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To Make Social Security Disability Insurance Fairer and Sustainable, Eliminate the Grid

Economics, Economics Tax & Budget, Healthcare

When severe and permanent disability strips workers of their ability to support themselves and their families, their plight demands our support. The United States has heeded this call through the Social Security Disability Insurance program, but at a large and growing cost. Our system is going broke and fails to reflect a 21st century labor force. 

The program uses a “Listing of Impairments” to determine whether an applicant is disabled. Traditionally, applicants without a medical condition meeting or mirroring an entry on the listing faced great difficulty in obtaining benefits. Listing-based determinations, however, have plunged from 80 percent to 50 percent over the past 30 years according to the Social Security Administration. In these decades, determinations shifted from the listings to a complex array of rules known as the “Medical-Vocational Grid.” 

The grid—designed for cases that fail to meet the listings—uses age, education/skills level, and language proficiency as determinations criteria. But the grid has grown increasingly outdated even as its use proliferated. Continuing to eschew the listings in favor of the grid is fiscally unsustainable, and grossly unfair to current workers.

In a bygone era, the U.S. labor force’s heavy reliance on physical labor made age a relevant factor in assessing disability. But the tremendous growth of the service sector in the “new economy” has supplanted old professions and introduced deskwork as the new norm. Dr. Timothy Church of the Pennington Biomedical Research Center estimates that the percentage of all jobs requiring at least moderate physical exertion declined from over 50 percent in 1960 to 20 percent in 2008.

This shift toward sedentary labor has gone hand-in-hand with increases in labor force participation by older workers. According to the U.S. Bureau of Labor Statistics, 30 percent of civilians aged 55 and over went to work in 1985. Today, 40 percent of the 55+ age cohort participates in the labor force. This upward trend continues, as advances in technology allow—and changes in social practices and market incentives encourage—the older worker to be the norm rather than the outlier. The rule of emphasizing age in disability determinations is outdated and unfair to the millions of Americans 50 and older who participate in the labor force.

A similar story emerges when we examine the role of English proficiency in the labor force over the past 50 years. In 1950s America, a Mexican or Columbian in the U.S. labor force would face substantial work limitations if he or she were “late to the game” in learning English. But contemporary America offers far more opportunity to foreign speakers. A Latino immigrant can now find a plethora of ethnic enclaves in the United States with ample opportunities for Spanish employment.

Even outside of these enclaves, industries heavily involved in trade and globalization put a premium on foreign speaking employees. Why, then, does English proficiency remain an integral part of the determinations process? A system where workers can readily use a foreign tongue to obtain disability payments is a fundamentally unfair system.

The SSA’s use of education level as a determination factor is equally outmoded. The grid favors those with a “limited education,” defined by a lack of a high school diploma. But the labor force is more educated than ever before. U.S. Census data tells us that 80 percent of adults 25 or over have a high school diploma, a 40-percentage-point increase from 1950.

The grid’s rules on education were written for a time when a vast majority of workers failed to complete high school and were at a sharp disadvantage compared to the few that graduated. Currently, struggling workers borrowing money to attend community college courses at night subsidize dropouts deemed to have “little education.” Keeping these built-in advantages for less-educated applicants is unfair, given the sacrifices made by workers trying to further their educations.

The continued use of education, language, and age in disability determination fails to account for the advances of the modern era. Restoring fairness to the determinations process means that the grid needs to go. Additionally, the Listing of Impairments needs to be frequently updated. The agency already promises five-year revisions, but these updates are rarely systematic.

Critically, medical advances that make diseases more “livable” are left out. Legal scholar Adrienne Jones castigates the SSA for using “1993 medical criteria to determine disability in 2014” in its handling of HIV/AIDS cases.

Factoring these societal and technological advances into the disability determinations process will end Disability Insurance’s unsustainable expansion and restore fairness to our nation’s critical moral endeavor.

For more information, see the Mercatus Center working paper Modernizing the SSDI Eligibility Criteria: A Reform Proposal That Eliminates the Outdated Medical-Vocational Grid.


Mr. Warshawsky is a visiting scholar at the Mercatus Center of George Mason University, a member of the Social Security Advisory Board from 2006 through 2012, and author of a new Mercatus Center working paper on “Modernizing the SSDI Eligibility Criteria: A Reform Proposal That Eliminates the Outdated Medical-Vocational Grid.” Mr. Marchand is a first-year economics graduate student at George Mason University. 

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