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Copying over a post from the ssc subreddit because I found it interesting. (Hope this is allowed.)
In the mid 2010s there was a crisis around social security disability. Things were so dire that estimates placed the DI reserves to run out by 2016.
And yet as we know, this didn't happen. Part of it was thanks to the Bipartisan Budget Act of 2015, which temporarily reallocated payroll tax revenues from the OAS fund to the DI trust fund but that was temporary and ran out in 2022. And as far as I can tell (and as far as my double checks with the chatbots can find), it wasn't extended.
And now with the upcoming social security crisis the DI reserves are the only part to not be facing any expected issues.
Another piece of the disability crisis, 14 million people were on disability in 2013 and the number was expected to keep rising and rising. And yet it didn't happen, the trend reversed and as of 2024, only around 7 million are on disability It was halved! Substantial drop! We're back to levels from two decades ago.
Why? How did things change so radically so fast?
Covid. I don't know how much of an impact Covid had, but it was disproportionately impacting the disabled both directly and indirectly (by using up hospital resources) and that likely lead to some deaths but it doesn't seem to be that much, we were already trending downwards before the pandemic. [Edit: See edit below, it's quite possible that Covid had a greater impact than I thought]
The social security admin changed up their policies a bit and got more pressure on appeal judges to make denials. This had an impact, but the changes to denial rates don't seem to be that drastic to explain a 50% drop. And since then that small trend downwards has actually reversed too, the overall final award rate of 2024 applications seems to be higher than the mid 2010s average.
I don't think those are the main reasons why it changed.
What do I propose was the main reason? The economy got stronger and the disabled got older.
You can see for yourself how disability applications correspond pretty heavily with the unemployment rate.
Unemployment has a selection bias, it mostly impacts the older, sicker and less educated. Those are people who in a good economy with low unemployment might be able to get jobs, but in a weaker economy they are too old and disabled to find something compared to their healthier younger peers.
You can see a huge surge in disability applications around the time of the great recession. These people were largely in their late 50s and early 60s, too young for early retirement but too old in the recession environment to compete well.
An NPR article from the time reveals this in an example of [in 2009] 56 year old Scott Birdsall and what an employee at a retraining center told him after a local mill closed down and the aging workers were left finding other jobs
A 56 year old in 2009 is what age in 2024? 71. They are past retirement age, and would have transitioned off of disability and onto normal retirement pay.
This is what I think solved a significant portion of the disability crisis. Overall disability in the late aughts and early 2010s was being used as a makeshift early retirement program for uneducated middle aged and senior workers who didn't yet quality for their benefits, but were functionally unemployable already in the post recession economy.
And while I came up with this idea for myself, during research I stumbled onto an analysis that suggests the same thing. Their analysis ended at 2019, where there was still roughly 9.8 million on the rolls, and found that about half the explanation is the business cycle/aging and half is ALJ retraining. The trend from 2019-2024 is likely explained in a similar way, and given the increased final award rates we've tended back towards, this is likely explained even more heavily by the aging explanation.
There are some factors that help support this explanation more. SSDI in general tends to go to older, poorer, more rural and sicker (at least given death rates are 2-6x higher than peers) individuals.
While this does not explain why the 2010s surge itself happened since those factors are relatively stable, it does explain why the surge was so temporary.
This also leads to an interesting question, what happens in the next period of high unemployment? How do we plan to address mass AI based layoffs if they occur?
Many people may be able to find a new job, but many won't and we will likely be facing a new disability crisis if it is forced to served as a early retirement program again.
Edit:
Thinking about it, one weirdness here is Covid unemployment which didn't seem to increase disability rates and in fact the trend downwards continued despite that. But we did see a huge surge in early retirement with about 2.6 million excess retirees. So maybe something changed in how early retirement works since? Or maybe Covid era unemployment mostly impacted younger healthier people or the jobs market for furloughed workers wasn't as bad. Or heck, maybe it's just coincidence that the downward trend was already happening and Covid really did have a major impact on the total number of beneficiaries.
My guess would be in the recovery, Covid unemployment surged higher but recovered really fast so we probably just didn't see as many Scott Birdsall situations.
Back to my thoughts, I'm extremely skeptical that the disability numbers could halve over such a relatively short period without some sort of accounting trickery. I could definitely see Covid having an impact, especially since the vast majority are older people. But the drop in numbers is just too great for me to take them at face value.
We've seen it before with disability, social security, etc, but often times the medicalized benefits system will just shuffle large amounts of people from one category to another once political pressure comes to bear on a label like "disability."
This also reminds me of the old post by Alone on how SSI is basically medicalizing political problems - can't seem to find it but if anyone knows what I'm talking about and has the link that would be great.
I worked for the state disability bureau in 2011, and I can confirm that your theory is basically correct. There was a huge application backlog stemming from the recession, and a huge chunk of it was people in their 50s who were laid off from blue-collar jobs and claimed bad backs, shoulders, etc. from slinging sheetrock for 40 years or whatever. The reason the bulk of the beneficiaries are in their 50s is because the law makes it very difficult to qualify if you are under 50; you have to either have a condition that meets a defined listing (and the listings are for the kinds of things that if you have no one's going to question your ability to work), or to be completely incapable of doing sedentary work. If you're over 50, it's assumed you can't adjust to other work, so you can only be sent back to a job you've done in the past 20 years. In some cases, it may be determined that you can do lighter work similar to what you did before (e.g., an auto mechanic (medium duty grade) can work as a tech at a quick lube place (light duty grade)) but that's pretty rare. If you're over 50 and already have an office job you're also out of luck, since you're effectively given the same standard as an under 50.
So a lot of people who were laid off, especially from the construction industry, especially those who were close to retirement anyway, just filed for whatever injuries they had accumulated over the years and said that was the reason they stopped working. To be fair, though, a lot of these people ended up going back to work while their claims were pending, so I don't want to paint with too broad a brush. The difference between then and now is that people above 50 but below 62 were part of the largest generational cohort in US history, so there were simply more of them. In 2008 only the oldest boomers had reached 62m and the youngest were still in their 40s. By 2020, everyone born before 1958 was 62 or older, and the youngest were already in their mid 50s. This gives 6 years worth of people to make claims, with the number going down every year.
A lot of the Boomers who retired during COVID did so because they already had enough savings to retire. The ones who didn't weren't likely to be laid off either, since COVID unemployment hit the service industry mostly and didn't really affect much else. Car mechanics and pipefitters weren't getting laid off, and if they were they were the ones at the bottom of the totem pole, not the ones who had been in the union for decades. The 2020 recession was also sharp and brief, unlike the 2008 recession where the recovery seemed to drag on for years until the job market felt normal again. It wasn't until 2013 that extended unemployment relief was ended.
So yeah, now that most of these people are on regular Social Security, and there hasn't been a comparable recession to cause a flood of new applicants, and the generational cohort of people in their 50s is smaller than it was before, there's no reason to have expected claims to keep rising. The 2010s projections were hitting right as the flood of applications was already peaking and about to decline.
If you had to guess at a ratio, how much of state disability is:
Please and Thank You.
The categories aren't really correct. 1 and 2 don't make sense because disability is a binary, and the benefit amount is determined at the financial qualification stage. This is the preliminary stage where SSA makes sure that claimants are legally qualified and has to be completed before they'll send it to adjudication. Once we start considering medical eligibility it's a binary; you don't get more money because you're "more disabled" or whatever. The sole exception would be that there's an optimization that can be made for people who continue to work but make below the financial eligibility threshold, but that really has nothing to do with the determination office. 3 isn't really a category because I had no way of knowing whether someone was using an attorney, what kind of advice they were getting, or whether they genuinely thought they were disabled. I'd break down the claimants into the following categories:
The Classic Case: The first category consists of the typical 50+ blue-collar worker (usually) who has some kind of musculoskeletal disorder (back problems being the most common) that prevents them from doing heavy labor. When I was there, these probably constituted half of our approvals. These people were genuinely hurt, but may or may not have been disabled, depending on the severity of their condition. For example (real case, though my memory isn't precise), Larry was a 55 year old black guy who worked as a welder for most of the 20 previous years, no other employment. His back problems had been developing for some time, causing him to miss work. About a year prior he had back surgery and was off work for a while recovering, and felt good doing work around the house. He tried to go back to work once he was medically cleared, but he only lasted a few weeks. He wasn't having the constant pain he was having before, but 8 hours of bending over, kneeling, and crawling around exacerbated the pain, which went away with rest. The medical records were about what one would expect from someone experiencing the symptoms he described. Easy approval.
The Generally Unhealthy: People with myriad legitimate health problems that don't rise to the level of a disability. These people are usually over the age of 40, can be male or female, and have significant employment history, though mostly at the kind of jobs that don't pay particularly well. They have HBP. They have diabetes. They have fibromyalgia. They have back pain. They have a heart condition. They're obese (usually, though not always). These tend to be the most annoying cases to deal with because the application asks them to specify the conditions for which they're claiming disability for, but if (more like when) we find they have 500 other problems we have to ask if it affects their ability to work, and of course it does, so now we have to keep requesting records from doctors that take forever to receive and don't contain any usable information. The worst part is that they are all on antidepressants they got from a PCP and they've never seen a psychiatrist. So when they tell us their anxiety and depression affects their ability to work we have to schedule as psych workup, which takes forever to schedule because these people always live in rural areas with one guy who's willing to accept the low rates we pay for them to fill out significantly more paperwork than usual. Once they actually see somebody who confirms that they aren't so anxious they can't go to the grocery store without freaking out, they get denied.
The Complex Cases: People who obviously can't work but only due to complicated situations that are hard to qualify under the existing criteria. People with lingering stroke recovery symptoms, people with rare auto-immune disorders, rare diabetic conditions, people who are fine most of the time but have conditions that flare up every couple months and put them in the hospital for 2 weeks, during which time they lose their jobs. It's 50/50 whether these are approved or denied upon initial determination. If they get someone who looks at the big picture, they'll be approved; if they get someone who is a stickler for the rules, they'll be denied. All supervisors would tell you to deny these people. If they appeal, they'll almost certainly be approved.
The Psycho Kids: These are people under the age of 30 who have never had a job that pays above minimum wage and no education beyond high school who are claiming disability due to vague depression/anxiety. Again, they're taking medication but it's unlikely they've ever seen an actual mental health professional, and if they did it was something like they talked to a therapist once or twice. They certainly aren't receiving any regular psychiatric treatment, and no suicide attempts or hospitalizations. These are almost always rural whites. They are invariably denials.
The Accidental Cases: These are similar to the first type of case except the claimant is younger and is claiming disability not based on a degenerative condition but on the inability to due his job following a traumatic injury. they are usually misinformed about the law, however, and think that they're disabled because they can't go back to their normal job, and are usually under this impression because they worked with an older guy who got it. Unfortunately for them, as long as they're capable of doing a sedentary job, they aren't disabled. One guy, who broke his back in a motorcycle accident, told me his doctor told him he wouldn't be able to be a mechanic anymore and should do something with computers. He then jokingly told me that he didn't know anything about computers. Though he didn't realize it, this was practically an admission from his doctor that he was still able to work. These cases are almost always denials.
The True Psychos: These are the real psych cases, almost always SSI, usually involving younger or homeless claimants. Mental retardation, schizophrenia, anxiety/depression serious enough to end in multiple hospitalizations, severe bipolar disorder. Children usually also have serious behavioral problems at home or at school. Usually approvals, with a few weird denials mixed in due to the occasional odd circumstance.
The Death Bed Cases: These are people with terminal diseases who aren't going to survive for much longer. There's an entire division that deals with nothing but these to get the approvals in faster, though in some cases there's an expedited process where they can start receiving benefits before full approval. Always approved.
The One-Shot Cases: People who have one weird condition that obviously doesn't qualify them, but they apply anyway on the off chance they're approved. One woman in her early 30s applied because of heavy vaginal bleeding. This also includes people who have already retired, get some condition, and apply for SSDI to top up their pensions before they qualify for regular benefits. One guy who had a desk job with the state Auditor General's office tried applying because he started having mini-strokes after he retired, though he was hard-pressed to explain how they would have theoretically prevented him from working had he not been retired. These are denials.
I hesitate to categorize them based on genuine cases versus those that are simply trying to game the system because, with the possible exception of the psycho kids and the one-shot cases, I don't really think that anyone is consciously trying to game the system. The rest of these people are either genuinely disabled or genuinely think they're disabled. The classic cases are actually disabled but will go back to work if they can. The generally unhealthy aren't disabled but are convinced they are, the complex cases may or may not be disabled but they can be forgiven for thinking they might be, the accidental cases think they are based on a misunderstanding of the law, the true psychos are disabled but might not know it themselves, same with the death bed cases. Even the one shot cases have a lot of people think that they're disabled based on the simplistic formula of medical condition + makes my job difficult = permanent disability.
And even if some people are consciously trying to game the system, their cases are so obviously bullshit that no one trained to adjudicate them would ever consider approving them. These articles can cite various doctors and lawyers all they want, but even with coaching, nobody who is willing to "retire" because $945/month is forthcoming is intelligent enough to keep up an elaborate ruse for decades. In my career since, I've had to prepare witnesses for depositions, and while I'm not going to say that witnesses never lie in depositions, I can say that it's not because of anything theur attorneys told them to say. Properly preparing a witness for deposition takes days, unless they're a corporate representative who has testified several times before. Even for a corporate witness, it's not easy to prepare them to answer questions in a way that isn't inadvertently damaging. And these are people with college degrees and careers at the highest levels of business. Some hillbilly who barely graduated high school isn't going to be able to effectively fake disability no matter how many doctors and lawyers talk to him, because he's not going to know how to answer the questions. I'd be more worried about a legitimate claimant being denied because they gave the answers they thought the adjudicator wanted to hear than someone who gets denied because they answered honestly. Unless they have a really sophisticated understanding of how the process works, they're not going to be able to do it, and the factors are complicated enough that they're not going to get such an understanding. Even the people here, or who write psych blogs, or articles from NPR, or who are physicians treating claimants, seem to have such an understanding.
Edit - Pinging @ThomasdelVasto
Would just like to thank you for writing all this up about a world some of us rarely see.
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