[Congressional Record Volume 140, Number 12 (Wednesday, February 9, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: February 9, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
  WELFARE REFORM MUST INCLUDE THE CLEANING UP OF THE SOCIAL SECURITY 
 DISABILITY INSURANCE [SSDI] PROGRAM'S SUBSIDIZATION OF SUBSTANCE ABUSE

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                          HON. GEORGE W. GEKAS

                            of pennsylvania

                    in the house of representatives

                      Wednesday, February 9, 1994

  Mr. GEKAS. Mr. Speaker, It has come to my attention that the Social 
Security Disability Insurance [SSDI] program is unintentionally 
subsidizing much of the drug and alcohol addiction that plagues our 
society.
  Under current law, although Title XVI Supplemental Security Income 
[SSI] beneficiaries who have drug problems may be required to under go 
treatment in order to receive benefits, there is no such parallel 
provision for those receiving Title II Social Security Disability 
Insurance [SSDI] benefits. Consequently, a worker who is an addict may 
remain for life on SSDI benefits due to his or her addiction, with no 
requirement to ever receive treatment.
  Moreover, the current requirement for treatment under Title XVI [SSI] 
is ineffective. There are insufficient numbers of treatment centers--or 
in some locales, no such centers--and inadequate followup to assure 
compliance with treatment even where treatment centers exist. Worse, 
the effect of the current system is to provide an incentive to remain 
addicted: to assure continuance of benefits, a beneficiary must remain 
addicted. The system encourages just the wrong kind of behavior.
  Another great weakness of the current program is the provision for 
representative payees. I am advised that often an addict becomes the 
representative payee for his friend and both continue to indulge in 
their addictive habits.
  For a full explanation of this problem and a list of solutions, I 
have written a letter to the Social Security Administration [SSA], 
which operates SSI and SSDI. To this date I have not received response. 
However, I do hope to work the SSA on this matter, since SSA is on the 
front line of this issue.
  As you know, the House Republican Welfare Task Force bill includes a 
provision to terminate SSI benefits for drug addicts who test positive 
to drug tests. Welfare reform will not be comprehensive without 
provisions to reform SSI and SSDI.
  For myself, I am introducing legislation requiring treatment for 
those addicts who are beneficiaries under Title II Social Security 
disability to conform with the Title XVI provisions for compliance with 
treatment. I will also support my colleague Congressman Bill Thomas' 
bill to provide for tightening of the provisions under Title XVI and 
for assuring compliance with treatment.
  My legislation will also require that representative payees be 
public, charitable, and/or other reputable institutions. Moreover, my 
proposal will provide that administrative law judges may terminate 
benefits prospectively, retaining jurisdiction in proper cases to 
provide additional protection to the claimant and the taxpayer.
  The result will be to take the individual out of addiction and off 
the rolls of the Social Security and SSI disability programs, producing 
great savings to the taxpayer. It will also go far in restoring the 
addict to a life of dignity and productive work.
  I am advised that Senator Cohen is working on this same problem. So, 
with the cooperation of the Senate and the House Committee on Ways and 
Means, I look forward to a successful deliberative process to reform 
our welfare and Social Security systems before the end of 103rd 
Congress.


                               background

  Ths Social Security Act provides for the payment of disability 
benefits to individuals who cannot work because of a medically 
determinable physical or mental impairment that has lasted, or is 
expected to last, for at least 12 months or to result in death.
  In implementing the disability standard, the Social Security 
Administration (SSA) has developed listings of physical and mental 
impairments that it accepts as prima facie evidence of disability. 
SSA's listing of mental impairments includes ``substance abuse 
disorders.'' To be awarded benefits under this listing, applicants must 
have a severe condition associated with alcoholism or drug abuse--e.g., 
a personality disorder, chronic depression or anxiety, organ damage, or 
an organic mental disorder. Applicants whose drug- or alcohol-related 
impairments differ from those described in this listing are given an 
individual assessment by SSA and may be granted benefits on the basis 
of reduced overall functional capacity.
  In addition to meeting the medical definition of disability, 
alcoholics and drug addicts who apply for SSI must comply with two 
statutory restrictions in order to receive benefits: (1) they must 
participate in a substance-abuse treatment program approved by SSA, and 
(2) their SSI benefits must be paid to another person or organization--
a ``representative payee''--who is responsible for handling their 
finances. (Under SSA regulations, alcoholics and drug addicts who have 
another qualifying disability--e.g., a heart condition, paralysis, or 
cancer-- are granted benefits on the basis of their non-drug-related 
impairment and are not subject to these requirements.)


                             program growth

  A recent GAO study, requested by Senator Cohen, found that the number 
of SSI alcoholics and drug addicts who are subject to the above 
requirements tripled between 1990 and mid-1993, rising from 23,000 to 
69,000. This increase exceeds significantly the 31 percent increase 
that occurred during 1990-93 in SSI payments to all disabled 
beneficiaries. The SSI alcoholic and drug addict population remains 
small in relative terms, however, constituting only 1.8 percent of all 
disabled SSI beneficiaries.
  In the SSDI program, the number of alcoholics and drug addicts rose 
by approximately 35 percent between 1990 and mid-1993. This compares to 
an overall 1990-93 increase of 29 percent in the SSDI program. 
Extrapolating from SSI data, the GAO estimates that there are currently 
about 50,000 substance abusers receiving SSDI benefits. As in the SSI 
program, the group is small on a relative basis, constituting 1.3 
percent of all SSDI beneficiaries.
  Of the SSI substance-abuse population, 55 percent are alcoholics, 16 
percent are drug addicts, and 29 percent have both addictions.


                enforcement of ssi program restrictions

                               treatment

  The GAO found little enforcement of the requirement that SSI 
beneficiaries who are disabled by alcoholism or drug addiction 
participate in treatment as a condition of eligibility. It reported 
that SSA has funded Referral and Monitoring Agencies [RMAs] in only 18 
States to place and monitor beneficiaries in treatment. Due in large 
part to SSA funding limitations, these RMAs are monitoring only 51 
percent of the SSI substance abusers residing within the 18 States and 
44 percent of the SSI substance abuse population overall. In the 
remaining 32 States, SSA has established no mechanism for referring 
beneficiaries to treatment or monitoring them.


                         representative payees

  In most instances, SSA satisfies the statutory requirement for a 
representative payee for SSI drug addicts and alcoholics by designating 
a family member or friend to manage monthly benefit checks. The GAO 
determined that 59 percent of representative payees for this group are 
family members, while 35 percent are friends, 2 percent are 
institutions, and 4 percent are social agencies.
  Some critics question whether family members and friends of drug 
addicts and alcoholics should be permitted to serve as representative 
payees. By law, representative payees are required to spend the funds 
to provide for food, clothing, shelter, and necessary treatment for the 
beneficiary. However, drug addicts and alcoholics in their desperation 
to feed their destructive habits can become verbally and physically 
abusive to those who control access to their benefits. In an attempt to 
avoid confrontation, family and friends of drug addicts and alcoholics 
may simply turn the money over to the beneficiaries who in turn use it 
to buy drugs and alcohol.
  In 1989, the Subcommittees on Social Security and Human Resources 
held a hearing on the representative payee program and heard testimony 
that drug-addict and alcoholic SSI recipients, who were required by law 
to have a representative payee themselves, were serving as 
representative payees for each other. In some cases, bartenders were 
serving as representative payees for their customers. In 1990, Congress 
enacted reforms to prevent this kind of abuse in the representative 
payee system, but some individuals who work with drug addicts and 
alcoholics assert that these problems with the representative payee 
program continue to exist.


                             1994 hearings

  In February 1994, the Ways and Means Subcommittees on Social Security 
and Human Resources will hold hearings on this matter. I am advised 
that these subcommittees are concerned by the sudden, sharp increase in 
disability benefit awards to alcoholics and drug addicts and want to 
understand its causes. Do the origins of this increase lie primarily in 
an increase in substance abuse in the general population? In higher 
application rates by substance abusers? In efforts by States to shift 
their welfare caseloads to the Federal government? In SSI outreach? Or 
in other factors?
  The Subcommittees are particularly concerned that administrative 
barriers to treatment and rehabilitation may be contributing to the 
observed program growth.


                       availability of treatment

  Some observers hold that a shortage of treatment is the major barrier 
to rehabilitation of alcoholics and drug addicts. Others hold that 
there is no shortage of treatment facilities but that, due to a lack of 
resources, referral agencies do not have the personnel to place 
substance abusers in available rehabilitation programs. Is there a 
bottleneck in this service delivery system and, if so, where is it?


               reform of the representative payee program

  How does the present availability of SSI and SSDI benefits impinge on 
the success of efforts to treat substance abusers? Should the duration 
of cash benefits be limited? Should drug addicts and alcoholics be 
given vouchers for residential treatment instead of cash benefits? How 
frequently do family members and friends who serve as representative 
payees serve as a conduit to drugs and alcohol? Should family members 
and friends be prohibited from serving as representative payees? Should 
rehabilitation facilities be permitted to serve as representative 
payees? Are there additional SSI or SSDI program requirements that 
would be likely to improve rates of rehabilitation? If so, what are 
they?
  Before the adjournment of the second session of the 103rd Congress, 
reform of the welfare system, including changes in both the SSI and 
SSDI system, should be a reality. And I pledge to contribute to that 
end.

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