The number of people receiving Social Security Disability Insurance (DI) benefits as disabled workers increased from 1.0 million in 1965 to 9.0 million in 2014, and beginning in 2009, the DI program began paying out more in annual benefits than it received in taxes and interest from its trust fund.1 In light of this growth, as early as 2012, the DI Trust Fund was projected to be depleted in 2016.2 This event was eventually postponed by the passage of the Bipartisan Budget Act of 2015, which in 2016 allowed the DI Trust Fund to borrow from the Social Security Old-Age and Survivors Insurance (OASI) Trust Fund.3 But no DI program reforms were initiated as part of this law.
- The Social Security Disability Insurance (DI) Trust Fund was declared technically solvent for the next 75 years in the 2022 annual report of its trustees, and that report also estimated that the combined Old-Age, Survivors, and Disability Insurance (OASDI) Trust Fund will be depleted in 2035.
- While DI recipience rates (beneficiaries as a share of the working-age population) have fallen slightly from their 2014 peak, they still are twice their 1990 level, in part because the United States has not fully adapted work-first policies that have substantially reduced recipience rates in other countries.
- A bipartisan consensus will need to emerge to meet this challenge, and that consensus is likely to reduce promised benefits and raise taxes across the OASDI system.
- Four lessons learned from other countries’ work-first success in lowering their long-term disability program’s recipience rates are: (1) disability does not mean incapacity, (2) incentives affect behavior, (3) early intervention reduces the flows into disability benefits programs, and (4) hurdles to reforms in the United States are surmountable.
The encouraging news is that based on Office of the Actuary projections reported in the 2022 Old Age, Survivors, and Disability Insurance (OASDI) trustees report, the DI Trust Fund is no longer borrowing such funds, and for the first time since the 1983 trustees report, its reserves do not become depleted within the 75-year long-range projection period.4 Furthermore, the recipience rate (i.e., the number of disabled-worker beneficiaries per insured worker through normal retirement age), which had been rising steadily since 1990, peaked in 2014 and has since fallen. Based on the latest Office of the Actuary projections, it will remain at approximately its current level over the next 10 years.5
A major reason for this turnaround in the fortunes of the DI Trust Fund was the substantial improvement in the United States economy, its impact on the employment prospects of working-age people with disabilities, their decisions to apply for DI benefits, and the unexpected impact this has had on the DI recipience rate since 2014. As Leila Bengali, Mary C. Daly, Olivia Lofton, and Robert G. Valletta document, in contrast to the business cycle of the 1990s, thanks partly to the longest National Bureau of Economic Research–recorded peak-to-peak business cycle (2007–20), the employment rate of working-age people (age 25–61) with disabilities increased over this period, as did their mean real wage earnings and household income.6
With coauthors Kevin Corinth and Douglas Holtz-Eakin, I showed in a 2021 article in the Annals of the American Academy of Political and Social Science that economic growth between the peaks of the 2007–20 business cycle lifted all Americans’ economic well-being.7 Consistent with conservative principles, we argued that the key lesson from the Great Recession is that strong economic growth and a hot labor market do more to improve the economic well-being of the working class and historically disadvantaged groups, including working-age people with disabilities, than does a slow recovery that relies on safety-net policies to help replace lost earnings.
Thus, we argue that the best way to prevent a “K-shaped” recovery out of the COVID-19-induced recession of 2020–21 is to ensure that safety-net policies do not interfere with a return to the strong pre-pandemic economy once the health risk subsides and pro-growth policies that incentivize business investment and hiring are maintained. This must be combined with a work-first approach to working-age people with disabilities—one that only provides benefits based on an “inability to work” once efforts to return those workers to the workforce have failed.
The less encouraging news with respect to the financial status of the DI Trust Funds comes in two parts. First, despite the legal separation of DI and OASI Trust Funds, in practice Congress has, when necessary, temporarily changed that law to allow inter-fund borrowing to maintain “technical solvency” of the borrowing fund. This is less encouraging, especially for those concerned with maintaining the joint long-term financial integrity of the two programs that comprise OASDI and the public’s trust in them, since the combined OASDI Trust Fund is in far worse financial shape.
This is best seen in Congress’s behavior in the process leading up to the 1983 amendments to the Social Security Act. Coming within months of having insufficient funds to fully pay its beneficiaries, Congress authorized the OASI Trust Fund to borrow DI Trust Fund money.8 This may occur again in 12 years (2034), when—based on Office of the Actuary intermediate assumptions—OASI Trust Funds will be depleted. Without a major change in the OASI system, either through increases in taxes or reductions in benefits, such inter-fund borrowing would quickly deplete the combined OASDI Trust Funds sometime in 2035 despite the “counterfactual world” of a DI depletion not occurring for the next 75 years without such borrowing.9
Second, it is unclear exactly what is driving the long-run improvements in the fortunes of the DI Trust Funds. However, it is more than likely to be the aging out of the baby-boom population from DI coverage and onto the OASI rolls rather than a substantial return to pre-1990 disability recipience rates, which in 2020 were still twice their level in 1990.10 This suggests that the United States can learn from disability policy reforms initiated in other Organisation of Economic Co-operation and Development (OECD) countries that, in response to similar increases in their recipience rates, managed to not only slow the pace of those increases but substantially reduce them over time through various work-first strategies.
The first section of this chapter provides a brief fiscal history of the OASDI system, focusing on the difficulty Congress faces in coming to a bipartisan compromise necessary to assure the long-term fiscal stability of the OASDI system.
The second section focuses on the unintended consequences of the 1983 amendments of the Social Security Act that disproportionately reduced the future benefits of workers transitioning out of the labor force as OASI beneficiaries relative to workers who did so as DI beneficiaries.
The third section describes efforts in other OECD countries to reduce their disability program recipience rates through work-first reforms, offering four lessons for the US to bring the OASDI system into long-term fiscal stability via disability policy reforms: Disability does not mean incapacity, incentives affect behavior, early intervention reduces flows into disability benefits programs, and hurdles to reform in the US are surmountable.
The Difficulty of Creating a Bipartisan Compromise
The difficulty of reaching the most recent great bipartisan compromise—the Social Security Act of 1983—offers a cautionary tale for reaching one more consistent with conservative principles of limiting unintended consequences, promoting work, and ensuring fiscal solvency. Despite warnings from the actuaries that the flow of taxes into the combined OASDI programs were insufficient to offset the outflow of benefits and, in 1974, that trust fund bonds would have to be sold to meet current costs, Congress failed to act decisively during that time. The National Commission on Social Security was finally appointed in December 1981.11 But a solution was not found until after the November 1982 election, with the certainty that the trust fund would be exhausted in 1983.
The commission’s pragmatic political “solution” was to advance already-scheduled payroll tax increases and postpone the time in the year when inflation adjustments would be made together with other minor adjustments. Collectively, this provided a patch on the system that would have allowed a few decades of fiscal relief but did little to resolve the long-term demographic challenges to the system. It was only later that an additional bipartisan change was made in the House along these lines by gradually increasing the normal OASI retirement age from 65 to 67 for succeeding cohorts of workers as they reached age 62 beginning in 2001 and ending in 2022. As of January 2022, all future OASI-eligible workers who reach age 62 and retire will receive only 70 percent of the OASI benefits they would receive at the new normal retirement age of 67.12
None of these changes directly challenged Social Security’s fundamental structure. These changes simply postponed the day of reckoning when younger cohorts more familiar with private defined contribution programs might refuse to continue to accept the “pragmatic compromises” necessary to sustain Social Security’s defined benefit structure and its complicated, out-of-date, within-cohort redistributive features.
For instance, issues related to OASDI’s long-term financial stability in 1983 crowded out necessary reforms of its differential treatment of one- and two-earner couples that were unjustified on either actuarial or redistributive grounds.13 Forty years later, two-earner couples across the wage distribution continue to have much lower benefits-to-taxes-paid ratios compared to one-earner households.14
Table 1 shows the consequences of inaction since 1983 in resolving the long-term funding of both the individual OASI and DI Trust Funds and the combined OASDI Trust Fund. Each year, the Social Security board of trustees must report on the long-term financial health of the OASDI system. If the system is in balance over the next 75 years, the “actuarial balance” (i.e., the amount that tax rates must be raised today to meet promised benefits) is zero.
Table 1. Current Year OASDI Combined Trust Fund Reserves and Long-Range Estimates of Actuarial Balances, Projected Year of Trust Fund Depletion, and Years Left Before Depletion (1982–2022)
In 1982, a 1.82 percentage point permanent payroll tax rate increase was necessary to keep the combined OASDI system in actuarial balance. But more importantly for Congress, it had to act by 1983, or there would be insufficient funds to fully pay current beneficiaries, even assuming inter-fund borrowing.
The Social Security Act of 1983 made current revenues again exceed current costs by immediately moving forward already-scheduled payroll tax increases, postponing when inflation adjustments were made, and, subsequently, gradually increasing normal retirement age. This growth in the combined trust fund increased continuously through 2020, and according to the 2022 trustees report, at the end of 2021, the trust fund was only slightly below its 2020 peak in terms of reserves.15
However, the growth in trust fund reserves belies that the shortfall in actuarial balances also began to grow almost immediately after the 1983 reforms and is now substantially larger than it was in 1982—3.42 percentage points.16 At current tax rates, while DI Trust Fund balances are not expected to be depleted again for the next 75 years, OASI Trust Fund balances are expected to be depleted in 2034, and even with inter-fund borrowing, combined trust fund balances are expected to fall again in 2022 and continue to do so until they are completely depleted in 2035.17
In 1986, the combined trust fund was not expected to be depleted until 2051, 65 years in the future. In 2001, two years after Sylvester J. Schieber and John B. Shoven urged congressional action, the expected depletion date was 2038, 37 years in the future.18 In the most recent trustees report, the depletion date is now 2035, 13 years away, thanks partly to the substantial increase in unemployment and the increased likelihood of a recession stemming from COVID-19 and the public health efforts to combat its spread, which have slowed economic growth.
Why hasn’t Congress acted in the face of the ever-shortening time before depletion of the combined trust fund? Most likely for the same reason that the 1983 amendments were not enacted until the trust fund was on the verge of exhaustion and current taxes would not cover current benefits. Any bipartisan agreement to bring Social Security into long-term balance will require some combination of tax increases and benefit decreases, a difficult task politically: the exact opposite of the compromises Congress made when the beneficiary-to-worker ratio was falling and average benefits were falling relative to average wage earnings.
While President Bill Clinton urged a long-term Social Security solution as early as 1998, President George W. Bush’s Commission to Strengthen Social Security in 2001 proposed the only major attempt at a long-term solution.19 Its key proposal held harmless all current old-age beneficiaries and focused solely on current workers.20 It would have reduced current workers’ future benefits by using a price-based rather than a wage-based index to determine a worker’s average indexed monthly earnings. This change alone would have reduced future promised benefits sufficiently to cover the entire shortfall in actuarial balances with enough left over to provide real increases in the minimum old-age benefit.
The commission also proposed a cost-neutral way for current workers to borrow from their future benefits to invest in personal accounts. While this offered workers a potentially higher return, it also required them to assume the downside risk inherent in private, defined contribution–style approaches to savings and was a deal breaker for Democrats. No further serious efforts to reform OASDI followed the failure to act on the 2001 commission’s recommendations, and little has changed since then regarding a bipartisan solution.21
Unintended Consequences of Raising the OASI Normal Retirement Age on DI
Increasing normal retirement age as part of the 1983 Social Security Act was meant to offset built-in future increases in OASI liabilities due to increases in longevity that would increase the number of years future OASI recipients would spend as beneficiaries and, hence, overall program costs. Rather than permanently linking increases in normal retirement age to increases in life expectancy as the Swedish social security system did, the increase from age 65 to age 67 was phased in over almost 40 years, with insured workers still allowed to take early retirement benefits at age 62, but at only 70 percent of the monthly benefits. This additional decrease in the yearly flow of OASI benefits at age 62 was intended to encourage workers to work longer (both increasing overall output in the economy and OASI tax revenues) as their life expectancy increased rather than continue to retire at the same age their parents did and increase their years receiving OASI benefits.
However, an unintended consequence of not increasing the early retirement age in tandem with the normal retirement age (i.e., from 62 to 64 as the normal retirement age increased from 65 to 67) was to further widen the potential reward for workers with some disabilities of gaining entrance to “early retirement” benefits via the DI program, rather than continuing to work until they were eligible for normal retirement-age OASI benefits.
The reason is that DI benefits are still pegged to the normal retirement age; that is, DI beneficiaries are entitled to a monthly benefit based on their full primary insurance amount (PIA) regardless of the age they received this non-actuarially reduced monthly benefit.22 This increased the difference in monthly benefits between two workers with the same PIA at age 62.
The OASI beneficiary now receives only 70 percent of the monthly benefit of a DI beneficiary with the same earnings history. This differential in benefits could increase applications for DI benefits, increase DI recipience rates, reduce employment of people with disabilities who might otherwise continue working rather than take reduced OASI benefits, and increase overall costs to the combined system.
The most straightforward solution to this unintended consequence is to phase in increases in the earliest retirement age for OASI to 64 and further increase the earliest retirement age in tandem with any future increases in the normal retirement age. An alternative, which would also reduce DI expenditures even more and increase employment, is to consider DI benefits more explicitly as a form of “early retirement” and hence, like OASI benefits, reduce them to 70 percent of PIA if taken at the new normal retirement age of 67 for those who become DI beneficiaries at or before age 62. The German disability system used this approach in 1996 as a means of reducing growth in its disability rolls.23
Since life expectancy is predicted to continue to grow, any further increases in normal retirement age as part of a future bipartisan compromise without one of these corrections will only further exacerbate this unintended consequence of encouraging DI receipt. To protect DI beneficiaries in low-income families from reductions in income that result from either solution, Congress could use the other program administered by the Social Security Administration (SSA)—Supplemental Security Income (SSI)—to provide an income floor for such workers making the transition onto the DI rolls. This has the advantage of explicitly making such income transfer payments for those not expected to work via a program funded by general revenues rather than the OASDI payroll tax.
More generally, policymakers should consider using general-revenue SSI funding to offset income losses to low-income families of workers affected by reductions in currently promised OASDI benefits or increases in OASDI payroll tax.24 For instance, as discussed above, rather than continuing to peg early retirement at age 62 when the normal retirement age increases, policymakers could lower the age of eligibility for SSI old-age benefits to 62 as they raised the OASI earliest retirement age.
Such approaches, which limit access to actuarially reduced OASI benefits to ages above 62 or reduce the DI monthly benefits of those who take DI benefits at or before age 62, have the additional value of protecting a feature of OASI and DI, which makes them almost unique among annuity plans. Both guarantee that once taken, future benefit payments will be protected against inflation. This feature makes OASI and DI annuity benefits of value in anyone’s portfolio.
Most recently, Alicia H. Munnell and Gal Wettstein make this point by suggesting that using tax-deferred 401(k) funds after age 62 as a bridge until age 70 when the flow value of inflation-protected Social Security benefits is maximized effectively uses the OASI system as a relatively safe alternative to stocks and a less expensive alternative to private annuities, which consider adverse selection issues in their pricing.25
More General Work-First Disability Program Reforms
The number of workers receiving some form of publicly financed disability cash transfer benefits has increased substantially in most industrialized nations since 1970. Population growth accounts for part of this increase, but so does the disability recipience rate. Figure 1 shows the total number of persons receiving long-term categorical disability cash transfer benefits as a share of the working-age population in six OECD countries. This rate has now peaked and fallen in all six, most recently in the United States.
Figure 1. Disability Recipience Rates Across Countries
Duncan McVicar, Roger Wilkins, and Nicholas R. Ziebarth, focusing on the five non–United States countries, trace differences in each and find that individual country policies play a major role in the levels and trends in their rates. They then report the key policy changes that have substantially reduced each country’s recipience rate from its historic peak.26
In a forthcoming book chapter I coauthored with Mary C. Daly, we draw lessons from these OECD country reforms for the United States’ case.27 Each OECD country implemented reforms slightly differently, but all shared the goal of curbing unsustainable program growth by changing the cultural and social expectations of and for people with disabilities and better aligning the incentives embedded in program design with these expectations.
Although each country recognizes its reforms have not been completely successful, from the United States’ perspective, these reforms demonstrate that policies matter and provide a relevant starting point for discussions about reforming the United States’ disability system.
We propose four policy lessons, which should be considered by anyone interested in lowering disability recipience rates in any future bipartisan agreement to bring the OASDI system long-term fiscal stability.
Lesson One: Disability Does Not Mean Incapacity. A substantial share of people who were moving onto long-term cash transfer disability programs could, with reasonable levels of government-provided support, find or maintain employment. Of course, a subset of workers with disabilities had impairments so severe that work was not possible, but this was a smaller portion than previously accepted onto these programs. Those now coming onto the rolls should be, by demonstration rather than assumption, unable to integrate effectively into the labor market even with appropriate incentives and support.
The lesson for United States disability policy is that the population with disabilities is heterogeneous and many of its members can work. This view is at odds with the current United States system, in which DI applicants must demonstrate an inability to perform substantial gainful activity before receiving access to benefits or any other type of support, including work support. Embracing the ideas of many European countries about the work capacity of individuals with disabilities calls for restructuring the United States’ system to bring forward the focus on employment and make long-term cash benefits a last resort once rehabilitation and accommodation have failed.
Lesson Two: Incentives Affect Behavior. Once it is recognized that the social and cultural environment faced by individuals with disabilities partly determines the extent to which their impairment limits them, it is easy to see that the incentives embedded in policy design can affect outcomes. All actors in the process to attain the outcomes desired must be incentivized to do so.
In the Netherlands, this meant making employers bear more of the direct costs of the program and making employees comply with rehabilitation and retraining to maintain benefits. In Sweden, this meant standardizing the disability-screening process and holding disability gatekeepers accountable for engaging applicants in work-rehabilitation plans. Finally, reforms focused on making workers comply with the work-first approach by reducing or eliminating benefits to those workers who did not comply with the rehabilitation and accommodation plans.
The lesson for United States policymakers is that program incentives affect how people with disabilities and their employers react to, and fare after, the onset of a health impairment. In the United States, DI is funded from a payroll tax, and the federal government is responsible for a great share of the costs associated with providing long-term disability benefits to working-age people with disabilities.
Because they bear no direct responsibility for funding benefits paid to former employees, employers have no direct financial incentive to accommodate and rehabilitate employees who become impaired. Incentivizing employers to make greater investments in accommodation and rehabilitation by creating a scheme that makes employers internalize some of the costs of moving employees onto long-term disability could curb DI growth by more effectively aligning incentives. David H. Autor and Mark G. Duggan propose one model for doing this in the United States, and my book with Daly proposes another.28
Lesson Three: Early Intervention Reduces Flows. A recurring theme in the experiences of Germany, Great Britain, the Netherlands, and Sweden is that reforms focused on early intervention can successfully reduce the flow of new beneficiaries onto the program and boost the flow of new beneficiaries off the program. In the Netherlands, for example, early intervention that coordinated employer action following the employees’ particular health shocks was crucial to keeping impaired workers in the labor force. Such intervention significantly increased impaired workers’ return to work and reduced time on the sickness or disability program.
In contrast, none of these countries, including Australia, successfully moved existing longer-term beneficiaries back into the labor market. Across all countries, once enrolled on disability benefits for more than a few months, only a small fraction of recipients returned to work, suggesting that early intervention and prevention were the most effective strategies.
These experiences have implications for United States policy discussions. First, that most current DI recipients do not work is not evidence that they would have been unable to work if given alternative policy treatments (e.g., timely accommodation and rehabilitation). Indeed, the marked difference in outcomes between those given early versus later employment-oriented services in the Netherlands and Sweden shows that in a system oriented toward long-term cash benefits rather than work (arguably, how the US system functions), many of those with residual work capacity will never return to work.
The experiences in these countries also call into question the viability of ongoing attempts to gain control of the growth in DI rolls in the United States by funding additional continuing disability reviews or enhancing postentry rehabilitation or job-training programs like Ticket to Work. While such programs have merits, the experiences in Sweden tell us these efforts will fall short of bringing growth in the rolls down to sustainable levels because the intervention happens too late.
Finally, the reforms and outcomes in these countries show the difficulties of focusing policy reforms on current beneficiaries—a practice the SSA is forced to follow by rules requiring SSA-collected funds to be focused on current program recipients. Congress should eliminate this rule. It should allow SSA to focus its energies on workers with health-based work limitations who are trying to decide whether to stay on the job or apply for benefits. This work-first shift in focus is more likely to curb DI growth than efforts focused on those already on the rolls.
Lesson Four: Hurdles to Reform in the US Are Surmountable. Despite this growing body of evidence that structural reforms to long-term cash disability programs can curb program growth and potentially improve outcomes for those with health-based impairments, the political coalition necessary to achieve fundamental disability policy reform has been slow to evolve in the United States.29
One issue raised in response to proposals for fundamental DI reform is that these benefits, while not especially generous, are essential to keeping millions of disabled-worker beneficiaries out of poverty. The evidence from Europe shows that this is a static view that assumes that, in the absence of benefits, individuals with disabilities would remain out of the labor market and dependent on other forms of public or private assistance for support. European disability reforms over the past two decades provide plausible evidence that increased employment will occur when pro-work policies replace policies that have had the opposite effect. Their reform experience shows that a significant number of people with disabilities, who would otherwise have moved onto long-term cash benefits, were able, with reasonable levels of support, to return to work.30
When programs are designed to award cash transfers in lieu of work, employment falls. In contrast, when programs are designed to encourage work and award transfers only when work clearly is not possible, employment rises. Since work generally leads to increased income, especially when public policies make work pay, efforts to promote work among those with disabilities can produce positive outcomes.
Another concern is that programs like DI are especially important in economic downturns, when individuals with limited work capacity are not only more likely to be laid off but less likely to find a new job. Experience in European countries, especially the Netherlands, which intentionally or unintentionally used this logic to turn its long-term disability programs into more general unemployment programs, suggests that it can be an expensive and ultimately ineffective policy decision. Indeed, many European nations struggled to regain control over their disability systems, which for many decades were used as long-term unemployment insurance programs.
A key message from the European experience is that explicitly divorcing long-term “unemployability” insurance from DI is crucial to targeting resources toward both populations. Efforts to shift to more work-first policies over the past two decades in Europe suggest that fundamental disability reforms, if done well, can lower projected long-term costs for taxpayers, make the job of disability administrators less difficult, and, importantly, improve the short- and long-run opportunities of people with disabilities.
A bipartisan majority in Congress will by necessity pass and the president will sign a Social Security Act before 2035 that will contain some combination of additional taxes and reduced benefits ensuring the OASDI system can continue paying its beneficiaries through some date in the future, but that bipartisan agreement is most likely to occur just before 2035, as was the case with the just-in-time 1983 reforms.
However, that does not mean serious consideration of such a solution by conservatives should be postponed until that date. Based on lessons learned both from the “success” of the 1983 amendments and the “failure” of President Bush’s Commission to Strengthen Social Security in 2001, while it is too early for any proposed changes to OASI or DI to be enacted, it is not too early to consider the ground rules for such a solution when that time comes.
Policy changes that reduce the DI recipience rate via work-first reforms will reduce the burden on both the DI and OASI trust funds by increasing employment.
I wish to thank John L. Palmer, John A. Turner, and Andrew J. Houtenville for their comments on earlier versions of this chapter.