Anthony

Professor John Glascock

Public Policy Formation

April 24, 2008

The Inadequacies of Health Care Policy for Disabled Persons in the U.S.

With the evolution of many health care policies in the United States throughout

the 20th and 21st centuries, we have witnessed the uprising of many injustices within the

health care system itself. In 2005, we observed that about 45 million people or 18% of

the nonelderly population in this country was without health insurance, and the number

has continued to grow every year (Kraft and Furlong 227). Of those Americans that are

uninsured, it is estimated that over 400,000 of them are disabled individuals (Center).

While the government has set up some provisions for disabled citizens, the procedural

policies and requirement standards to attain them are inadequate and inefficient. As a

student with a developmental spinal disability whose mother is also disabled as the

result of a car accident, I have personally encountered the injustices of the health care

system for both children and adults. With regard to the federal government’s attempts

to provide disabled citizens with health care, I have seen that the greatest flaws in this

system are the result of inadequate policy design, inefficient policy problem analysis,

and the failure to meet the evaluative criteria of public policy proposals.

According to Michael Kraft and Scott Furlong, in Public Policy: Politics, Analysis,

and Alternatives, policy design refers to “the careful consideration, during the policy

formulation stage, of the role of the government agents and the target population –
those who receive benefits or who the objects of government regulation are” (Kraft and

Furlong 137). In other words, the focus of policy design should be directed by the need

of those it targets. The federal Medicare program began in 1965, following an

amendment to the Social Security Act of 1935, to help senior citizens age 65 or older

meet basic health care needs (Kraft and Furlong 230). In 1972, Medicare was

expanded to include people who have “significant” disabilities. With this change,

lawmakers created a waiting period which mandates that people with disabilities must

first receive Social Security Disability Insurance (SSDI) cash benefits for 24 months,

before receiving any Medicare benefits.

For starters, to even be considered medically disabled according to SSDI rules,

an individual must be “unable to engage in any "substantial gainful activity" due to any

medically determinable physical or mental impairment(s) which can be expected to

result in death or which has lasted or can be expected to last for a continuous period of

not less than 12 months. In addition to being unable to perform his or her previous work,

the person cannot, considering age, education, and work experience, engage in any

other kind of SGA that exists in the national economy” (Social). In my experiences, I

have observed these standards to be so stringent and unreasonable to the point where

my own mother, age 41, who has an immobilizing nervous condition, cannot sit or stand

for long periods of time, cannot lift more than 30 pounds, and is certainly unable to

maintain a job in the workplace was repeatedly denied benefits for four years before

finally qualifying for SSDI. This discrimination is even more observable on a broader

scale: 64% of applicants in 2005 were flat out denied admission into the program

(Social). Is it really likely that only 36% of SSDI applicants were actually disabled? In
fact, the system actually has a variety of technicalities and standards which are merely

meant to limit the beneficiaries of SSDI services. The policy design of this system is not

only inefficient, but is unfair, discriminatory, and irrational.

Typically, SSDI has a period of approval determination from the Social Security

Administration followed by an undefined waiting period before cash benefits are

received, and then another 24 month waiting period to get Medicare coverage

(Supplemental). Is a federal policy really reasonable when disabled individuals, with

little ability to provide for themselves, may have to wait years to attain medical

coverage? To further exemplify the flaws of the system’s policy design, I, as a child did

in fact qualify for SSDI, however, when I reached age 18, I had to re-qualify and start

the entire approval process over again because of the absurd appeal process, further

delaying my access to medical care for many years. In fact, the condition of my spinal

disability can only worsen over time. There is no chance that it could have improved or

could have miraculously gone away from age 17 to 18, but SSDI’s unreasonable

policies mandate that a child on turning 18 be reevaluated as a new participant in the

program.

Because of all these waiting periods and discriminatory biases, it is no wonder

that 400,000 Americans with disabilities are uninsured and many more are underinsured

at a time in their lives when the need for health coverage is most dire. In fact, various

studies show that death rates among SSDI recipients are highest during the two year

Medicare waiting period (Center). A policy design certainly cannot be viewed as an

efficient one when it is, in effect, responsible for the deaths of its target citizens. The

policy design of disability health care in the United States allows disabled persons
access to medical care; however, it shows its obvious faults. Again, the goal of a policy

design is to accommodate the needs of the target group or population. If a policy

program is not successful in doing this, then there needs to be some problem analysis

and evaluation.

In Public Policy: Politics, Analysis, and Alternatives, Michael Kraft and Scott

Furlong present the concept of problem analysis. “Problem analysis involves trying to

answer the basic questions about the nature of a problem, its extent or magnitude, how

it came about, its major causes, and why it is important to deal with as a matter of public

policy” (Kraft and Furlong 123). To conduct problem analysis on a public policy, there

needs to be some kind of defining indicator or quantitative measure which details the

extent of the problem at hand. With respect to disability health care policy, some of the

problems at hand are complex and are at times immeasurable by some quantitative

value; however the primary issue is indeed a measurable one. As stated previously,

400,000 plus disabled citizens are without health care.

As the cost of medical care continues to grow, the uninsured, especially the

disabled, are subject to being sicker more frequently, will receive inadequate medical

attention for emergencies, and are 25% more likely to die than citizens with health

insurance (Kraft and Furlong 227). In addition, it is known that four percent of persons

on SSDI die during the waiting period for Medicare. These are obvious quantitative

figures that can be useful in establishing problem analysis; however there are many

other qualitative problems to be analyzed. One such issue includes SSDI’s narrow

response time allocation for the disabled individuals enrolled. For example, if there is

paperwork that a disabled person must fill out within a certain time period (i.e. usually
seven days), and they are unable to submit that paperwork by the deadline, they are

subject to being expelled from SSDI. Doesn’t it seem hypocritical to make a disabled

individual go through a series of extensive waiting periods, while penalizing this

potentially helpless person for not submitting some paperwork within an unreasonable

narrow time gap? Also, as mentioned previously, the reevaluation cutoff at age 18 for a

child receiving services is another problem to be analyzed. The sum of all these issues

explains the extent of problems to be analyzed as well as how they came about as a

direct effect of the policies established. In problem analysis, we also have to try and

forecast the extenuating effects of a problem if left unresolved and how they will affect

the policy target population over time (Kraft and Furlong 129). As the baby boomers

reach the age of increased likelihood of disability, the need for medical care will only

grow. However, from evidence presented, it is clear that the future of disability health

care policy, unchanged, will only lend itself to leaving more and more disabled persons

without medical care. The next step is to look at the evaluative criteria to see how

disability health care has failed as a policy.

Kraft and Furlong discuss evaluative criteria as “justifications or rationales for a

policy or government action” (Kraft and Furlong 148). With regard to health care policy

for disabled persons, it seems that the attempts to meet the evaluative criteria are

abysmal. These policy evaluations depend greatly on the problem analysis results, and

since those results are hardly reflective of the true problems to be addressed, the

evaluation results are skewed and result in only minor changes, if any, to the system.

While the focus of most national attention seems to be reducing the overall percentage
of persons without health coverage, reducing the percentage of uninsured disabled

individuals seems to take a back seat.

The selected criteria for evaluating public policy proposals are based on:

effectiveness, efficiency, equality, liberty, political feasibility, administrative feasibility,

technical feasibility, and social acceptability of the policy. To address the evaluating

criteria in disability health care policy, we need to first shed light on its effectiveness

before examining other flaws in the process. The need for effectiveness criterion is

evident in the complaints about all flawed government programs including SSDI. In this

sense, effectiveness refers to reaching the starting goals and objectives of the policy at

hand (Kraft and Furlong 151). Since hundreds of thousands of disabled citizens remain

without health care despite the establishment of a federal program to alleviate this, the

effectiveness of disability health care policy needs to be addressed. With this,

lawmakers should consider both problem analysis of quantitative data and ethical

analysis of feedback from disabled citizens (Kraft and Furlong 173). The efficiency of

disability health care policy must truly be questioned as well. When a policy design

mandates that disabled persons have to wait years and years to receive Medicare

benefits, this is clearly the farthest thing from efficiency. Additionally, this policy is not

even fiscally responsible because of the determination and redetermination costs and/or

the cost of human life. Similarly, equality in health care policy is an area to be

addressed. When a policy program makes efforts to ensure that 64% of disabled

applicants are denied access to federal assistance for medical care, there needs to be

some recognition to the fact that this is outright discrimination and blasphemy. This

nation’s founding fathers established the United States on the basis of liberty, or the
condition of being free from governmental restriction or control. However, what is more

impious than a federal policy which imposes so many restrictions, limitations, and

unreasonable burdens on its beneficiaries in hopes that they will breach the qualification

standard and be expelled from the program? Political, administrative, and technical

feasibility are by no means limited by financial restrictions. With $1.9 trillion of the

federal budget in 2005 and an expected $3.6 trillion in 2014 going to subsidized health

care, it should be feasible to accommodate the needs of every disabled person in the

nation (Kraft and Furlong 239). Perhaps a reallocation of funds or governmental

monitoring of policy spending are ways to insure that no disabled person be without

medical care. Finally, social acceptability of disability health care policy is dependent on

three factors: whether the decisions being made reflect the intent of the policy design,

whether the policy is consistent and fair throughout the system, and whether or not the

programs are lacking funding. Just from review of the other evaluative criteria

mentioned here, it is clear that none of these factors are met with success, and

therefore do not meet the standards of social acceptability. The failure of disability

health care policy (i.e. SSDI) to successfully meet the evaluative criteria for a public

policy is indicative of a need for change to the policy itself.

With health care policy receiving a great deal of attention in the 2008 election

year, there should be a greater focus of attention on reforming disability health care

policy. Indeed some of the presidential candidates thus far have expressed interest and

concern over this matter, however the great extent of the current policy flaws are still

under-evaluated. With hundreds of thousands of disabled citizens unable to attain

medical coverage, there needs to be serious changes. As a student with a

developmental disability growing up with a disabled mother, I have personally witnessed

the unrighteousness of the system, and the discrimination against individuals who

should qualify for benefits, but are repeatedly turned down. As such, it is evident to me

that the greatest flaws in this system are the result of inadequate policy design,

inefficient policy problem analysis, and the failure to meet the evaluative criteria of

public policy proposals. As we approach the future of health care in this country, we can

only hope that reform will help to reduce the number of disabled persons without

medical coverage, and that steady changes to policy will mandate effectiveness,

equality, and efficiency in providing assistance to those who need it.

 Work Cited

Center for Medicare Advocacy Inc. “Sen. Bingaman’s Bill to end 24 month waiting

period.” 2005. 10 April 2008

http://www.medicareadvocacy.org/Reform_BilltoEnd24moWaitingPeriod.htm

Kraft, Michael E., and Scott R. Furlong. Public Policy: Politics, Analysis, and

Alternatives. Washington DC: CQ Press, 2007.

Social Security Disability Insurance (SSDI): Program Description. World Institute on

Disability. 12 April 2008.

http://www.disabilitybenefits101.org/ca/programs/income_support/ss_disability/ss

di/program.htm

Supplemental Security Income & Social Security Disability Insurance. American

Diabetes Association. 12 April 2008. http://www.diabetes.org/advocacy-and-

legalresources/healthcare/healthinsurance/social-security.jsp