State says number of Kentuckians getting disability benefits has exploded since 1980; rates are highest in Eastern Kentucky

By Melissa Patrick and Al Cross
Kentucky Health News

The number of Kentucky adults and children receiving disability benefits has increased in "staggering proportions," since 1980, and the Social Security disability system needs "radical reform, says a report from the state Disability Determination Services agency.

The report says that from 1980 to 2015, while Kentucky’s population grew by 21 percent, its combined disability enrollment grew by 249 percent. In the same 35 years, the national increase was 211 percent, so Kentucky's rolls were growing faster than the nation's.

By 2015, the report says, 11.2 percent of Kentuckians were receiving some form of disability benefit payment, higher than any state but West Virginia. It has held second place since the ranking were compiled, the report says.

Disability is prevalent in Central Appalachia. Twelve adjoining Eastern Kentucky counties had the state's top shares of the population receiving disability benefits in 2015, the report says: Wolfe, 24.9 percent; Owsley, 24.6; Breathitt, 23.8; Clay, 22.9; Magoffin, 22.3; Floyd, 21; Lee, 20.2; Leslie, 20; Martin, 19.3; Harlan, 18.9; Perry, 18.8; and Bell, 18.4 percent.

The report said that as the number of disability enrollees increased, so did prescriptions for controlled substances. Counties in the top 12 of disability and opioid use in 2015 (in alphabetical order) were Bell, Breathitt, Clay, Floyd, Lee, Leslie, Owsley, Perry and Wolfe.

Owsley County was in the top 12 for psychotropic drugs such as Xanax in 2001, 2005, 2010 and 2015, all the years surveyed for the report. Owsley and Clay counties were in the Top 12 for disability and opioids per person in 2001, 2005 and 2010.

Opioid prescriptions among those receiving disability payments rose from 48 doses per person in 2000 to 147 doses in 2015, an increase of 210 percent. Nationally, the use of opioids increased due to a greater emphasis on the treatment of pain and aggressive marketing by opioid manufacturers, especially in Central Appalachia, which ranks high in the share of the population on disability.

Central Appalachia has a relatively large percentage of workers who did not graduate from high school, worked in manual labor, and when injured found it difficult to get other work. Most of Kentucky's disability recipients have diseases of the musculoskeletal system and connective tissue (33.4 percent) or a mental disorder (32.8 percent), the report says. Other conditions included diseases of the circulatory, nervous and respiratory systems. National figures are similar.

Most of the state's disabled children (70 percent) are enrolled for mental disorders. Those who got Supplemental Security Income benefits or were in Medicaid had a 168 percent increase in psychotropic prescriptions from 2000 to 2015, from 273 doses per person to 457 doses.

The report's main author, Bryan Hubbard, acting commissioner of the state Department for Income Support, said in a news release, “The explosive growth of benefit dependence over the past 35 years has been fueled by a multitude of factors which are completely unrelated to the mitigation or treatment of hardship borne of genuine disability.”

A 2014 Center on Budget and Policy Priorities report said the number of disabled workers collecting monthly benefits tripled from 1980 to 2013, from 2.9 million to 8.9 million. It cited four factors for most of the increase: population growth, an aging population; growth in women's labor-force participation; and later retirements. It also offers results from several other studies with similar conclusions.

Adapted chart from Kentucky Center for Economic Policy

The liberal-leaning Kentucky Center for Economic Policy replied to the state report with similar points, noting that the share of Kentuckians aged 50 to 64 has increased by half, from 13.6 percent in 1990 to 20.2 percent in 2016, and that three-fourths of Kentuckians on disability are 50 or older. Now that baby boomers are retiring, Kentucky's disability enrollment "has dropped every year since 2013."

The state report suggests another reason for the growth in disability benefits. It says the federal Social Security Administration's culture is an obstacle to change because it is motivated to protect and expand enrollment for disability benefits in order to maintain its budget. The report says SSA administrative law judges award disability benefits "at rates substantially higher" than the state's Disability Determination Services, and it gives a list of the judges and their award rates.

The report calls for "radical reform," including making it a requirement that "objective medical evidence" be used to determine eligibility; removing all "subjective non-severe conditions" from the list of eligible conditions; and allowing the judges only to correct errors by state disability determiners. The report is available in PDF, with an accompanying PowerPoint presentation.

The report has language remarkable for a government document. After identifying politicians, lawyers, judges and doctors as obstacles to change, it says "There are individuals and institutions which exploit and derive power from an ever-expanding dependency class populated by desperate but functional people. These actors promote a dependence system which often functions as an apparatus of state sponsored suicide – anesthetizing and euthanizing its victims – a disproportionate number of whom are either young, poor, or both."

The Kentucky Center for Economic Policy said in its reply, "Concerns that DI in Kentucky is being overused reflect a fundamental misunderstanding about the program. It is actually very difficult to be approved for DI — in Kentucky as well as nationally. . . . Fewer than one in four applicants for DI receive it after an initial request in Kentucky. Ultimately, after two rounds of appeals, a total of 28.3 percent of Kentucky applicants receive DI benefits, which is below the net approval rate nationally of 32.1 percent in 2015." And it called the benefits "modest," saying "The median monthly benefit for a DI recipient in Kentucky was $1,055 per month in 2016," or $12,660 a year, "barely above the poverty line."

Research shows that disability rates are higher in more rural areas, ranging from 11.7 percent in the most urban areas to 17.7 percent in the most rural counties, according to the University of Montana Research and Training Center on Disability in Rural Communities.

The report speculates that rural rates are higher because rural populations are older. The share of people 65 and older in urban areas was 13.6 percent, compared to 18 percent in the most rural counties. The center has county disability data at http://rtc.ruralinstitute.umt.edu/resources/disability-counts-data-finder/.