Today, Explained - The Disability Belt

Episode Date: March 8, 2018

Out of the ten counties with the most adults on Social Security Disability Insurance (SSDI), nine voted overwhelmingly for Donald Trump. But in the president’s new budget, he’s calling for $72 billion in cuts to the program over the next ten years. It's a “thin piece of duct tape that’s keeping everything together,” according to Vox’s Dylan Matthews, who traveled to Tennessee to talk to people on SSDI. Learn more about your ad choices. Visit podcastchoices.com/adchoices

The cool thing about electric toothbrushes is they work better. And Quip has made a really nice looking electric toothbrush. Quip starts at just $25. And if you go to getquip.com slash explained right now, you'll get your first refill pack free with a Quip electric toothbrush. G-E-T-Q-U-I-P dot com slash explained. You've probably heard of the Rust Belt and the Bible Belt, and there's a bunch of other ones across the country.

There's the Corn Belt, Cotton Belt, Frost Belt, Lead Belt, Rice Belt, Salt Belt, Snow Belt, Sun Belt. But there's one belt you probably will not see on any list. The Disability Belt. Dylan Matthews writes about belts for Vox. If you map the United States and see where people have stopped working because they can't go on and are on this program, it's very concentrated in certain areas. It's concentrated in Appalachia. It's concentrated in the Deep South. The disability belt is largely made up of Trump voters. Actually,

nine out of the 10 counties with the most adults on disability voted for Donald Trump, and they really voted for him. Trump won each of those nine counties with over 70% of the vote. But President Trump's new budget calls for $72 billion in cuts to disability over the next 10 years. And it feels like he's forgetting a fundamental part of his campaign. The forgotten men and women of our country will be forgotten no longer. So why would President Trump cut benefits to his own base? I'm Sean Robinsfirm. This is Today Explained. Dylan, what exactly is disability? Let's start with that. Technically, the name is SSDI.

So SSDI stands for Social Security Disability Insurance. And so right off the bat, the thing to say about it is that it's part of Social Security. We think of Social Security Disability Insurance. And so right off the bat, the thing to say about it is that it's part of Social Security. We think of Social Security as the checks you get when you're retired from the government. And as part of that system, you can get money if you get too disabled to work. Okay, so disability is just like Social Security, but for people who can't retire but can't work either. Exactly. Social Security is an insurance system. One thing it insures against is getting too old to work,

and another thing it insures against is getting injured or sick. So it's sort of meant to be a two-pronged system where either due to old age or disability, there is a program to support you that you've paid into over the years from your paychecks. It's not a welfare program. It's meant to be in part like a pension system, where if you pay more into the system, you get more out of it. How long has it been around? When did it come into being? So there was a push to include disability insurance in the original 1935 Social Security law,

the one that did retirement benefits. But ultimately, disability wasn't added, and it didn't become part of the system until 1956 under Eisenhower. At first, it was limited to people 50 and older, but then it got expanded into the program that we know today. Was it bipartisan, or was it pretty divisive even then? The Social Security program in general was pretty divisive. Yeah. I mean, Social Security for old people is this giant scheme to take people out of the workforce, sort of. It's a way to pay people to not work after a certain

age. FDR, in introducing it, thought, you know, in a civilized society, there comes a point where we don't expect you to work anymore. We can never ensure 100% of the population against 100% of the hazards and vicissitudes of life. But we have tried to frame a law which will give some measure of protection to the average citizen and to his family against the loss of a job and against poverty-stricken old age. And it fits into the way that we've thought about poverty and need in America, even before America existed. Elizabeth I in England passed something called the Poor Law, and it had this very clear division between the deserving and undeserving poor.

There were categories like disabled people who were deserving of charity. And then you have the idle poor, and they should be sent to the workhouses. And I think we've carried that mentality forward for hundreds and hundreds of years. And so one way to look at Medicaid, it's our way of saying to poor people, we're not going to let you die because you don't have health care. And I think there's another way to look at it, which says, we're giving you this huge benefit. And so, like, what are you doing for it?

Thinking about people who deserve help and don't deserve help, it just sort of reminds me of this populist campaign that President Trump ran in which he – it seemed like he thought a lot of people were deserving of help from the government, deserving of benefits. I think he even promised healthcare for everyone, if I'm not forgetting. He promised a lot of things, yeah. Let's run through them. What are some of the populist-y things he promised health care for everybody universal health care i am going to take care of everybody i don't care if it costs me votes or not everybody's going to be taken care of much better than they're taking care of now he promised that he would not cut medicare he promised that he would not cut medicaid which

i feel like is a promise that gets forgotten a lot. Save Medicare, Medicaid, and Social Security without cuts. He just came out with a budget that cuts Medicaid and Obamacare by 22.5 percent. It cuts Medicare by over 7 percent, and it cuts billions of dollars from SSDI. His defense of the last one is remarkable. His budget director, Mick Mulvaney, told this kind of tongue-in-cheek story to a reporter about how he got Trump to agree to cut disability insurance. He proposed this to Trump, and Trump said, but that's like part of Social Security, right? And he said, no, no, no, no, no, it's welfare. Trump's like, oh, well, I don't like welfare.

Welfare bad. Welfare's bad. Dylan, you took a trip to talk to people on SSDI. I'm wondering if you could tell me about some of the people you met. One of the guys that I met was a fellow named Randy Pitts. Randy Pitts. Randy Pitts. Really charismatic guy.

He lives out in western Tennessee. I was born in Dyersburg about 30 minutes from here and I've lived here mostly all my life. He's actually a retired politician. He was the county commissioner of his county for about four years. You know everybody. You know your neighbor. You know the people that work at the store. And for many years he worked as a 911 operator. We had a big ice storm here. I mean, the whole county was out of electricity. There ain't but three ways out of this county. If there's trees and poles lined on every road and nobody can get out, people start

panicking. And just to be able to talk to somebody and calm them down is a huge asset. He got sort of a slew of diagnoses all at once. I had like three or four herniated discs, arthritis. He had kidney failure and sort of really chronic anxiety of a kind that you don't want a 911 operator dispatching emergency services who will sort of freeze or panic. And he was noticing that he was starting to do that, that he couldn't find the words. And now I'd be freaking out just like they would, you know. He tried to campaign for reelection, but he was just sitting in his car, driving around and couldn't get out of the car to talk to voters because to stand up would be too painful.

To this day, his son has to help him sort of. Getting in and out of bed, everything that's wrong with me, it's just left me so weak that it's hard to do anything. I don't think he fits our stereotypes of what a disabled person looks like. He isn't blind, he isn't deaf, but he's in severe pain all the time and is taking dozens of medications.

And it sounds like if he was a police operator and also a local politician, these are the kinds of positions we would expect to have some sort of pension, right? Some sort of benefits that would take care of him in the situation. He was still out of luck. I mean, I think they have generous pensions, especially if you reach retirement age. But he didn't. He's in his 40s. And the thing that keeps him and his family afloat primarily is SSDI. How does he feel, like, depending on his kids and his mom and SSDI?

Oh, he does not want anyone to take care of him. That's a hard thing to do, coming from my background. I've never had to ask for help, you know. I've always stood on my own two feet. I think Randy would be the first one to tell you that he wishes that he could make it all go away

and go back to work. This is no one's first choice, but it is the only way that he can pay rent. And it's the only way he can buy food. I think his attitude toward choice, but it is the only way that he can pay rent, and it's the only way he can buy food. I think his attitude toward it, and this is something that across the people I talked to, I heard again and again, was, if not this, then what? I'm just kind of stuck here in limbo, watching cars go by, you know, on most days.

If he were cut off the program tomorrow, I don't think he would suddenly find some magical job that he's capable of doing despite everything. I don't think that job exists for him. It's hard on me to even get out and see all the people that I used to see and talk to and whatever because I'm ashamed that I have to walk with a cane and I'd rather just sit here.

He would just be in a position where he'd have to rely on the charity of family and friends. This is the thin piece of duct tape that's keeping everything together, both for the safety net as a whole, but also for individual families like his. Disability insurance is definitely helping people like Randy,

so what's the argument against it? Freeloaders. That's after the break. Quick message about Quip electric toothbrushes. I've basically been brushing my teeth my entire life. I've probably used hundreds of brushes, but I've never used one quite as pretty as my Quip electric toothbrush. Plus, with Quip, guiding pulses alert you when to switch sides, making brushing the right amount really, really easy. Quip can also help with dental

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I'm Sean Ramos for him. This is Today Explained, and I've been talking to Dylan Matthews. He's a senior correspondent at Vox, and we're talking about Social Security Disability Insurance, a.k.a. SSDI. In practice, disability sounds smart, right? It gives people money if they're unable to work. But a lot of people have beef with the program because they say it encourages people to stay out of the workforce. Senator Tom Coburn has a special name for it.

The Social Security Disability Trust Fund. And here's White House Budget Director Mick Mulvaney. Social Security Disability is not Social Security. It's a welfare program for the disabled. And then there's one of SSDI's biggest haters, Senator Rand Paul. Over half the people on disability are either anxious or their back hurts. Join the club. You know, who doesn't get up a little anxious for work every day and their back hurts?

Everybody over 40 has a back pain. Is there an argument to be made that, sure, like we should question these entitlements? People abuse them and people don't need them. A few things right off the bat. It's really, really hard to get on this program. First, you need to quit your job because you can't be making above a threshold amount of earnings to be on the program because if you were making that much money, then you would, by definition, not be disabled. And so it typically involves months, years, not working, not getting earnings, and also not getting benefits, and sort of relying on charity from their church or from family or friends.

After all that, only about 20% of people get let on, and only 35% of people get let in after they exhaust all their appeals. So ultimately, almost two-thirds of applicants are rejected. I think the idea that this is a program that's easy to game isn't really matched by the evidence. Okay, but is there a good argument that once you're on disability, it discourages rejoining the workforce? I think the sophisticated argument that something's going wrong is that typically when people go on the program, they don't go off. But what I would say to that is that the program already has a bunch of incentives for people to go back to work and has been sort of actively experimenting with different ways to do that. There was an interesting experiment that they did called

a benefit offset. The way it works now under current law is if you're making over $14,000 a year, you're going above what's called the substantial gainful activity level. So if you make more than that for too long, then you're going to get your benefits cut off entirely. Gotcha. In this experiment, they changed the rule so that you would lose 50 cents for every dollar you earned. So you could work significantly more and you were not threatened with much loss of benefits.

The vast majority of people had severe enough disabilities that even when you're given this big incentive to try to work again, they didn't do it because they couldn't do it. Just cutting off money to people without providing them with tools that help them work isn't going to do much good for anybody. And you also talked to a woman in Tennessee who only applied for disability after she lost her job, right? Yeah, that's Rebecca Tackett. How does that work? I mean, why should she get disability after losing her job? Is she taking advantage of the program? I don't think she was. I mean, I think critics of the program will look

to that and say, see, people are using this as an unemployment program. Why can't you just go get a job? I was a security guard at the plant over in Oak Ridge. She has sort of chronic enough pain that she can't walk for any duration of time. It's just way too painful. Because I had knee problems. I had to have surgery. I had to have both knees replaced. And so she got into this arrangement where the only way she could do her job was to be in the room with the cameras looking at the screens basically always.

And sort of counting on her colleagues to do the rounds and do the walking. And she was eventually laid off, in part because I think the employer wanted her to be able to go around and make the rounds. I mean, I was a dependable employee. I never missed. I think that 15 years I worked every holiday, Christmas, Thanksgiving, everything. I'm not super sympathetic to the employer, but at the same time, they had a point, which is this is a job whose requirements Rebecca was not physically capable of doing anymore.

She looked around and thought, you know, there aren't a lot of jobs that I'm physically capable of doing anymore at my skill level. And really what it was is they didn't want to accommodate my disabilities. The program that's meant to help people who can't physically do the work that they were doing before is disability. And I think that's an appropriate use of the program. I think it's meant to keep people alive and keep people afloat in really desperate situations. And I think her situation was desperate. So thinking about Becky and Randy before her, I'm just wondering, how will these $70 billion in cuts over the next 10 years affect them if they're approved? So one thing that will happen if the cuts are approved is they'll get a lot more aggressive about reviewing people like Becky and Randy. More medical tests, more people from the Social Security Administration

going in to double- check that they're really disabled. And some people will get kicked off as a result of that. But the biggest part of the cuts isn't for people like Becky or Randy. It's for people who might be like Becky or Randy in the future. That the big focus is on making sure that people who are working today are less likely to go on the program. There are going to be some folks who maybe could manage to work a little bit more, but there will also be a lot of folks who really are disabled and are cut off from this program that it turns out they really need. This might seem sort of obvious, but I'm just trying to reconcile how cuts like these sort of gel with maybe one of the most

historic tax cuts to the wealthy in this country's history? It's really shocking. And it's not a natural place to start cutting. If you look at the budget, the problem isn't that we're spending some grotesque amount of money. We're not. And in fact, on health care, we're spending a lot less than we thought we were going to spend. If you're not willing to raise taxes and deal with the revenue situation, all efforts to make the budget balance are going to involve cuts to more and more programs that are actually essential and serving purposes that I think we should all agree are

appropriate functions of the government. Is SSDI working? Is disability working? I think it is. I think it's serving the function that it's meant to serve of giving people who are severely disabled a way to get by when they determine that they can no longer work. It's not costing an exorbitant amount of money. It's not taking a significant share of people who could work out of the labor force and hurting the economy. I think it's a modest program that helps people in really desperate need. And we don't have a lot of those left in America. Thank you, Dylan. Thanks, Sean.

Dylan Matthews is a senior correspondent at Vox. I'm Sean Ramos-Verm. This is Today Explained. You know those SpaceX rockets? How they kind of look like the future we thought we'd have? That's what Quip's like, except with electric toothbrushes. And if you go to getquip.com slash explained right now, you'll get your first refill pack free with a Quip electric toothbrush.

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