The Trump Administration recently proposed changes to the rules governing disability benefits administered by the Social Security Administration (SSA).1 The proposed rules are projected to cause many current recipients of government benefits to lose an important source of income.2 This essay draws attention to an enormous, but previously unrecognized, cost of the proposed rules. By diminishing payments to people with disabilities, the proposed rules threaten the growth of the multi-billion dollar assistive technology industry.3 This industry, which represents thousands of patents worth of innovative activity, is predicted to reach $31 billion by 2024 and to grow at 7.4% annually.4 But those numbers are put at risk if consumers are unable to purchase assistive technologies because they do not receive s Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits.
The Social Security Administration Act establishes several categories of government benefits based on the recipient’s disability, including SSI5 and SSDI.6 A series of statutes and implementing regulations in the 1980s established a review process for the Social Security Administration to periodically assess whether people with disabilities receiving these payments still meet statutory eligibility criteria.7 The SSA determines the frequency of Continuing Disability Reviews (CDRs), either through a full medical review or a less-intensive mailer review, based on an assessment of the recipient’s likelihood of medical improvement, categorized into three Medical Improvement Diaries.8 The Medical Improvement Expected category is for recipients whose conditions are likely to improve such that they can again engage in substantial gainful activity, and typically involves a CDR every six to eighteen months.9 The Medical Improvement Possible category is assigned to all other disabilities that might improve, and involves a CDR at least every three years.10 Finally, the Medical Improvement Not Expected category includes disabilities that are not likely to improve or are likely to progressively worsen, and involves a CDR every five to seven years.11
The proposed amendments to the SSA’s regulations add a new medical improvement diary: Medical Improvement Likely, which imposes a CDR every two years.12 More than four million current recipients of SSDI or SSI will fall into this category should the rules be adopted.13 The SSA also proposed revisions to the existing diary categories to acknowledge advances in testing and treatment for different conditions.14 The SSA estimates that increasing the frequency of CDRs through these changes will result in a net reduction of $2 billion in Old Age, Survivor’s, and SSDI payments, and a reduction of $0.6 billion in SSI payments between fiscal years 2020 and 2029.15
These proposed changes by the Social Security Administration will cause many people with disabilities to lose their SSI or SSDI benefits.16 The proposals are based on the assumption that an increased frequency of CDRs will reduce the SSA’s expenditures and improve reemployment of those who lose their benefits sooner than they would under the current rules.17 This justification is tenuous at best—by the SSA’s own admission, its past experience suggests that many of those who lose benefits do not return to the workforce at a Substantial Gainful Activity (SGA) level.18 Further, a causal link between a shorter duration of receiving benefits and improved work outcomes has not been established.19 Therefore, the more frequent and burdensome CDRs will leave many current beneficiaries without benefits despite their inability to work, with devastating impacts on individuals who rely on these benefits to cover food, medical care, and housing costs.20
But there is another, less obvious impact of the proposed rule: the expected loss of benefits will threaten the progress of design innovation for accessible technologies, to the detriment of disabled and nondisabled people, as well as to the businesses and entrepreneurs who create and sell these technologies.
For over a century and a half, government-support payments to people with disabilities have been important drivers of innovation in accessible design.21 The needs and preferences of people with disabilities have spurred innovations in artificial limbs, wheelchairs, vehicles, software, electronics, and the built environment.22 But people with disabilities often lack the wealth to purchase new technologies. There is a long history of social welfare payments, which include the SSI and SSDI payments subject to the proposed rule, driving design innovation.23 These types of benefits give people with disabilities who may be unable to work or unable to work full time the buying power to create demand for a wide variety of assistive technologies.24 This demand incentivizes firms to develop and produce better products.25 Moreover, these design innovations have wide benefits to people with and without disabilities.26
An early example of social welfare payments driving design innovation is improvements to artificial limbs spurred by payments to veterans.27 Prior to the Civil War, artificial limbs were expensive, custom-made wooden pieces made to order by artisans.28 Following the Civil War, amputee veterans received “limb allowances,” and by the end of World War I the government had invested in artificial limb development itself.29 Government pensions and allowances for Civil War and World War I veterans allowed more people to be able to afford these devices, and firms responded by investing in innovations to take artificial limb from a prohibitively expensive bespoke creation to a mass-produced and affordable technology.30 Once able to access these devices, veterans were better equipped to re-enter the workforce, providing for their families and contributing to the economy.
Later, subsidies to World War II veterans to purchase cars modified to be driven by veterans who had lost one or both legs drove demand for accessible automobiles.31 Buick Motor Company responded with a version of its Reliant automobile that radically transformed mobility for veterans. These subsidies were instrumental to getting veterans who benefitted from them back into the workforce.32 However, these subsidies were short-lived, and once the subsidy program ended, the innovations all but disappeared.33 The story of the post-war automobile subsidies starkly illustrates how important government benefits are in creating and sustaining demand for technological innovations.
These days, people with disabilities may use their SSI and SSDI benefits to purchase a broad range of assistive technologies that improve their lives immeasurably. These technologies, which often are not covered by insurance, include specialized wheelchairs for work and for leisure, artifacts for modifying their offices and their homes, and thousands of other products that improve users’ health, happiness, and productivity.34 Already, 3D printing and artificial intelligence are further expanding the range of assistive technologies for people with disabilities.
Social welfare payments that allow beneficiaries to use the funds as they choose, like the SSI and SSDI benefits subject to the proposed rulemaking, enable people with disabilities to purchase assistive technologies beyond mobility aids and medical equipment. This buying power creates innovation incentives that benefit not only people with disabilities, but also people without disabilities and businesses and entrepreneurs across a variety of industries. Many common products and technologies started as assistive technologies for people with disabilities.35 For example, the speech-to-text and voice recognition capabilities now standard in smartphones got their starts as software to assist people with a variety of disabilities.36 The Segway, now a common vehicle for police departments, security guards, and city tourists, started as a mobility aid (and is still popular as such, including among veterans who have lost one or both legs).37 Eye-gaze-tracking technology that originated to facilitate communication by people with paralysis is now a central component of marketing analytics in e-commerce and has been used to develop new safety features in luxury automobiles.38 Finally, OXO Good Grips kitchen utensils were originally designed to make cooking easier for people with disabilities such as arthritis, but are now enjoyed by a wide variety of consumers, with and without disabilities, who find the large grips improve the experience of cooking.39
The SSA’s analysis of the costs of implementing the proposed rule changes completely ignores the costs of losing the demand-side design incentives generated by SSI and SSDI payments, the resulting opportunity costs to disabled and nondisabled people who will be without technological innovations that make their lives easier, and the costs to businesses in losing a significant sector of their market.40 Further, the proposed rules ignore the fact that SSI and SSDI payments give people with disabilities the financial means to purchase assistive technology necessary to facilitate their return to the workforce. Accordingly, the proposed rules undermine their own fundamental goals. Because the proposed rules will be bad for people with disabilities, bad for people without disabilities, and bad for the economy, we urge the SSA to not adopt the proposed amendments to the SSA rules.
The above essay was adapted from the authors’ comment submitted in opposition to the Trump Administration’s Proposed Rules Regarding the Frequency and Notice of Continuing Disability Reviews.