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I felt rage form in my stomach as I read Terrence McCoy’s June 2 Washington Post article “Generations, disabled.” As both a disability lawyer and a disabled person [1], I am enraged by the tone, content, and lack of context in this article. However, I do not want to replicate one of the major flaws of the article by trying to paint a picture without an understanding or explanation of the forces that made things this way.
So before we go into the details, everyone needs to understand the programs that are the topic of this article, though they are not once mentioned by name within the article. Without understanding the programs and context, the article leaves readers with the feeling that this article is about a family who has scammed a system for generations by trying to get medications (or “pills” in McCoy’s words) and false diagnoses. The truth is that individuals with legitimate disabilities that should be receiving these benefits are stuck in a system that requires a very specific set of diagnoses and medical records to receive extremely minimal sets of benefits that keep generations in poverty.
Poverty kills people. But before it kills them it makes them sick.
There are two federal programs that provide what can be considered “disability.” The first one is called “Disability Insurance Benefits” (I’m going to use “DIB” for short [2]). DIB is the fund that workers pay into and after a certain amount of quarters of work, you can receive benefits if you are found disabled. You can only get DIB if you have worked, and the average amount of monthly DIB benefits was $1171 in 2017.
There is another program called Supplemental Security Insurance (SSI) [3] that you do not need to have ever worked to receive; you can receive it if you prove you are disabled and your income and assets are under a certain amount. Current limits allow only $2000 in assets and up to $65 [4] per month in income for individuals before seeing a reduction in benefits.
In 2017, the average monthly amount of SSI is $735 for an individual. McCoy would have you believe that there is a financial incentive for families to collect SSI rather than work, though even a full-time job at the abysmal national minimum wage of $7.25 an hour would give an individual close to double (before taxes) the amount they receive in SSI benefits [5]. Basically, SSI is for very poor disabled people and it keeps them in poverty.
To get these benefits there are usually multiple sets of hoops that people need to jump through. Best practices are that people who apply for SSI proffer detailed narratives from treating doctors. You can be denied benefits if your doctor uses one kind of form or another (I have seen many denials due in part to doctors using “checkbox forms” rather than more narrative versions).
Keep in mind that since applicants have never worked — or not worked enough — to receive DIB, this usually means that all these medical records must be obtained from doctors who take Medicaid. If you have ever been on Medicaid, you will know that even getting a few minutes in person with a doctor can take herculean amounts of effort, let alone even the basic medical records.
Generally, if you are unable to work because of mental impairments, it is even more difficult since the system requires the disabled individual to prove disabilities in large part through “objective” testing. Since the specific subjective words your doctor uses to describe your symptoms may determine whether you are approved for SSI, of course people will want their diagnoses to give them the best chance. Remember that these are people who are too disabled to work and therefore may be unable to survive without these benefits, especially since welfare was gutted in the 1990s.
Poverty kills people.
But before it kills them it makes them sick. You know what sick people are called? Disabled people [6]. McCoy notes that The Post found that “multigenerational disability is far more common in poor families.” The subtext of McCoy’s article is that poor, disabled families are at fault for both their disabilities and their poverty and exaggerate their symptoms to try to get disability and continue have kids to leech of the system. This narrative (and straw man) should sound familiar as it convincingly mimicks Reagan’s “welfare queen” caricature, [7] though that was aimed at poor Black folks while the “disability queen” is stereotyped as a poor rural white person.
"You know why the Tidwells have so many pills? Because that is one of the few treatments that Medicaid will pay for."
There are actually many reasons off the top of my head that multigenerational disability is seen more often in poor families, namely that being disabled means living in poverty unless you have someone like a parent or a child who can work to support you. If your parents and/or children are too disabled to work, then there is no choice but to rely on SSI which inevitably means you are poor. If we are going to infer a causal relationship between poverty and multigenerational disability, doesn’t my theory make more sense? Once again because McCoy is very unclear about what he means by “multigenerational disability”, he may be referring to “multigenerational SSI recipients.”
By its own parameters receiving SSI means that you are in poverty. Therefore, obviously the more people in your “family” [8] that are supposed to survive on such a small amount of money, the more likely you will be in poverty. So the only solution is to give people on SSI more money so they can no longer be in poverty. Other causes for multigenerational disability may include: the genetic nature of many disabilities, environmentally caused disabilities, disabled people being more attuned to potential disabilities in their children, and poor schools and healthcare that can exacerbate instead of treat childhood disabilities. Rather than looking at these causes, and others brought up by an expert that was quoted, McCoy cryptically takes the word of “others [who] say it’s about money.”
McCoy’s article highlights a family that has been failed by their government and forced into such deep poverty it is impossible to escape it with their health intact. You know why the Tidwells have so many pills? Because that is one of the few treatments that Medicaid will pay for. Many people would love to have access to other treatments that Medicaid may not cover, like physical or mental health therapy. However, even if they can somehow get these treatments covered by Medicaid, they still need to access the treatments which may not even exist even some rural areas.
McCoy is right about one thing. There is a story here that needs to be told.
But it is not the story of dishonest folks trying to make a quick buck who keep reproducing to just burden the government further. The real story is the complexity and unfairness of the SSI (and DIB) system and how it keeps people in poverty and with subpar medical treatment that worsens outcomes for individuals and their families. The newsworthy part is that people survive this and continue to do the same things that lots of non-disabled people do, have families, support each other, take care of ourselves. Disabled people are being killed slowly by a system that does not value us, and we live in fear of things becoming even worse under Trump. With so many of us poised to lose healthcare and the meager benefits that a few of us get, articles like McCoy’s is not only irresponsible, it is dangerous.
[1] Among many other things – because that’s the thing about people with disabilities - we are multi-facet people with actual identities, though you would never know it by reading xxx’s article
[2] This is often referred to as “SSDI”, Social Security Disability Insurance, but I prefer “DIB” since it is easier to tell apart in print from its sister program, “SSI”.
[3] This appears to be the program that McCoy was talking about when he says “benefits”, but an article of this length should have been clearer.
[4] This is not a typo. This is the real amount. This is called a “work incentive,” though for every two dollars you make above $65, your payment is reduced by a dollar.
[5] Granted, this equation becomes more complicated when you are talking about children, but the point still stands that SSI is no windfall for anyone.
[6] There are many disabled people who are not sick and feel that their disability is a part of them that they would not want to be able bodied even if they could be. This is called the social model of disability and you should learn about it.
[7] If there is any silver lining to this article maybe it is that finally poor white people are being victim to some of the same stereotypes that Black people and other People of Color have been subject to for decades. I am being sarcastic of course, but it is important to note that as usual People of Color have been screwed over longer and harder by these policies and rhetoric than white people have and we can’t forget that.
[8] I.e. the people you share resources with.
