Cornell Law Review Volume 92 Issue 2

Medical Proof, Social Policy, and Social Security’s Medically Centered Definition of Disability

Disability is one of the well-known categories of “deserving poor” that have defined eligibility for public benefit programs in the United States since the colonial period. Yet the first major federal public benefits law, the Social Security Act of 1935 (the Act), did not include disability as a basis of entitlement. This was in part because the framers of the Act could not decide whether the government should provide disability benefits in the form of public assistance, social insurance, or both. An important lingering concern was that lawmakers would not be able to define disability adequately enough to keep a federal disability benefit program under control. The debate over public assistance versus social insurance ended effectively in a tie in the 1950s when Congress added disability as a basis of eligibility for both programs—first for joint federal-state public assistance programs and then a few years later for the federal social insurance program. Congress dealt with its concern about an open-ended eligibility criterion by enacting a medically centered definition of disability for social insurance, which it later adopted for federal public assistance benefits as well. This definition limits benefits to persons who can show not only that they are unable to work—a term that the Act partially defines as the ability to engage in “substantial gainful activity”—but also that their inability to work is due to a “medically determinable physical or mental impairment.”

 

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