By Alex Walsh and William Thornton
Matthew Martin knows plenty about pain medication. Martin, 43, used to work as a freelance writer before the daily pain of Sjogren’s Syndrome, an autoimmune disorder he was diagnosed with in college, forced him to retire.
Today he’s one of more than 237,000 Alabamians on federal disability. Alabama sees a higher percentage of people who are physically unable to work than nearly every other state.
If you include spouses and children, the number of people in Alabama that benefit from the Social Security Administration disability program is nearly 300,000.
That’s more than 6 percent of the population. That means Alabama has the second-highest percentage of residents dependent on federal disability. Only West Virginia sees a higher rate.
Nationwide, nearly 10 million Americans — about 3 percent of the population — are enrolled in the Social Security disability program. Those numbers have been increasing since the early 1980s.
Martin lives in Gadsden, which sees some of the highest enrollments within Alabama. He says he’s not surprised to learn Gadsden has some of the highest rates of disabled workers.
“Every time I go over to the Social Security Administration building at 8:30 in the morning, there’s already 20 people waiting at the door,” he said.
Social Security disability enrollment is higher in the Southeastern U.S. than in other parts of the country. Alabama, West Virginia, Arkansas, Kentucky, and Mississippi are all in the top five for enrollment as a percentage of total population.
Social Security disability enrollment by state
The map below shows which states have a higher share of their population enrolled in the Social Security Administration’s disability insurance program. Enrollment is higher in the Southeast, although not in Georgia or Florida.
Areas that are home to many disabled workers may have a difficult time realizing economic growth, says Keivan Deravi, an economist at Auburn University at Montgomery. “Businesses are aware of this,” Deravi says, citing the availability of labor as a key issue when companies decide where to set up shop. “High-growth businesses will avoid such markets” with high rates of disability, Deravi contends. Alabama’s wide participation in government benefits programs frequently shows up in national income statistics. In June, a report showed that Alabama was 12th among states in income growth. That was to start 2014. But wages and salaries grew by 1 percent. Payments from benefits programs grew at twice that rate, showing the impact that programs like Social Security disability have on Alabamians’ wallets.
Martin in Gadsden used to play tennis in college. In the years since, he has developed rheumatoid arthritis in his hips and shoulders. A broken arm once took six months to heal. On good days, he can play with his children and be mildly active, he said. But his condition continued to worsen over the last five years, making retirement a necessity. Nationally, the most common problems cited by recipients of Social Security disability income are issues with muscle pain. According to the agency, about 30 percent of disabled workers have “musculoskeletal system and connective tissue”-related diagnoses. “I live with pain every day,” Martin said. “My pain is different from a healthy person’s. My good days would disable some people. On some days, I have a lot of swelling and stiffness and can’t move. There are days I’ve needed help to get from the bed to the bathroom. There’s no rhyme or reason for when those days happen.” Alabama’s high enrollment rate may be the legitimate result of a hurting work force. There’s evidence that Alabamians are feeling significant pain more often than residents in other states. A recent CDC study showed that Alabama led the nation in painkiller prescriptions — just ahead of West Virginia, a flip-flop of the top two states in disability enrollment ranks. In general, states with higher rates of painkiller prescriptions have a higher share of their population benefiting from the Social Security Administration’s disability program. The fact that so many Alabamians are being prescribed painkillers suggests it’s likely that physical injuries are preventing at least some disability recipients from working.
Disability and painkillers
The graph below charts painkiller prescriptions per capita by state against disability enrollment as a percentage of the population. It shows that states where residents are prescribed more painkillers are also home to more disability enrollees.
Plus, Alabama has for decades been more reliant on blue-collar, labor-intensive jobs than the nation as a whole. At the start of 1990, nearly 29 percent of all jobs in Alabama involved making things — manufacturing, mining, construction — compared to just 22 percent nationwide.
Goods-producing jobs in the workforce
Compared to the United States, a larger share of total jobs in Alabama operate within a goods-producing industry — manufacturing, construction, mining — rather than a service-industry job, such as finance, information services, or retail.
The gap has shrunk since then, but remains significant.
Any conversation about federal benefits is likely to raise questions about fraud.
“There is zero tolerance for fraud at the Social Security Administration,” says Frank Viera, a deputy regional communications director for the Social Security Administration.
The agency “has an aggressive and ongoing program to prevent, deter, detect, investigate and prosecute fraud involving Social Security programs,” he says. “The public can report fraud and abuse to our Office of Inspector General.”
Nationally, the Social Security Administration saved $165 million through its Cooperative Disability Investigations program in the most recent fiscal year (ended March 2014), with 22 states participating. Alabama did not participate.
That said, the extent to which fraud happens in an individual state was not immediately clear. Searching through the website for the Social Security inspector general’s office yields two links to stories about defrauding the agency, both of which appeared originally at this website.
Elsewhere on the site are links to reports that are labeled as audits of the state of Alabama. But the reports do not provide any information about the frequency of fraud within the system for an individual state.
The national numbers are in line with what Jan Cox, a former Social Security employee currently working as an attorney in Birmingham, has seen in Alabama.
“We see a lot of chronic back pain that develops after a herniated disc where surgery did not alleviate the pain,” Cox says. “Many people have had multiple surgeries and are in pain management.”
Cox adds that those applications are often denied on first attempt by the state because those conditions are difficult to document.
Younger applicants often report suffering from mental ailments, such as bipolar disorder, borderline personality disorder, and post traumatic stress disorder. “Some have intellectual deficits along with a mental disorder,” Cox says.
It’s not easy to qualify for disability.
Just four out of 10 first-time claims by Alabamians are approved, according to monthly agency data.
Each state’s approval rate is between 32 and 62 percent. That means, while enrollment rates are higher in Alabama, denials rates are also higher here than in most states.
(West Virginia, the other state with high rates of both disability enrollment and painkiller prescription, is within a few percentage points of Alabama at a 38 percent approval rate.)
According to Viera, disability payments are designed for Americans who cannot work due to medical condition, and are expected to be out of work for at least a year. Benefits usually last for as long as an individual is disabled.
In most cases, beneficiaries must choose between earning an income or receiving benefits. A person applying for disability benefits for the first time might actively avoid working, so as to improve the chance that their case is approved.
At the same time, Viera says, there are some special cases where beneficiaries can do some work.
“We have special rules to help you get back to work without jeopardizing your initial benefits,” Viera explains. “You may be able to have a trial work period for nine months to test whether you can work.”
The average monthly benefit for a male disabled worker was between $1,200 and $1,300 in 2012, the latest available figure from the Social Security office. The average benefit for a female disabled worker was about $1,000, because women tend to earn less, and benefits are based on incomes earned in the workplace.
Also, there may be more disabled Alabamians who receive assistance. Totals here refer specifically to Americans receiving disability benefits from Social Security due to an inability to find work. This does not count individuals deemed disabled by some other agency (e.g., disability access through the Alabama Motor Vehicle Division), nor does it include those receiving disability benefits through a private insurance policy.
Help or harm?
Despite the disproportionate participation in disability, Alabama officials continue to say they are uneasy with reliance on federal benefits.
The governor’s office declined to comment on the high rate of disability dependence in Alabama.
But Gov. Robert Bentley has said he will not accept the federal government’s proposal to expand Medicaid to help the working poor in Alabama.
“We will never help our poorest citizens, or our future generations by casting over them the net of federal government giveaway programs,” he said during the State of the State address this year. “We can break the cycle of poverty, but not with programs that drag our communities and our people into the downward spiral of dependence.”
Given currently available resources, questions remain about how fraud impacts the Social Security disability benefit system in Alabama. And local-level data shows that the program’s impact reaches statewide. North of Jasper, east of Tuscaloosa, and in the center of Birmingham, the numbers show that hundreds of Alabama residents receive these benefits.
Are you a beneficiary of the Social Security Administration’s disability program? Does someone you know depend on that income? Have you witnessed any attempt at defrauding the system? Use the submission tool below to share your story with us.