Duggan said the disability plan has been running on autopilot for decades and lawmakers could find savings to help avoid the scheduled cuts. While federally financed, the program is administered by the states and disability rates among them vary widely. West Virginia topped the list in 2010, with 9 percent of residents between ages 18 and 64 receiving aid. Utah and Alaska had the lowest rates at 2.8 percent.
Subjective Conditions
People whose benefit applications are rejected can appeal to administrative law judges, and statistics show some judges are far more likely to approve benefits than others. One reason is that the program, which once focused largely on people who suffered from strokes, cancer and heart attacks, increasingly supports those with depression, back pain, chronic fatigue syndrome and other comparatively subjective conditions.
"They're very, very hard to evaluate," said Nicole Maestas, director of the RAND Center for Disability Research. "Reasonable people differ about what constitutes a disability."
Statistics show that once people enter the program they are unlikely to leave, with fewer than 1 percent rejoining the workforce. Many worked "menial" jobs that didn't offer health insurance and the program gives them an opportunity to join Medicare long before they might otherwise qualify, Nibali said.
"Many want to be on the disability rolls not necessarily for the cash income but for the medical coverage," he said. "That's a real plus for them."
Review Backlog
The agency faces a backlog of 1.4 million reviews it's supposed to periodically conduct to ensure beneficiaries are entitled to stay on the rolls. The agency has said it doesn't have the money to do the reviews.
Lawmakers haven't made major cuts in the program since President Ronald Reagan's administration, and Congress reversed those changes after a public outcry.
Amid concerns about increasing disability rolls and wasteful spending, the agency in 1981 began stricter screening of beneficiaries. It halted aid to hundreds of thousands.
Lawmakers were besieged with constituents' complaints of unfairly being cut off. Some people lost their homes or killed themselves after being dropped.