Sam: The biggest issue for a lot of people who are on SSDI or SSI, until the Affordable Care Act, was that that disability assistance was the ticket to receiving health insurance. There have been some work incentive programs designed to insure that people don’t lose their health insurance, their Medicare, or Medicaid when they go back into the workforce, that have had some, but not very much success. Once the Affordable Care Act is fully implemented, maybe some of the need to go on SSI or SSDI to get health insurance will go away, and that might help the picture as well.
Harold: I’m struck by two anecdotes here. One I found in the “This American Life” episode. Chana Joffe-Walt interviewed this guy. He was maybe 58. He had lost a job in a paper mill. He had a heart condition. He would have loved to remain working in that paper mill, but that job vaporized. He ended up on disability.
You can imagine his health insurance must be quite costly given his age and his health history. What else is he going to do? If the health insurance were taken care of, he probably could do another job. He’d probably be much happier and more productive, but there’s no employer who’s going to hire that guy, and pay the annual insurance and healthcare costs he probably incurs. It’s just unrealistic for him.
I was on the campaign trail in 2008, going door to door for the Obama campaign … I met a number of people, who were in very serious financial trouble, who were actually getting on disability, but who were in the waiting period for Medicare. There was this one guy who needed a liver transplant, and he was getting excellent medical care. He was basically going medically bankrupt while he was sitting in this two-year waiting period. It’s such a barbaric requirement, that these people go through this very long process to qualify for SSDI. Then they have this additional waiting period before they can get Medicare coverage. His family was having a garage sale, selling little trinkets to try to raise money to pay his medical bills. I bet you that on their front lawn they probably had $5,000 worth of stuff … We treat people in such an indecent way when they’re in these very serious circumstances.
That’s another aspect of disability policy: What do you do with people who have these really serious conditions? It was clear for me that one of the real challenges that ACA was at least trying to deal with this, trying to protect people from catastrophic medical expenses that leave them not only on the disability rolls, but that cause people with cancer to lose their homes. What’s your take on how well ACA is doing the job of filling in some of these gaps?