Dissing the Disabled
Rolling in the grass outside his family's trailer in north Springfield, Illinois, eight-year-old Jack tackles his younger sister too roughly, forcing her to scream until his mother makes him stop. Eventually he earns a time-out in his room, where he stays until he calms down, oblivious to the storm children like him are creating in the halls of Congress. Psychologists say Jack can't control his impulsive, fidgety behavior because he has attention deficit hyperactivity disorder (ADHD). That makes him disabled under current federal law, and his family's income is low enough to qualify him for Supplemental Security Income (SSI). But the Social Security Administration has turned down Jack's application for SSI several times, and his case is currently under appeal.It doesn't make sense to Jack's mother, Dawn Gray, that her eleven-year-old son Marvin receives SSI for an attention deficit problem when Jack can't get it. She says Jack's condition, which keeps her from working outside the home, is worse than Marvin's.If key planners in Congress have their way, not only will Jack be turned down for SSI, his older brother will lose his benefits as well. Conservative Republican leaders, calling SSI payments "crazy checks" for kids whose parents coach them into faking mental illness, have introduced legislation to scale back the program for children like Jack and Marvin.Congress has kicked some 200,000 drug addicts and alcoholics off the disability rolls effective January 1, 1997, and many of the nation's 968,780 children on SSI are the lawmakers' next target. A proposal to deny benefits to legal immigrants also is on the drawing board. Under the guise of welfare reform, the government's "contract for America" is beginning to sound more like a contract on disabled Americans."People with disabilities are the poorest of the poor, so when you're cutting programs for the poor, you're certainly hurting people with disabilities," says Rob Kilbury, executive director of the Springfield-based Coalition of Citizens with Disabilities in Illinois.Kilbury finds the proposed cutbacks for the people he represents "disconcerting to say the least. The world is a much better place for people with disabilities than it was in 1982 when I had a spinal cord injury. A lot of that is a result of the Americans with Disabilities Act" (ADA) and other federal programs currently under attack. House Speaker Newt Gingrich has complained orally and in writing about the 1990 ADA going too far in extending the legal rights of the disabled. Other endangered programs include Medicare and Medicaid, which Kilbury terms "critical to the existence" of low-income people with disabilities; special education laws regulating how schools treat children with disabilities; low-income housing subsidies, long a staple for the disabled poor; and public transportation, where funding cuts already are hurting services for people with special needs.Current efforts in Washington, D.C., "are nickel-and diming poor people to death, especially disabled poor people," says Barbara Otto, director of the SSI Coalition, a Chicago-based national advocacy group for the low-income elderly and people with disabilities."There was nothing democratic about the process" by which drug addicts and alcoholics lost their benefits in the 1995 Congress, says Otto. Now legislators are trying "to reverse a Supreme Court decision," she says, by hacking away at the children's SSI program.In 1990 the high court expanded the definition of childhood disability, leading to a tripling of the number of beneficiaries by 1996. In Zebley v. Sullivan, the justices ruled the Social Security Administration could not hold children to the same standard as adults in determining eligibility.In the welfare reform package currently before Congress, U.S. House and Senate proposals would change the way children are evaluated, resulting in a loss of benefits for close to 20 percent of the nearly one million children currently enrolled.The majority of children on SSI are mentally retarded. Those targeted for removal from the rolls have other problems, such as learning disabilities and behavior disorders. Without SSI, states will drop them from Medicaid rolls, and they won't be able to afford treatment, such as drugs for ADHD..Who will suffer most? asks Otto. Teachers and day-care providers already have a tough time managing these children. Most affected will be the parents like Dawn Gray, Jack's mother, who says she wants the government's help for her son, not herself."It's not my need, it's his need for his future," says the mother of four, whose family income is at the poverty level despite her husband's job as a certified nursing assistant. She can't work outside the home, she says, because of Jack's special needs. Even though he is in a separate classroom for behaviorally disordered kids, the school calls her several times a week to come in because he won't behave."He's going to have problems in school, problems holding a job, problems all his life," she says. "I wish some of these senators could be in my shoes. Give them Jack for a month. They talk the talk, but can they walk the walk?"Recipe for relapseThe "Contract with America Advancement Act of 1996" signed by President Clinton March 28 eliminates both Social Security Disability Income (SSDI) and SSI payments for people on the disabled rolls because of substance abuse. [People eligible for SSDI have worked a certain number of years while paying Social Security (FICA) taxes; SSI is a welfare program for the low-income elderly and disabled who don't meet the SSDI work requirement and earn less than $500 a month.]Few would dispute the view it was sheer folly for the government to put cash in the pockets of drug addicts and alcoholics. "That's the worst thing you can do," says Matt Nachtwey, a counselor at a Salvation Army Adult Rehabilitation Center. "Any money given to a bona fide addict or alcoholic usually ends up at the liquor store or crack house."The old system was "a recipe for relapse," in the words of Dave Dierks, area director of Gateway Foundation, a drug treatment agency. A recovering alcoholic himself, Dierks says if he'd been given cash with no strings attached, he probably would have drunk himself to death.A closer look at the demise of Social Security's drug addict and alcohol (DA & A) program, however, suggests Congress may have thrown the baby out with the bath water.The new law takes the place of promising reforms barely a year old that encouraged substance abusers to seek treatment. SSI and SSDI recipients are automatically eligible for Medicaid or Medicare, so stopping their cash benefits also means ending their health benefits and access to treatment. Nachtwey fears this could put more people on the streets breaking laws to support their drug habits, and Dierks predicts it will send more to hospital emergency rooms with no way to pay their bills. Benefits for drug addicts and alcoholics are as old as the SSI program itself, which was created in 1972 for low-income people too old or sick to work. Rejecting the widely held public view that people become addicts and alcoholics because of character defects, the federal government recognized that drug addiction and alcoholism are psychiatric illnesses, and people who couldn't work because of them are entitled to help.The program seemed to attract little attention until the early 1990s, when highly publicized cases of addicts and alcoholics squandering government funds on dope and booze began to appear in the media. Politicians expressed outrage at stories of bartenders acting as representative payees for their alcoholic customers and accounts of addicts getting SSI payments in prison.Congressional hearings in 1994, however, led the government to adopt tight new regulations for the DA & A program, and by March 1995, substance abusers could no longer serve as payees for their monthly checks. They had to be enrolled in drug treatment with their cash benefits administered by an agency acting as payee, and the new law put a three-year cap on payments."What we have now is working, [but] the federal government has not given it time to be evaluated," said Dierks of Gateway, which acts as payee for the disability funds of more than eighty clients undergoing treatment in the Springfield area.Preliminary reports indicate the new reforms are successful, according to Rebecca Holland, special counsel for policy at Illinois Treatment Alternatives for Safer Communities (TASC), the agency charged with monitoring substance abusers and referring them for treatment. Holland, who lobbied against eliminating the DA & A program, said the new law appeared to pass the House and Senate "in response to a situation that no longer existed. Congress members were arguing as if the new regulations had never occurred. Nobody wanted to be seen in favor of cash benefits to alcoholics."Government leaders argued during Congressional debates that eliminating the program for drug addicts and alcoholics would save up to $69 billion dollars over the next several years. But the Congressional Budget Office estimates 75 to 80 percent of these recipients will qualify for benefits under another disability category, most notably mental illness. This means the government will end up sending monthly checks to most of the people it planned to cut off, but without the safeguards instituted a year ago, including the requirements for drug treatment and an agency payee. This could signal a return to the very abuse Congress sought to eliminate.Even if only 25 percent of the current recipients are kicked off the rolls permanently, that's still a considerable savings in tax dollars, says Jim Jameson of the Social Security Administration's office in Chicago.Gateway's Dierks suggests a different scenario for the substance abusers who lose their medical coverage: "If an alcoholic's benefits are canceled, and he's in need of detox, he will go to the hospital and run up an $850-a-day hospital bill he can't pay, whereas if he were still on SSI, he could come into a treatment center like ours at $140 a day and get the situation taken care of. Society will pay one way or another."Not meant to be a handoutDaniel Richards, an articulate thirty-one-year-old man who went into drug treatment at Gateway two years ago after minor scrapes with the law, expects to continue to qualify for his benefits. He lost his left arm above the elbow in a work accident in 1994, shortly after he'd applied for benefits under the drug and alcohol program.Richards says the government has done the right thing by eliminating the program, at least for SSI recipients. "Social Security is not meant to be a welfare program nor was it meant to be a government handout," says the young entrepreneur, who has four fledgling local businesses. "It was meant to reward the American people who were willing to invest in their future with something to fall back on."Sporting a "Clinton/Gore in '96" cap, Richards, who makes political campaign accessories, figures he's entitled to his benefits because he's worked since age twelve. But he has little sympathy for the substance abusers he claims "could work but choose not to. There are people getting SSI who've never worked a day in their lives."Richards views his disability support as temporary, to help him get back on his feet and catch up on obligations he neglected when he was abusing drugs, such as child support. But he also says the current system of monitoring works. He has no problem with Social Security sending his check to Gateway, which typically charges each client a fee (10 percent of their monthly check up to $50) to pay their rent and other fixed obligations and sends what's left over to the recipient.But Peter Georinger says having his $597 in benefits come through Gateway is a bureaucratic nightmare resulting in routinely late rent payments and times when his utilities were cut off because he didn't get the money in time to pay bills.Georinger has been severely depressed and suicidal most of his life, he says, and psychiatrists tell him his illness dates back to age twelve when he began to medicate himself with alcohol. Being a DA & A recipient is no picnic, he says; because government employees at the local, state, and federal level make no secret of their contempt for people on the program."People think this is an easy life," says the sixty-year-old former restaurant cook, who receives benefits under the SSDI program because of his work history. "It's not. I'm not taking something for nothing. I'd rather be working."Georinger's psychiatrist has assured him he will continue to qualify for disability because of mental illness, but when he called the Social Security office to request the necessary paperwork, he says he was told rudely not to bother because he would be discontinued January 1.Others report similarly unhelpful advice when they call local offices, and two recent inquiries confirmed that the folks answering the phones at some offices are simply telling people they will no longer qualify at year's end and are not volunteering information about the appeals process.Social Security's Jim Jameson, team leader in disability operations , expressed dismay upon learning that calls were being handled in this manner. "The last thing we need is for people to be told that," he said, referring to Georinger's experience. By the end of June, all DA & A recipients should have received mailings from Social Security informing them of the new law and how to appeal. Jameson said the agency is adding staff in anticipation of a "worst-case scenario" in which 90 percent will reapply.Those appealing won't be able to count on much legal help. Some lawyers take cases involving SSDI because if they win, Social Security pays them one-third of the person's back benefits, which often amounts to several thousand dollars. But few take SSI cases because the compensation is lower and more problematic, and even fewer will want to handle the drug and alchohol appeals because they won't involve any back benefits. In the past "the poorest of the poor" could turn to legal aid services for help with Social Security appeals, but the budgets of these agencies, too, have been cut to the bone. Some people who appear to qualify under another disability category are getting help with their appeals from client advocates in drug treatment facilities.David Murphy isn't worried about keeping the disability benefits he's lived on for eleven years because he's been diagnosed with terminal lung cancer.The forty-four-year-old former veterinary assistant, who is living out his final months alone with his pet cat and two-to-three-pack-a-day cigarette habit, predicts people like him, who got into trouble with alcohol to mask their mental illness, will have a hard time convincing the government they deserve benefits."I don't know how crazy you gotta be," he says. "A lot of people out there can't manage their own affairs. They sleep in alleys, they poop in their pants. Some really are mentally ill and use drugs to cope with it, and some are just flat-out alcoholics. Sometimes it's hard to tell the difference. I think a lot of people will be put out on the street who are actually mentally ill."Ending the DA & A program won't make them go away, warns Gateway's Dierks. "They may look funny and act funny, and they may not smell good, but they are going to live among us.""Crazy checks"Like the drug and alcohol program, the children's SSI program became a pariah in 1994 after highly publicized media reports about a handful of cases. Families were accused of collecting so-called "crazy checks" for children who appeared normal but were classified as mentally impaired. "Act crazy and you can get a check of more than $400 a month from the government," intoned correspondent Chris Wallace on ABC's "PrimeTime Live."Four internal government audits, including one by the General Accounting Office, found little evidence of fraud in the children's program, but the damage was done. Congress has been working on proposals to eliminate or scale back the program since 1994The image of government disability programs as "fraud-ridden" is at least partly the fault of the Social Security Administration, according to Thomas Yates, counsel for the Legal Assistance Foundation of Chicago. It has routinely failed since 1984 to do the continuing disability reviews required by law. This means people who no longer qualify continue to get benefits, giving the entire program a bad name."The best way to protect the integrity of a welfare program," says Yates, is to make sure people in it qualify. Social Security officials say the agency has had neither the staff nor funding to do these reviews since the Reagan-era budget cuts of the early 1980s.