledgeable impartial physicians oversaw a central review in Baltimore of every State Agency disability decision. Decisions were realistic; SSA received and deserved high praise.
4) Beginning around 1971, the Nixon Administration so underfunded his SSI program that SSA had to pare the 100% review to 7%—well below critical mass. That freed liberal State examiners to allow hundreds of thousands of non-meritorious claims. (NOTE: Doctors lost control of the assessment to the liberal social agenda!)
5) Congress, (PL 96-265, 1980), sought to staunch the hemorrhaging 'trust fund' and mandated that SSA review 65% of all State allowances by 1983. The percentage of reviewed denial decisions was minuscule. Thus, an unwitting Congress created an institutional bias to deny at the State level. The 50% review of all allowances today continues that institutional bias to deny—especially in Southern states.
6) In FY 82-83, the Reagan OMB/SSA instituted formulas (called ‘guidelines’) to govern the assessment of what one could or could not do. Now, a conservative, fiscal agenda subordinated doctors to approve the fiscally oriented assessments. Not only did denials receive little to no review, the Federal review system itself enforced an unrealistic decisional stringency. The SSA/OMB formulas produced hundreds of thousands of denials, some egregious, and that created a huge public outcry and a huge public relations problem.
7) The same Congress that saw the hemorrhaging trust fund as the problem four years prior now faced hemorrhaging public trust; they codified the medical improvement standard (PL 98-480, 1984), i.e., SSA cannot remove anyone from the rolls unless his/her condition improves. BUT if a claimant was not disabled when s/he went on the rolls, medical improvement is impossible to show, and the claimant will remain on the roll until death or transfer to the OASI ‘trust fund’. The disability rolls are now swollen with those who are not as medically impaired as the law requires.
8) Enter the Administrative Law Judges: Appeals to ALJs rose from 72,000 in FY 75 to 750,000 today because the public knows the chances of an ALJ grant are great, moreso in different locales. ALJs reverse, on average, 65% of State denials; studies show at least 50% of those reversals are unwarranted. ALJs are lawyers, not doctors. Medical expertise drops off sharply at the ALJ level and beyond. ALJs’ medical training is grossly inadequate, which means their decisions rest heavily on how their uninformed impression of the claimant's personal appearance at the hearing—to which they would strenuously object. But if one does not have expertise to evaluate medical evidence, all that is left is perception colored by bias. That is why some ALJs are to the right of Genghis, most to the left of Santa Claus. Here, I must say that it is much easier for the press to highlight egregious denials than egregious allowances. No one complains to the press for receiving benefits they do not merit. Most of the occasional ‘fraud’ cases that appear in the press were probably poor allowances to begin with. The hidden story is that insupportable ALJ reversals are costing taxpayers about $20 billion annually.
9) The 80s outcry prompted Congress and the Courts to impose huge amounts of paperwork on the State decisionmakers that actually erode the quality of decisionmaking and increase processing time and cost. Through the years, processing time, public relations, legal, political, and/or bureaucratic policymaking—whichever applies at the time, have subordinated doctors to their agendas.
10) Like bees to flowers, the huge mostly unwarranted ALJ reversal rate has prompted the flood of appeals that has swamped ALJ offices with claims; a more realistic reversal rate would cut the number of appeals and speed processing time. Until that happens the only answer is increased funding—which will only process inconsistent decisions faster at additional cost to the taxpayer.

BOTTOM LINE: Inconsistent and/or insupportable decisionmaking abounds at all levels and has since 1971. Today, the decision hinges less on the evidence than on the location, timing, level of the decisonmaker, and ultimately the luck of the draw, i.e., in whose hands does the case fall to make the decision? Mountains of feckless procedure and paperwork slow processing times at the State level. Inflated, unwarranted ALJ reversals that draw huge numbers of applicants clog the system at both levels. Throwing more money and personnel at the symptoms of the problem will create the appearance of program health in the short term but leave the root cause of the whole problem unsolved.
Summary. 1) THE root cause of all problems: Knowledgeable, impartial physicians lost control of the assessment of what a claimant can or cannot do since 1971; too many decisions have been haywire since. 2) Those with the power to effectuate program reform, or even influence it, do not have a clue as to what the root cause of the problem is, and even if they did, the program is now so mired in politics that they cannot effectuate substantive reform. This just skims the surface.
Bob Burgess (NADE President, 1993-94)
Cedar Creek, TX

Anonymous said...

I have been waiting to recieve ssi For over 2 years now And was told I still have 8 months to another year to wait for a hearing. I Am a mother of 3 and We are struggling horrible.
I think the problem is every jerk that is lazy to work is filing making those who are truly disabled Wait forever.
I see people on disabilty doing so called "UNDER THE TABLE JOBS ALWAYS!" I wish i could work but I am truly unable to and they recieve checks and work for cash! While me & my children suffer.
I am so tired of waiting & so are my kids.
God Bless those trying to get things better