Accepted Manuscript People with Disabilities in the United States Debra L. Brucker, PhD, Andrew J. Houtenville, PhD PII:
S0003-9993(15)00214-2
DOI:
10.1016/j.apmr.2015.02.024
Reference:
YAPMR 56130
To appear in:
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Received Date: 20 January 2015 Revised Date:
26 February 2015
Accepted Date: 26 February 2015
Please cite this article as: Brucker DL, Houtenville AJ, People with Disabilities in the United States, ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION (2015), doi: 10.1016/ j.apmr.2015.02.024. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT People with Disabilities in the United States People with Disabilities in the United States
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Debra L. Brucker, PhD
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Andrew J. Houtenville, PhD
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University of New Hampshire
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Institute on Disability
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Acknowledgements: This project was funded by the U.S. Department of Education, National
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Institute for Disability and Rehabilitation Research under cooperative agreement H133B130015.
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The findings and conclusions are those of the authors and do not represent the policy of the
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Department of Education (Edgar, 75,620(b)). The authors retain sole responsibility for any
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errors or omissions.
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Corresponding author:
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Debra L. Brucker
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10 West Edge Drive, Suite 101
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Durham, NH 03824
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Email: [email protected]
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Phone: 603-862-1643
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People with Disabilities in the United States
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Abstract: A recent compilation of published disability statistics available for the United States
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(U.S.) showcases the pervasive and persistent disparities that exist between people with and
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without disabilities across multiple fronts, including employment, earnings, poverty, and
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participation in safety net programs. Understanding the relevance of these statistics within the
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current policy environment can help guide further innovations to improve the lives of persons
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with disabilities in the U.S.
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Introduction
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How are people with disabilities faring in the United States (U.S.)? According to a recent compilation of published disability statistics for the U.S., people with disabilities still lag
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significantly behind their peers without disabilities in terms of employment and earnings.
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Investments in special education and vocational rehabilitation services—services that could
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increase levels of employment—pale in comparison to federal expenditures on health care and
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income support. Poverty rates are higher for people with disabilities than for people without
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disabilities, leading to increased levels of participation in public safety net programs. Rates of
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participation in disability benefit programs are holding relatively steady compared to years past.
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In terms of health-related outcomes, people with disabilities are more likely to be obese and to
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smoke than people without disabilities, yet are more likely than people without disabilities to
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have health insurance coverage. People with disabilities are less likely to binge drink than people
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without disabilities1. More detail about each of these areas is provided below. Taken as a whole,
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however, the facts convey the sustained need for attention at a national level for improving the
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ability of people with disabilities to participate fully in their communities and to have access to
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appropriate services and supports. Fortunately, there are a number of national policy initiatives
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underway that have the potential to improve key outcomes for people with disabilities.
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Each year, different agencies within the federal government collect a vast amount of information that can be used to understand the scope and complexity of disability in the U.S.
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Synthesizing this information into a cohesive picture of disability can benefit the work of the
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many advocates, health care practitioners, policy makers, researchers, and service providers that
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seek to improve the lives of people with disabilities. Researchers at the University of New
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Hampshire’s Institute on Disability annually compile this information into one document, an
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annual Compendium of disability statistics2. The Compendium can be accessed by the public in
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hard copy and online. Research staff members are available to assist with any questions about the
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data. The Compendium and its companion annual report 3provide ‘just the facts’, however. The
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purpose of this paper is to assess the key patterns and trends evident in the data, describing
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findings within the current policy development framework.
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Prevalence of disability
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Before examining particular outcomes, an understanding of the size of the population
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with disabilities in the U.S. is required. A seemingly innocuous question such as, “How many
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people with disabilities reside in the U.S.?” can be challenging to answer, however, as available
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administrative and survey data provide disparate results. Administrative data, data collected by
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federal or other agencies, is limited in that such data only enumerates the number of people with
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a disability within a particular service delivery population. Survey data, while able to capture a
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broader population, has limitations as well. Based on data from the American Community
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Survey (ACS), 12.7 percent of the 314.8 million civilians living in the community in the U.S. in
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2013 had a disability4. Many of the disability prevalence estimates routinely provided by the
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ACS are for the non-institutionalized population, people who are not residing in jails, long-term
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care facilities, prisons, or psychiatric hospitals, even though the ACS collects data on these
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individuals. This ignores a large section of the disabled population5. In addition, the ACS uses a
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set of six questions to identify people with disabilities. The six questions gather information
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about the existence of functional, sensory and activity limitations at the individual level, but have
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been shown to miss a substantial portion of the population with disabilities6. Given these
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limitations, it is safe to say that estimates from the ACS likely provide a low estimate for the
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number of people with disabilities in the U.S.
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Prevalence estimates from additional surveys, summarized in the Compendium as well,
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can provide varied estimates, due to differences in the definitions and data collection processes
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used to compile data. The Survey of Income and Program Participation (SIPP), for example,
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asks respondents more detailed questions about health conditions, activity limitations and
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functional limitations, providing a greater level of detail about disability. Estimates from the
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2010 SIPP suggest that 18.7 percent of the U.S. population has a disability – six percentage
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points higher than the estimate from the ACS7. Using just these two estimates, we can state
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conservatively that between 40 million and 57 million Americans are living with a disability.
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The prevalence of disability varies by sub-population. Data from the ACS and SIPP demonstrate, for example, how disability prevalence increases with age. Similarly, results from
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the latest Behavioral Risk Factor Surveillance Survey (BRFSS) suggest that disability prevalence
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is higher when considering just the adult population, with nearly 22 percent of adults age 18 and
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older having a disability. Veterans experience disability at higher rates than the general
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population. In 2013, approximately 29 percent of the 19.3 million veterans age 18 and over
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living in the community in the U.S. had a disability8.
Employment
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Disparities between people with and without disabilities exist on multiple fronts,
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including employment9. A large gap between the employment rates of people with and without
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disabilities currently exists, although the size of this gap varies across states and by type of
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limitation. For the nation as a whole, 34 percent of people with disabilities and 74 percent of
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people without disabilities who were a part of the labor force were employed during 201310.
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Persons who are a part of the labor force are defined as those working or looking for work. The
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employment gap has persisted over time, as evidenced by trend data available in the
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Compendium. The trend data provided in the Compendium is based on historical data from the
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Current Population Survey (CPS), data which uses a different definition of disability than the
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data provided through the ACS. The definition used in the trend data considers disability as
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solely a limitation in the ability to work and therefore undercounts people with disabilities.
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Although this definition of disability has been expanded in the CPS by the use of the six
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disability questions included in other federal surveys since 2008, the use of just this ‘work
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disability’ question allows for comparison of data over a longer period of time.
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To place things in somewhat of a historical context then, CPS data show that in 1981, seven percent of non-institutionalized civilians age 16 to 64 reported a work limitation. By 2014,
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the percent of people age 16 to 64 reporting a work limitation had increased only slightly to eight
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percent. Although the percent of people reporting a work limitation has remained fairly constant
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since 1981, participation in the labor force (working or looking for work) has steeply decreased
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for people with disabilities, from 29 percent in 1981 to 16 percent in 2014. In contrast, labor
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force participation for people without disabilities increased slightly, from 76 percent in 1981 to
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78 percent in 2014. Looking more specifically at employment, 25 percent of people with a work
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limitation were employed in 1981 and 13 percent of people with a work limitation were
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employed in 2014. The percent of people without disabilities who were employed remained
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fairly stable, increasing from 70 percent in 1981 to 72 percent in 2014. For people with
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disabilities, the change in the full-time/full-year employment rate is particularly concerning,
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decreasing from 12 percent in 1981 to less than six percent in 2014. Lastly, disparities in
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earnings exist between people with and without disabilities for people who are employed. In
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2013, median earnings were $20,785 for people with disabilities, substantially lower than the
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median earnings for people without disabilities ($30,728).
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Research seeks to disentangle the possible effects of demographic, economic, and
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legislative factors that might have influenced this downward trend. The changing composition of
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available jobs and the structure of the public disability benefit system have been identified as
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possible reasons for this decline in employment 11,12. In addition, some have suggested that the
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unintended consequences of the passage of the Americans with Disabilities Act of 1990 (Public
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Law 101-336, ADA), a civil rights law that prohibits discrimination against people with
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disabilities in employment as well as in other areas of public life, has negatively influenced
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employment13. The likely answer is a complex interaction of many factors, including those listed
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here. Regardless, the bottom line is that many people with disabilities are disengaged from the
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work force.
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In recent years, the Social Security Administration (SSA) has funded the implementation
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of four demonstration projects designed to increase the economic security of its disability benefit
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recipients. Assessments of these demonstrations suggest that modest improvements in
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employment are possible14. Research that can help to illuminate, at an individual level, the
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reasons for the declining participation in the labor market can help to drive necessary policy
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changes. One opportunity for a new approach is embedded in the Workforce Investment and
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Opportunity Act (WIOA) of 2014 (Public Law 113-128). In addition to improving access to
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employment services supports, particularly for youth with disabilities, WIOA is encouraging
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state vocational rehabilitation agencies to engage with people with disabilities who are currently
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employed, to assist with job retention. This approach would seem to be particularly relevant for
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the population which ages into having a disability.
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The Compendium includes data about special education services and vocational
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rehabilitation services, two services which are directly connected to employment outcomes. Over
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eight percent of students age 6 to 21 were served under the Individuals with Disabilities
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Education Act (IDEA) during the fall of 2012 (5.7 million youth). Most (2.3 million) had
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specific learning disabilities. Eighty-one percent of the youth served under IDEA were served in
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a regular classroom environment. This varied by state, from a low of 69 percent in New York
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State to a high of 93 percent in North Dakota. Transitioning youth with disabilities from the
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supports available under IDEA and in the childhood Supplemental Security Income (SSI)
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program into independent living is the focus of a current federal demonstration project, the
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Promoting Readiness among Minors on Supplemental Security Income (PROMISE)
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demonstration. PROMISE, a joint initiative of the U.S. Department of Education, the U.S. SSA,
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the U.S. Department of Health and Human Services and the U.S. Department of Labor, is testing
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new ways of providing and coordinating services for youth who are SSI recipients to facilitate a
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successful transition to the adult work force and independent living15.
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During federal fiscal year 2012, state vocational rehabilitation (VR) agencies helped 177,172 people attain successful employment outcomes, a national rehabilitation rate of 55.5
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percent. Of the total federal fiscal year expenditures of $3.8 billion, an estimated $282 million
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supported higher education expenses for VR consumers. The rehabilitation rate varied by state
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and type of agency – general, combined, blind – with agencies serving blind clients having
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higher rehabilitation rates. Spending for employment related programs accounts for only a small
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portion of overall federal spending to support people with disabilities, however16.
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At the federal level, approximately seven percent of the workforce has a disability. New
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regulations for federal contractors established similar benchmarks and went into effect in March
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of 201417. New partnerships among advocacy groups and business leaders demonstrate some
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innovative approaches that are attempting to improve the employment of people with disabilities
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by also focusing on the employer side. Working collaboratively, the American Association of
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People with Disabilities (AAPD) and the United States Business Leadership Network (USBLN),
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for example, have rolled out a “Disability Equality Index”, a new benchmark tool that scores
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major employers on the favorability of their disability employment policies and practices to
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fostering an inclusive workplace culture. Employers are assessed on culture and leadership,
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enterprise wide access, employment practices, community engagement and support services18.
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Such tools can bring to light the changes that need to occur on the employer side to hire and
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retain more people with disabilities.
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Poverty
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Improving opportunities for employment can address another key issue for people with
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disabilities: poverty. Trend data from the CPS are included in the Compendium and show how
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official poverty has increased over time. Poverty can be measured in different ways and the trend
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data from the CPS use the official measure of poverty, a family-based measure that compares
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family income to set pretax income thresholds that vary by family size and composition19. Using
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this measure, poverty has increased nearly 30 percent for both people with and without a work
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limitation since 1981, although the poverty rate for people with disabilities is consistently and
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substantially higher. In 1981, 25 percent of people with a work limitation were in poverty. This
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percent grew to 32 percent in 2014. A similar rate of growth in poverty is seen among people
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without a work limitation, from 10 percent in 1981 to 12 percent in 2014.
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The Compendium also includes information that highlights poverty among veterans.
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Although more than $63 billion in compensation and pension benefits was provided to veterans
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with service-connected disabilities in 2013, veterans with disabilities are still more likely to be in
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poverty than veterans without disabilities. Employment services and supports are available to
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veterans, however.
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More attention is being paid within the U.S.to exploring the association between poverty
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and disability. Recently, Brucker et al.20 examined four different measures of poverty among
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working age people with and without disabilities and found that people with disabilities fare
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worse in terms of poverty, whatever the measure. In September 2014, the U.S. Senate Health,
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Education, Labor, and Pensions Committee released their investigation of the barriers that people
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with disabilities face as they seek to rise out of poverty. The key barriers that they identified
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included cultural biases and prejudices, challenges with the current system of public programs
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and supports that would allow for a transition to the middle class, a lack of accessible housing
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and transportation, and continuous need for improving access to high quality education for
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students with disabilities21.
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The Achieving a Better Life Experience Act (ABLE) (HR 647/S.313) was introduced in the 133th Congress and aims to improve economic self-sufficiency for people with disabilities by
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making tax-free savings accounts available to people who became disabled by the age of 26.
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Funds in the accounts can be used to cover qualified expenses including education, housing and
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transportation. ABLE was signed into law in December 201422.
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Public programs
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Benefit programs administered by the SSA provide an important source of income support to millions of Americans with disabilities23. The SSI program provides monthly income
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to low-income people with disabilities. In December 2012, more than 7 million people with
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disabilities were receiving over $46 billion of SSI benefits. Approximately 1.3 million SSI
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recipients were children, under age 18. The Social Security Disability Insurance (SSDI) program
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is a social insurance program that provides monthly income to disabled workers and their
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dependents. In December 2013, 8.6 million disabled workers received SSDI. Approximately 1.4
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million people were receiving both SSDI and SSI. The SSDI program is currently being
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scrutinized for reform, given that the trust fund will not be able to fully fund benefits by 2016.
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Much of the program’s growth, however, can be attributed to demographic factors including
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population growth, aging of baby boomers, rise in women’s labor force participation, rise in SS
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full retirement age24. A number of national employment demonstrations designed to slow or
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reduce the growth in public disability benefit receipt have been tested in recent years, with
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minimal success on the whole. Interventions that appeared most promising were those that
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focused on narrow subpopulations including younger people and people with mental health
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disorders25.
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Health
Data from the Behavioral Health Risk Factor Surveillance System demonstrate that
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people with disabilities have higher rates of some risky health behaviors than people without
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disabilities. Twenty-five percent of adults with disabilities and 16 percent of adults without
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disabilities smoked during 2013. People with disabilities are more likely to be obese, with 40
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percent of people with disabilities and 25 percent of people without disabilities obese in 2013.
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People with disabilities were less likely to report binge drinking, however, with 12 percent of
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adults with disabilities and 18 percent of adults without disabilities reporting binge drinking. The
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BRFSS also provides data on health care coverage, providing similar estimates to those found
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using the ACS.
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On a positive note, people with disabilities are slightly more likely to have insurance than
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people without disabilities. In 2013, 84 percent of working age people with a disability had
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health insurance coverage and 81 percent of working age people without a disability had health
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insurance coverage. Among working age people with disabilities, 44 percent had private
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insurance coverage and 51 percent had public insurance coverage. Medicaid provides health care
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coverage to low income individuals. Nearly 10 million people with disabilities were covered by
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Medicaid at some point during fiscal year 2011. While these 10 million people comprised
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approximately 14 percent of the total number of Medicaid recipients in the U.S., Medicaid
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payments for people with disabilities, at $155 billion, comprised 43 percent of all Medicaid
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payments. Medicare provides health care coverage to older adults and adults who are receiving
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SSDI. In July 2012, 8.4 million people with disabilities were enrolled in Medicare. People with
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disabilities accounted for 17 percent of the total 50 million people enrolled in Medicare and for
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20 percent of total $345 billion in Medicare costs. While having health coverage is certainly
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important, recent research has suggested that people with disabilities still face substantial
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financial and structural barriers in accessing timely health care26.
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Conclusion
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People with disabilities are a substantial part of the U.S. population, yet, according to the most recent results from a variety of data sources contained in the Compendium, disparities
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between people with and without disabilities are pervasive and persistent across multiple fronts,
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including employment, earnings, poverty, and participation in safety net programs. Government
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support of employment services continues to lag behind support of health care and income
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maintenance programs. New government initiatives are designed to address these disparities by
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adjusting current programs and improving coordination of education and employment services.
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In the coming years, the Compendium will continue to monitor these patterns and trends to see if
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any progress is being made.
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References 1
Houtenville, A., Debra L. Brucker, and Eric Lauer. Annual Compendium of disability statistics.
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Houtenville, A., Debra L. Brucker, and Eric Lauer. Annual Compendium of disability statistics. Durham: Institute on Disability/UCED, 2014. Print.
Stoddard, Susan. 2014 Disability Statistics Annual Report. Durham: Institute on
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Durham: Institute on Disability/UCED, 2014. Print.
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Stapleton, David, Todd Honeycutt, and Bruce Schechter. "Out of sight, out of mind: Including
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group quarters residents with household residents can change what we know about working-age people with disabilities." Demography 49.1 (2012): 267-289. 6
Burkhauser, Richard V., Andrew J. Houtenville, and Jennifer R. Tennant. "Capturing the
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“Annual estimates from the American Community Survey.” U.S. Census Bureau. (2014). Web.
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Brucker, Debra L., et al. "More Likely to Be Poor Whatever the Measure: Working‐Age Persons with Disabilities in the United States." Social Science Quarterly. (2014).
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Houtenville, A., Debra L. Brucker, and Eric Lauer. Annual Compendium of disability statistics. Durham: Institute on Disability/UCED, 2014. Print.
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Bound, John, Stephan Lindner, and Timothy Waidmann. "Reconciling findings on the employment effect of disability insurance." IZA Journal of Labor Policy 3.1 (2014): 11. Burkhauser, Richard V., and Mary Daly. The declining work and welfare of people with
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disabilities: What went wrong and a strategy for change. AEI Press. (2011). 13
Acemoglu, Daron, and Joshua Angrist. Consequences of employment protection? The case of
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the Americans with Disabilities Act. No. w6670. National bureau of economic research. (1998).
Mann, David R., and David Wittenburg. Back to Work: Recent SSA Employment
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Demonstrations for People with Disabilities. No. 7485. Mathematica Policy Research, 2012. 15
Fraker, Thomas, et al. "Promoting Readiness of Minors in SSI (PROMISE) evaluating design report." Washington, DC: Mathematica Policy Research . (2014). Livermore, Gina, David Stapleton, and Megan O’Toole. (2011). Health care costs are a key
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driver of growth in federal and state assistance to working-age people with disabilities.
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Health Affairs, 30. 9. (2014):1664-1674.
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“Disability Equality Index FAQs”. AAPD. (2014). Web.
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Short, Kathleen. "The research supplemental poverty measure: 2010." Current Population Reports. (2011): 60-241.
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Brucker, Debra L., and Andrew J. Houtenville. "Living on the edge: Assessing the economic impacts of potential disability benefit reductions for Social Security disability beneficiaries." Journal of Vocational Rehabilitation 41.3 (2014): 209-223. 15
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“Fulfilling the Promise: Overcoming persistent barriers to economic self-sufficiency for people with disabilities.” U.S. Senate HELP Committee. (2014). Web. Crenshaw, Ander. “ABLE Act”. Ander Crenshaw - United States Congressman for Florida's
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4th District. (2014). Web. 23
Brucker, Debra L., and Andrew J. Houtenville. "Living on the edge: Assessing the economic
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impacts of potential disability benefit reductions for Social Security disability beneficiaries." Journal of Vocational Rehabilitation 41.3 (2014): 209-223.
Ruffing, Kathy A. "Social Security Disability Insurance is Vital to Workers With Severe
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Impairments." Center on Budget and Policy Priorities .(2012). 25
Wittenburg, David, David R. Mann, and Allison Thompkins. "The disability system and programs to promote employment for people with disabilities." IZA Journal of Labor Policy 2.1 (2013): 1-25.
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Hyde, Jody Schimmel, and Gina A. Livermore. "Gaps in Timely Access to Care Among Workers by Disability Status Will the Patient Protection and Affordable Care Act
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S0003-9993(15)00214-2
DOI:
10.1016/j.apmr.2015.02.024
Reference:
YAPMR 56130
To appear in:
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Received Date: 20 January 2015 Revised Date:
26 February 2015
Accepted Date: 26 February 2015
Please cite this article as: Brucker DL, Houtenville AJ, People with Disabilities in the United States, ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION (2015), doi: 10.1016/ j.apmr.2015.02.024. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT People with Disabilities in the United States People with Disabilities in the United States
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Debra L. Brucker, PhD
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Andrew J. Houtenville, PhD
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University of New Hampshire
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Institute on Disability
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Acknowledgements: This project was funded by the U.S. Department of Education, National
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Institute for Disability and Rehabilitation Research under cooperative agreement H133B130015.
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The findings and conclusions are those of the authors and do not represent the policy of the
13
Department of Education (Edgar, 75,620(b)). The authors retain sole responsibility for any
14
errors or omissions.
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Corresponding author:
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Debra L. Brucker
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10 West Edge Drive, Suite 101
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Durham, NH 03824
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Email: [email protected]
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Phone: 603-862-1643
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1
People with Disabilities in the United States
2
Abstract: A recent compilation of published disability statistics available for the United States
4
(U.S.) showcases the pervasive and persistent disparities that exist between people with and
5
without disabilities across multiple fronts, including employment, earnings, poverty, and
6
participation in safety net programs. Understanding the relevance of these statistics within the
7
current policy environment can help guide further innovations to improve the lives of persons
8
with disabilities in the U.S.
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Introduction
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How are people with disabilities faring in the United States (U.S.)? According to a recent compilation of published disability statistics for the U.S., people with disabilities still lag
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significantly behind their peers without disabilities in terms of employment and earnings.
15
Investments in special education and vocational rehabilitation services—services that could
16
increase levels of employment—pale in comparison to federal expenditures on health care and
17
income support. Poverty rates are higher for people with disabilities than for people without
18
disabilities, leading to increased levels of participation in public safety net programs. Rates of
19
participation in disability benefit programs are holding relatively steady compared to years past.
20
In terms of health-related outcomes, people with disabilities are more likely to be obese and to
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smoke than people without disabilities, yet are more likely than people without disabilities to
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have health insurance coverage. People with disabilities are less likely to binge drink than people
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without disabilities1. More detail about each of these areas is provided below. Taken as a whole,
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however, the facts convey the sustained need for attention at a national level for improving the
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ability of people with disabilities to participate fully in their communities and to have access to
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appropriate services and supports. Fortunately, there are a number of national policy initiatives
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underway that have the potential to improve key outcomes for people with disabilities.
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Each year, different agencies within the federal government collect a vast amount of information that can be used to understand the scope and complexity of disability in the U.S.
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Synthesizing this information into a cohesive picture of disability can benefit the work of the
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many advocates, health care practitioners, policy makers, researchers, and service providers that
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seek to improve the lives of people with disabilities. Researchers at the University of New
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Hampshire’s Institute on Disability annually compile this information into one document, an
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annual Compendium of disability statistics2. The Compendium can be accessed by the public in
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hard copy and online. Research staff members are available to assist with any questions about the
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data. The Compendium and its companion annual report 3provide ‘just the facts’, however. The
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purpose of this paper is to assess the key patterns and trends evident in the data, describing
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findings within the current policy development framework.
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Prevalence of disability
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Before examining particular outcomes, an understanding of the size of the population
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with disabilities in the U.S. is required. A seemingly innocuous question such as, “How many
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people with disabilities reside in the U.S.?” can be challenging to answer, however, as available
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administrative and survey data provide disparate results. Administrative data, data collected by
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federal or other agencies, is limited in that such data only enumerates the number of people with
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a disability within a particular service delivery population. Survey data, while able to capture a
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broader population, has limitations as well. Based on data from the American Community
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Survey (ACS), 12.7 percent of the 314.8 million civilians living in the community in the U.S. in
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2013 had a disability4. Many of the disability prevalence estimates routinely provided by the
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ACS are for the non-institutionalized population, people who are not residing in jails, long-term
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care facilities, prisons, or psychiatric hospitals, even though the ACS collects data on these
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individuals. This ignores a large section of the disabled population5. In addition, the ACS uses a
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set of six questions to identify people with disabilities. The six questions gather information
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about the existence of functional, sensory and activity limitations at the individual level, but have
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been shown to miss a substantial portion of the population with disabilities6. Given these
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limitations, it is safe to say that estimates from the ACS likely provide a low estimate for the
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number of people with disabilities in the U.S.
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Prevalence estimates from additional surveys, summarized in the Compendium as well,
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can provide varied estimates, due to differences in the definitions and data collection processes
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used to compile data. The Survey of Income and Program Participation (SIPP), for example,
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asks respondents more detailed questions about health conditions, activity limitations and
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functional limitations, providing a greater level of detail about disability. Estimates from the
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2010 SIPP suggest that 18.7 percent of the U.S. population has a disability – six percentage
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points higher than the estimate from the ACS7. Using just these two estimates, we can state
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conservatively that between 40 million and 57 million Americans are living with a disability.
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The prevalence of disability varies by sub-population. Data from the ACS and SIPP demonstrate, for example, how disability prevalence increases with age. Similarly, results from
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the latest Behavioral Risk Factor Surveillance Survey (BRFSS) suggest that disability prevalence
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is higher when considering just the adult population, with nearly 22 percent of adults age 18 and
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older having a disability. Veterans experience disability at higher rates than the general
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population. In 2013, approximately 29 percent of the 19.3 million veterans age 18 and over
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living in the community in the U.S. had a disability8.
Employment
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Disparities between people with and without disabilities exist on multiple fronts,
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including employment9. A large gap between the employment rates of people with and without
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disabilities currently exists, although the size of this gap varies across states and by type of
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limitation. For the nation as a whole, 34 percent of people with disabilities and 74 percent of
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people without disabilities who were a part of the labor force were employed during 201310.
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Persons who are a part of the labor force are defined as those working or looking for work. The
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employment gap has persisted over time, as evidenced by trend data available in the
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Compendium. The trend data provided in the Compendium is based on historical data from the
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Current Population Survey (CPS), data which uses a different definition of disability than the
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data provided through the ACS. The definition used in the trend data considers disability as
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solely a limitation in the ability to work and therefore undercounts people with disabilities.
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Although this definition of disability has been expanded in the CPS by the use of the six
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disability questions included in other federal surveys since 2008, the use of just this ‘work
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disability’ question allows for comparison of data over a longer period of time.
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To place things in somewhat of a historical context then, CPS data show that in 1981, seven percent of non-institutionalized civilians age 16 to 64 reported a work limitation. By 2014,
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the percent of people age 16 to 64 reporting a work limitation had increased only slightly to eight
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percent. Although the percent of people reporting a work limitation has remained fairly constant
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since 1981, participation in the labor force (working or looking for work) has steeply decreased
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for people with disabilities, from 29 percent in 1981 to 16 percent in 2014. In contrast, labor
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force participation for people without disabilities increased slightly, from 76 percent in 1981 to
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78 percent in 2014. Looking more specifically at employment, 25 percent of people with a work
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limitation were employed in 1981 and 13 percent of people with a work limitation were
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employed in 2014. The percent of people without disabilities who were employed remained
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fairly stable, increasing from 70 percent in 1981 to 72 percent in 2014. For people with
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disabilities, the change in the full-time/full-year employment rate is particularly concerning,
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decreasing from 12 percent in 1981 to less than six percent in 2014. Lastly, disparities in
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earnings exist between people with and without disabilities for people who are employed. In
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2013, median earnings were $20,785 for people with disabilities, substantially lower than the
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median earnings for people without disabilities ($30,728).
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Research seeks to disentangle the possible effects of demographic, economic, and
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legislative factors that might have influenced this downward trend. The changing composition of
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available jobs and the structure of the public disability benefit system have been identified as
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possible reasons for this decline in employment 11,12. In addition, some have suggested that the
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unintended consequences of the passage of the Americans with Disabilities Act of 1990 (Public
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Law 101-336, ADA), a civil rights law that prohibits discrimination against people with
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disabilities in employment as well as in other areas of public life, has negatively influenced
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employment13. The likely answer is a complex interaction of many factors, including those listed
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here. Regardless, the bottom line is that many people with disabilities are disengaged from the
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work force.
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In recent years, the Social Security Administration (SSA) has funded the implementation
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of four demonstration projects designed to increase the economic security of its disability benefit
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recipients. Assessments of these demonstrations suggest that modest improvements in
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employment are possible14. Research that can help to illuminate, at an individual level, the
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reasons for the declining participation in the labor market can help to drive necessary policy
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changes. One opportunity for a new approach is embedded in the Workforce Investment and
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Opportunity Act (WIOA) of 2014 (Public Law 113-128). In addition to improving access to
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employment services supports, particularly for youth with disabilities, WIOA is encouraging
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state vocational rehabilitation agencies to engage with people with disabilities who are currently
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employed, to assist with job retention. This approach would seem to be particularly relevant for
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the population which ages into having a disability.
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The Compendium includes data about special education services and vocational
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rehabilitation services, two services which are directly connected to employment outcomes. Over
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eight percent of students age 6 to 21 were served under the Individuals with Disabilities
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Education Act (IDEA) during the fall of 2012 (5.7 million youth). Most (2.3 million) had
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specific learning disabilities. Eighty-one percent of the youth served under IDEA were served in
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a regular classroom environment. This varied by state, from a low of 69 percent in New York
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State to a high of 93 percent in North Dakota. Transitioning youth with disabilities from the
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supports available under IDEA and in the childhood Supplemental Security Income (SSI)
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program into independent living is the focus of a current federal demonstration project, the
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Promoting Readiness among Minors on Supplemental Security Income (PROMISE)
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demonstration. PROMISE, a joint initiative of the U.S. Department of Education, the U.S. SSA,
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the U.S. Department of Health and Human Services and the U.S. Department of Labor, is testing
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new ways of providing and coordinating services for youth who are SSI recipients to facilitate a
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successful transition to the adult work force and independent living15.
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During federal fiscal year 2012, state vocational rehabilitation (VR) agencies helped 177,172 people attain successful employment outcomes, a national rehabilitation rate of 55.5
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percent. Of the total federal fiscal year expenditures of $3.8 billion, an estimated $282 million
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supported higher education expenses for VR consumers. The rehabilitation rate varied by state
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and type of agency – general, combined, blind – with agencies serving blind clients having
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higher rehabilitation rates. Spending for employment related programs accounts for only a small
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portion of overall federal spending to support people with disabilities, however16.
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At the federal level, approximately seven percent of the workforce has a disability. New
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regulations for federal contractors established similar benchmarks and went into effect in March
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of 201417. New partnerships among advocacy groups and business leaders demonstrate some
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innovative approaches that are attempting to improve the employment of people with disabilities
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by also focusing on the employer side. Working collaboratively, the American Association of
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People with Disabilities (AAPD) and the United States Business Leadership Network (USBLN),
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for example, have rolled out a “Disability Equality Index”, a new benchmark tool that scores
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major employers on the favorability of their disability employment policies and practices to
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fostering an inclusive workplace culture. Employers are assessed on culture and leadership,
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enterprise wide access, employment practices, community engagement and support services18.
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Such tools can bring to light the changes that need to occur on the employer side to hire and
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retain more people with disabilities.
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Poverty
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Improving opportunities for employment can address another key issue for people with
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disabilities: poverty. Trend data from the CPS are included in the Compendium and show how
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official poverty has increased over time. Poverty can be measured in different ways and the trend
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data from the CPS use the official measure of poverty, a family-based measure that compares
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family income to set pretax income thresholds that vary by family size and composition19. Using
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this measure, poverty has increased nearly 30 percent for both people with and without a work
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limitation since 1981, although the poverty rate for people with disabilities is consistently and
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substantially higher. In 1981, 25 percent of people with a work limitation were in poverty. This
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percent grew to 32 percent in 2014. A similar rate of growth in poverty is seen among people
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without a work limitation, from 10 percent in 1981 to 12 percent in 2014.
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The Compendium also includes information that highlights poverty among veterans.
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Although more than $63 billion in compensation and pension benefits was provided to veterans
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with service-connected disabilities in 2013, veterans with disabilities are still more likely to be in
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poverty than veterans without disabilities. Employment services and supports are available to
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veterans, however.
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More attention is being paid within the U.S.to exploring the association between poverty
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and disability. Recently, Brucker et al.20 examined four different measures of poverty among
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working age people with and without disabilities and found that people with disabilities fare
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worse in terms of poverty, whatever the measure. In September 2014, the U.S. Senate Health,
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Education, Labor, and Pensions Committee released their investigation of the barriers that people
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with disabilities face as they seek to rise out of poverty. The key barriers that they identified
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included cultural biases and prejudices, challenges with the current system of public programs
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and supports that would allow for a transition to the middle class, a lack of accessible housing
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and transportation, and continuous need for improving access to high quality education for
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students with disabilities21.
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The Achieving a Better Life Experience Act (ABLE) (HR 647/S.313) was introduced in the 133th Congress and aims to improve economic self-sufficiency for people with disabilities by
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making tax-free savings accounts available to people who became disabled by the age of 26.
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Funds in the accounts can be used to cover qualified expenses including education, housing and
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transportation. ABLE was signed into law in December 201422.
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Benefit programs administered by the SSA provide an important source of income support to millions of Americans with disabilities23. The SSI program provides monthly income
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to low-income people with disabilities. In December 2012, more than 7 million people with
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disabilities were receiving over $46 billion of SSI benefits. Approximately 1.3 million SSI
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recipients were children, under age 18. The Social Security Disability Insurance (SSDI) program
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is a social insurance program that provides monthly income to disabled workers and their
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dependents. In December 2013, 8.6 million disabled workers received SSDI. Approximately 1.4
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million people were receiving both SSDI and SSI. The SSDI program is currently being
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scrutinized for reform, given that the trust fund will not be able to fully fund benefits by 2016.
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Much of the program’s growth, however, can be attributed to demographic factors including
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population growth, aging of baby boomers, rise in women’s labor force participation, rise in SS
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full retirement age24. A number of national employment demonstrations designed to slow or
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reduce the growth in public disability benefit receipt have been tested in recent years, with
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minimal success on the whole. Interventions that appeared most promising were those that
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focused on narrow subpopulations including younger people and people with mental health
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disorders25.
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Data from the Behavioral Health Risk Factor Surveillance System demonstrate that
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people with disabilities have higher rates of some risky health behaviors than people without
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disabilities. Twenty-five percent of adults with disabilities and 16 percent of adults without
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disabilities smoked during 2013. People with disabilities are more likely to be obese, with 40
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percent of people with disabilities and 25 percent of people without disabilities obese in 2013.
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People with disabilities were less likely to report binge drinking, however, with 12 percent of
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adults with disabilities and 18 percent of adults without disabilities reporting binge drinking. The
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BRFSS also provides data on health care coverage, providing similar estimates to those found
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using the ACS.
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On a positive note, people with disabilities are slightly more likely to have insurance than
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people without disabilities. In 2013, 84 percent of working age people with a disability had
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health insurance coverage and 81 percent of working age people without a disability had health
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insurance coverage. Among working age people with disabilities, 44 percent had private
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insurance coverage and 51 percent had public insurance coverage. Medicaid provides health care
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coverage to low income individuals. Nearly 10 million people with disabilities were covered by
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Medicaid at some point during fiscal year 2011. While these 10 million people comprised
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approximately 14 percent of the total number of Medicaid recipients in the U.S., Medicaid
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payments for people with disabilities, at $155 billion, comprised 43 percent of all Medicaid
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payments. Medicare provides health care coverage to older adults and adults who are receiving
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SSDI. In July 2012, 8.4 million people with disabilities were enrolled in Medicare. People with
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disabilities accounted for 17 percent of the total 50 million people enrolled in Medicare and for
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20 percent of total $345 billion in Medicare costs. While having health coverage is certainly
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important, recent research has suggested that people with disabilities still face substantial
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financial and structural barriers in accessing timely health care26.
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Conclusion
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People with disabilities are a substantial part of the U.S. population, yet, according to the most recent results from a variety of data sources contained in the Compendium, disparities
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between people with and without disabilities are pervasive and persistent across multiple fronts,
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including employment, earnings, poverty, and participation in safety net programs. Government
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support of employment services continues to lag behind support of health care and income
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maintenance programs. New government initiatives are designed to address these disparities by
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adjusting current programs and improving coordination of education and employment services.
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In the coming years, the Compendium will continue to monitor these patterns and trends to see if
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any progress is being made.
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