the counterpoint is that this is bad. we have a program that is expanding and we need to shrink it. and the measure here is that it's just not related. we have to think about the size of the program. thank you. >> this gets back to the beginning of my talk. it seems to me the real reasons to consider reform respect the fiscal issue and the number of people on the roles. it's their economic status. the decline in employment. it's just harder and harder for people with disabilities to be self-sufficient or even partly self-sufficient as time goes on. and that's what the statistics show. many live in poverty. it seems to me that's the fundamental reason to consider reforms.

>> i think i said during my presentation i completely agree that the employment situation sr. people with disabilities is not good. we need to do a lot more as a country to assist people with disabilities to go to work. when they are able and up to their capacity, whatever that is for the individual. if you go back to one of the slides in dave's presentation, the one area where we have cut spending and we have seen a minus 2.6% in the time period that dave outlined is on employment, training, and education services. so if we're serious about helping people with disabilities go to work, we shouldn't start with the vital income support situation and looking at what we need to reform. we need to look at how can we improve our special education, how can we improve the outcomes of people in school? how can we improve our job training programs and how can we

improve our employment support programs? so my answer to that second question is there's a lot that should be done about it, but it doesn't have anything to do with the social security disability insurance program that provides income support. that's what it does and that's what it should do. but we should do a lot more to help people get jobs, keep jobs, and not have to apply for benefits in the first place. >> one of the problems -- sorry. one of the problems that i see is even if a person gets a job, there are all these extraordinary expenses that particularly people with disabilities have to cover. it's not just rent and mortgage and food and basic transportation. it's the personal assistance both at home and work. it's the cost of an accessible vehicle. it's the cost of a wheelchair.

these things are very valuable tools, but they are also way outside many people with disabilities to purchase. i don't know. there are some thoughts about turning the disability insurance cash flow into a supplemental income stream in order to help pay for some of these things. that would take a radical departure from where we are today. but somehow you have the tax code or through additional supports, we're going to have to find a way to help people with disabilities to pay for these devices and services and suppor supports. . >> thanks, mark. >> i guess a little further. when we talk about reforming a

program, there are two ways to do that. if we're projecting in the future that the cost is going to be more than the scheduled taxes coming in, one way is to try to find a way to pull down those coasts. another is to come up with more revenue to pay for the the costs. i think everybody knows the definition of disability for the program. it's a really tricky definition. there have been some changes over time. but it still continues to be a strict definition. up at retirement age, we have 10 to 15% of our population that's ensured receiving those benefits. so i think going forward, that has to be something that we consider. are we going to pay for what we have or are we going to find ways to pull back on the cost on that? i add one little rejointer. the numbers that i put up i think are exactly in consonance.

dave had the chart where the number of beneficiaries is something like 28% higher than of the prevalence rates. the likelihood to be disabled had stayed the same over the last 20 years or so. the difference is because women have had increased incident rates and basically moved to parody. and both men and women have had a shift towards younger ages. i would just add that one thing that we'd hope, we have some fantastic people in our office. our deputies who work on this stuff all the time with dave and others, understanding more why there's been a shift towards disability would be a step in the right direction to understand why we had the increased cost. >> if you look at the general job market and the slack that we still have in terms of joblessness and the slack in the

market, the challenge on the discrimination side seems to be a big, tall hill to climb. you have already rampant discrimination based on age. disability was mentioned. we even have a lot of discrimination against people who have been out of a job for awhile. you step back and look at the marketplace positions. let's take a question here. >> good morning. my name is nathan dansky. i have a follow up question and the significance for the program. for example, 40% of people who have hiv and are receiving care are paid for through medicaid program but most of those people only receive that benefit after becoming disabled due to their illness. so i'm wondering to what extent are people who have a preventable disease or treatable disease who have lacked health

care driving disability costs whether or not that's a factor? and whether or not health care reform is something that will really address that? i'm wondering how big of a piece of the pie is it? is it large or small? >> i think it's hard to put a number on it. i think it's pretty important. the example you're alluding to is just one example of -- i indicated we get things backwards. we don't figure out what people need so they can continue to work. a couple years later we get them into medicare. and i did a paper on the beneficiaries on their way into ssdi and medicare and how many department have insurance that n that period of time. and at that time, about 15% didn't have any coverage at all. and some of them died before

they became eligible for medicare. so what you're saying is just an example of how we have things backwards. we don't figure out what people need so they continue to work and be productive. we let them get into the programs and then we give them services such as health insurance. >> i don't disagree we ought to provide people better services ahead of time. but i will reiterate that did you want mean we have to change ssdi. it means we have to change the other programs that make someone apply for ssdi before they can get access to health care or employment supports as oppose eed to changing the vital income support program that people with disabilities rely on to keep a roof over their head. >> we'll take another question. >> i'm kathy herwit.

i want to follow up on that. i was actually surprised with the chart two charts you had failing taxpayers to finding that as essentially too many people are on ssdi. and i don't think that's failing taxpayers. i think that's a good thing as a taxpayer. i don't know what would be happening to them. i assume that you're saying not that there are too many people getting ssdi, but there should be other things for them in the workplace. and i guess -- i hope that's what you mean. i hope you don't mean we should take 2.2 million people and just throw them on the streets. but in terms of the workplace, i'd like to know how you think

we get employers to provide not just jobs for people with disabilities, but good jobs for people with disabilities that provide good benefits and the supports that they need, particularly in this time, but in this political time when nobody seems to want to be required to do anything in the the employment sector. do we require that they provide adequate health coverage? do we require that they provide supports? how do we do this? >> so i certainly didn't mean we should throw whatever it was -- 2.2 million people off the rolls. and i agree largely with lisa about the issue isn't reforming the ssdi program. it does provide essential benefits. i do think there are some changes we could make in the larger reforms. and i think one thing that's

happened is that because ssdi is the program that's available to workers when they have a problem, we have made changes to ssdi to make it more attractive for them to work when they are on ssdi. and we wouldn't have had to do all that if we had something in front of ssdi so not so many people were getting on the program in the first place. rather than get into ssdi before they get support. as far as getting employers to be more interested and supportive of hiring people with disabilities, it's tough to do. and the health insurance -- and actually this gets back to one of marty's comments. they would assume the aca would be implemented and that would be the basic form of health insurance for everybody. we probably should have consulted with the supreme court first. but it is incredibly important.

i don't think forcing employers to provide health insurance is the best way to do it though because that imposes costs on employers. and if they are having to foot the cost for an employee's health care and that employee happens to have a lot of health care, why would they want to keep employing that person? i think it's difficult to find options that would encourage employers to hire people with disabilities, but i think we have to look at those more carefully whether there are tax incentives or other things. perhaps in reducing the payroll tax. if you hire somebody with a disability at the level they would otherwise qualify for ssdi or ssi, so that's an example. >> i guess i just want to add that i think in a broader context, the one possibility is

we talked about this in the context of are guys like dave and i are ageing and trying to encourage people to work longer provide tax incentives. if that means they have an edge over younger workers to get a job, that's not the best of worlds. i would suggest something in the broader context. it's the rising tide. what we really need is more economic opportunity and jobs in general. it's a temporary. but i think looking forward, it really is a serious question. competitiveness, job opportunities in this country and folks who have medical impairmen impairments, but if we have more jobs available in general, that will be to the benefit to all of us. more taxable payroll. more money coming in. it is sort of the root towards solving the problems for programs like this.

so i think beyond just disability and just for folks with impairments, enhancing the job opportunities in this country would generally go a long way. >> just to add to that a little. i think one of the things we could do again is to have a national medicaid buy in. if employers knew that the health care costs would not affect them, that could remove some of that misperception and fear. i think another thing we can do is encourage the federal government to fully comply with the executive order on hiring people with disabilities in the federal government. one of the biggest ways that we can encourage employers to hire people with disabilities is to show them what good workers people with disabilities are. the fact that they have lower absenteeism, at least as high productivity, and the best way to do that is to lead by example. if the government were to become

a model employer for people with disabilities, it would do a lot to educate employers about the truth of workers with disabilities and if we could also have their health care taken care of, it would remove a lot of the fear and anxiety around hiring people with disabilities. >> let's go to another question. >> thank you. good morning. i'm with america's health insurance plans. i enjoyed the interesting discussion this morning. going back a ways. a question about the rise in the disability population in recent years and outlook for the future. the question basically is you mention the raet recession. you mentioned that the changing participation of women. are you able to offer an opinion is that some of the rise is actually a success story. a success story in dealing with certain disabling conditions,

cancer, hiv, that we have progressed to a point where survive sorship is strikingly higher and there's a way to progress even further to a point where work capacity can be preserved and maintained? >> that's an extremely important question. in one sense, what you're saying is exactly right. we have had a success story in so many areas where there are disabling conditions of maint n maintaining people to continue to live and live a good life. even if not able to recover to the point of being able to go back to work. and that has contributed towards people who come on our disability roles, staying on the disability roles, surviving longer. and that certainly increasing the prevalence and percentage of our population that's receiving disability benefits. in that sense, there's no question that it's a success story. just as i think we would probably agree that once people

reach 62 or 65, if they live longer, that will increase the cost of our retirement program but hopefully we'd agree that's a success story that people live longer after they reach age 65. >> good morning. i'm with the u.s. department of labor. i've got a question that gets to the main question of why are more people claiming and i wonder about the substitution effects. some people talked about the rise in the retirement age as being one reason health insurance going away for some people being another reason. i'm wondering if anybody has investigated the evolution of other social insurance programs like workers compensation and other things where the state reductions and benefits might be causing some of the increases in the costs. >> i'll mention a couple things.

one is welfare reform, which the law was passed in 1996, i believe. and there's been quite a lot of research on the effect of welfare reform on low income parents obtaining disability benefits. initially ssi, but to the extent they have had some work experience. for fairly young people, it doesn't take a lot of work experience to qualify for ssdi. so part of the rise in the disability incidents that steve has pointed to for women could be, and for younger people, could be explained by the welfare reform. but i may be a fairly small amount. it's an interesting controversy about the research in that area. there's been a couple papers published one finding that

compensation reduction of benefits has increased the numb of people on ssdi. there's another paper that finds no relationship. so it's very difficult to tell which is correct. but i think it's an important thing to think about. certainly when people studied changes in other countries, they often see there's a ripple effect in other social insurance systems. so there was a tightening of eligibility in austria i guess in the early 2000s for older workers. they have something that's equivalent to our vocational factors. they found that more people worked at that age level, but they also found that more unemployment insurance or other types of benefits from the government. so it is an important issue. >> to your good point about substitution effects, we have

one of those that operates within the program. when we raise the retirement age, we have already goneage, w one year and will go up another, with the benefits available in '62, if you take your requirement benefit dropped from it used to be 80%, the benefits you'd get if you wait until the normal retirement age, down to 70%. however, if you start to receive disability benefits, you get the full benefit without those reductions. shifting of benefits from 62 from 80 down to 70%, could provide incentive for people to be a bit more inclined for people to apply and we take it into account into our projections into the future and see that that has happened so far. >> i just want to point out it's not via a complete transfer of people from one program to

another though. the social security test is very difficult. a very high standard to me. you have to be able to perform substantial activity due to an impairment that will last one year or result in death, so not everybody who is on the other programs is going to be able to meet that high of a standard to qualify for social security. >> i don't see anymore people at microphones, but i have one more question for steve if you have a question, we'll start thinking about wrapping up. a question for you about this edition, spefblly, the requirement program, periodically, we hear proposals for early changes in the osdi programming. we hear about yet another

increase in full retirement age. what would the be to the disability program? do you really make meaningful gains, quote unquote gains, by a reform like that? >> good question. usual at having legislative changes to the overall social security program. lisa was exactly right. when we raged the normal retirement agency, one major thing happens. instead of paying up to 65, we're paying out to 66. the disability trust fund is one year less that's paid out of the survivors insurance fund, so it's a tradeoff. doesn't make a huge difference. what does was the substitution idea that we were talking about before. you raise the normal retirement

age, think of it, by a year, if people decide to take the benefit, raise the benefit by about 6.5% or fully start the benefit by one year, get the same amount up to one year less. so raising the retirement age clearly does save money overall, but there's a bit of an off set just by virtue of the fact that ages 62 up to the normal retirement age, disability benefit becomes a little bit more attractive financially as to taking the retirement benefit and that off sets, but the fact of raising the retirement age is clearly significant savings. >> as opposed to the way the benefit for retirement? >> there is certainly that.

the administrative costs for disability benefits are higher than for term because of the work that has to be done in making determination, so there is some regard. >> there are discussions about not just increasing retirement age, but over 62, i think there's been a lot of concern about that precisely because of people with disabilities, not so much that they're going to end up on ssdi and in fact, some people would suggest maybe we need to make it easier to get on ssdi if that were to happen. but because there are many people who experience medical problems in their 50s, 60s, that continue to work and they're using early retirement benefits. because they really -- continuing to work.

i think that ssdi, someone who's not, i think one of the important issues for people with disabilities, if there is a retirement, and there are those ideas increase in income tax for people that age, some kind of a health benefit, what happens at the aca, but there are various things you could do to address that that i think would be important to do in the context of a retirement policy. >> the composition of the ssdi population, has there been a marked change in the ratio of mental health disabilities to physical disableties and is anyone tracking that in religion

to economic and the absence of programs to help people get beyond ssdi? anybody? >> really had a couple of very colorful slides in the presentation earlier. as it turns out, this question has arisen before. if you look at people who start receiving disability benefits at any given age, a greater proportion of them come on our roles with a primary diagnosis of mental illness as opposed to more physical. we found people age 25 to 34, the percentage of them coming on the roles that are mental and other reasons has been pretty stable over the last 20, 25 years. that's true for higher ages, also. there's a greater proportion of

muscle and skeletal impairments for people over 45 as opposed to mental. but the distribution of reasons have been quite stable across the ages. where things have really changed is the item mentioned before is that we've had a relative shift in the average age of which disability incidents occurs. we've had more people coming out at younger ages because they tend to have a higher likelihood they'll come out with a mental impairment and they have the prospect of staying on a long time until they reach age 66. overall, we've had a share of d disability and mental impairments. >> there are no other comments, i think we're going to wrap up. i want to thank the terrific panel for their comments and thank you for attending. thanks to cspan for covering the event. let me remind you all to fill out your blue evaluation forms

and give them to a staffer before you leave. i believe that you can also find presentations and other resources about today's event at the website probably sometime this week at nasi.org and thanks to everybody. tonight, tavis smiley leads a discussion on poverty in america and its affects on women and children. >> there's a number in the fact sheet i shared with folks.

in 1990, the average member of congress had a net worth of $250,000 excluding their home. by 2010, the average net worth of congress had 150,000. so, what happened with congress that they could triple their wealth. meanwhile for the rest of us, about $120,000 in 1990 and 2010, so everybody else stayed level, but these members of congress found a way to enrich themselves. here's what i'm saying. people who have that kind of wealth don't understand somebody who needs extra $40 in their biweekly check to take the bus. >> you can watch the whole event tonight starting at 8:00 p.m. eastern on cspan. all this week on cspan 3,