Perceptions of Deservingness and the Politicization of Social Insurance: Evidence From Disability Insurance in the United States

• Author: Albert H. Fang,Gregory A. Huber
• Date: 01 September 2020
• Published date: 01 September 2020
• DOI: 10.1177/1532673X19863439
• Subject Matter: Articles

https://doi.org/10.1177/1532673X19863439

American Politics Research

2020, Vol. 48(5) 543 –559

© The Author(s) 2019

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DOI: 10.1177/1532673X19863439

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Article

How do citizens form opinions about the merits of benefit

provision under social insurance programs? In contrast to

universalistic redistributive social assistance programs,

most social insurance programs require potential beneficia-

ries to contribute ahead of time to be eligible to receive ben-

efits in specific, defined circumstances. These programs

therefore pool risk among a contributing population and are

generally popular relative to redistributive programs that

also serve individuals who are in need.1 However, there is

little scholarship examining whether the basis on which

social insurance beneficiaries are eligible for and receive

assistance affects perceptions of their deservingness. Such

concerns are particularly important for understanding the

contemporary politics of those social insurance programs

where individuals receive benefits only after discretionary

determination of the merit of their claim (as compared with

programs where eligibility is determined by formal objec-

tive criteria like age, as in the case of Social Security and

Medicare). As the size and cost of these “discretionary”

social insurance programs (often involving case-by-case

determinations of the merits of each claim for benefits) have

grown over time, new efforts to scale back these programs

have emerged and appear, in part, to be motivated by con-

cerns that these programs increasingly pay benefits to those

who should not receive them.

Prior work argues that support for redistributive welfare

programs is governed by a “deservingness heuristic,” in

which the willingness to support programs or benefits for

particular beneficiaries is shaped by beliefs about whether

beneficiaries demonstrated they warrant care.2 Perceptions

of the deservingness of welfare beneficiaries in general are

correlated with support for welfare (i.e., cash assistance), and

differences in perceptions of deservingness across individu-

als (e.g., across beneficiaries of different races) are corre-

lated with differences in support for providing benefits to

those individuals (e.g., Appelbaum, 2001; Gilens, 1999).

This raises the question of whether, despite key differences

in program design, the psychological processes explaining

mass attitudes toward program beneficiaries are similar for

social assistance and discretionary social insurance pro-

grams. Specifically, are beneficiaries of discretionary social

insurance programs evaluated on the basis of the same

863439APRXXX10.1177/1532673X19863439American Politics ResearchFang and Huber

research-article2019

1Independent Scholar, Seattle, WA, USA

2Yale University, New Haven, CT, USA

Corresponding Author:

Gregory A. Huber, Forst Family Professor of Political Science,

Department of Political Science and Institution for Social and Policy

Studies, Yale University, New Haven, CT 06520, USA.

Email: gregory.huber@yale.edu

Perceptions of Deservingness and

the Politicization of Social Insurance:

Evidence From Disability Insurance in

the United States

Albert H. Fang1 and Gregory A. Huber2

Abstract

Concerns about the deservingness of policy beneficiaries appear to explain skepticism about redistributive social assistance

programs. Many social insurance programs, despite requiring beneficiaries to pay in ahead of time, require discretionary

evaluations of the merits of claims for benefits. Do perceptions of deservingness also affect attitudes toward these

discretionary social insurance programs? Examining the politics of Social Security Disability Insurance (SSDI), a program

whose size and beneficiaries have been increasingly politicized, we investigate these questions by analyzing novel survey data

and two experiments conducted on national surveys. We show that people use information about a beneficiary’s eligibility-

determining impairment—but not their race, which prior work argues is a key heuristic—to infer their deservingness.

Moreover, support for SSDI is responsive to policy arguments emphasizing the program’s social insurance features and

potential abuse. Our findings demonstrate important psychological processes relevant to the contemporary politicization of

social insurance programs involving discretionary eligibility rules.

Keywords

public opinion, policy attitudes, social insurance, deservingness, disability insurance

544 American Politics Research 48(5)

“deservingness heuristic” that prior work shows is a power-

ful predictor of attitudes toward those receiving welfare and

other social assistance programs? And do perceptions of the

race of program beneficiaries, which prior work shows is a

key predictor of attitudes toward support for redistributive

spending (Gilens, 1999), also affect beliefs about the deserv-

ingness of Social Security Disability Insurance (SSDI) recip-

ients? In this regard, SSDI is a useful case for study because

it is not an overtly racialized policy domain, although indi-

viduals may perceive it as such.

We investigate this question using the case of support for

the SSDI program. SSDI is a large and growing social insur-

ance program in the United States that provides cash assis-

tance to individuals who have a severe, long-term disability

that interferes with work.3 Theoretically, SSDI combines a

social insurance program design with support for individuals

who have been determined to have a health-driven disability

that prevents work. It is therefore an ideal case for under-

standing the interplay of these two factors—the requirement

to pay in ahead of time and discretionary determination of

the merit of a claim for receiving benefits—in shaping pro-

gram support. The program is funded by worker payroll

taxes and provides benefits only to those who have met

recent work and earnings requirements. Because of the pro-

gram’s social insurance features such as prior contribution

requirements and the limited basis for claiming benefits,

SSDI (and SSDI recipients) may be broadly popular. In

recent decades, however, the number of individuals success-

fully obtaining SSDI has increased substantially, accompa-

nied by changes in who is participating (increasingly

working-age men) and the basis for being declared disabled

(increasingly certain musculoskeletal and mood disorders)

(Autor & Duggan, 2003). To some observers, these changes

show that the core function of the program has changed from

being last-resort social insurance to a subsidy for individuals

who choose not to work.4 What is unknown, however, is

whether these changes have had any effect on support for

SSDI. Is support for SSDI beneficiaries, or for the program

more generally, related to beliefs about whether those seek-

ing benefits are in fact unable to work, or do the program’s

social insurance features blunt these concerns about deserv-

ingness? Relatedly, if support for SSDI beneficiaries is partly

a function of their perceived deservingness, what are relevant

markers of beneficiaries that people use to form perceptions

of their deservingness? Is beneficiary race a relevant factor

in shaping opinions toward the program despite its social

insurance features and lack of past history of racialization?

A nascent line of political science research examines sup-

port for government-provided health care benefits for sick

individuals and finds that those with diseases that are less

controllable (e.g., due to a pathogen or genetics rather than

failure to exercise) warrant greater support (Jensen &

Petersen, 2017). That research has not examined willingness

to provide cash assistance to individuals with health impair-

ments, which may differ in important respects from the

provision of health care because of the greater possibility of

misuse of cash. Nor has that work examined how determina-

tions of merit are affected by different models for eligibility

for government benefits (e.g., in the case of medical care,

social insurance [like Medicare], means-tested redistributive

programs [like Medicaid], universalistic government provi-

sion, etc.). Finally, whereas the source of an illness may be

an important basis for deciding about the merits of providing

government health care, SSDI is designed to compensate

individuals not for lost health directly, but instead for the

labor income that is lost because an impaired individual is

unable to work. The critical question in adjudicating the

merit of an SSDI claim, therefore, is whether the claimant is

able to work, which, in addition to evaluating whether the

person is sick, requires determining whether or not they

could work. Thus, even if one broadly believe that sick indi-

viduals are deserving of government health care, we do not

know if the basis on which one claims medical impairment

affects perceptions of deservingness in the social insurance

context.

In particular, building on prior theoretical work on deserv-

ingness perceptions, we expect that individuals combine

cues about beneficiary-level attributes (such as the impair-

ment they have) and group stereotypes (about beneficiaries

possessing specific attributes) to form judgments about their

deservingness as a function of those attributes. We focus on

ease of diagnosis, by which we mean the degree to which an

impairment is readily verifiable as preventing work, as a key

measure of deservingness (e.g., the true merit of a claim). We

expect increased perceptions of undeservingness to be asso-

ciated with reduced support for a social insurance program

like SSDI and its beneficiaries. The need for a discretionary

evaluation of the merit of a person’s claim may therefore

counteract the general popularity that accompanies social

insurance programs where beneficiaries pay into those pro-

grams ahead of time. In addition, we compare the effect of

beneficiary impairment with another possible marker of

deservingness, beneficiary race, to understand the similarity

between SSDI and more traditionally racialized policy

domains such as welfare. Finally, in light of these counter-

vailing forces and prior research on policy framing effects

and historical accounts of the politicization of social insur-

ance in the United States, we test whether public support for

social insurance programs is also responsive to policy argu-

ments emphasizing the program’s social insurance features

and potential abuse.

To investigate these expectations, we analyze both obser-

vational and experimental data from a novel nationally rep-

resentative survey, supplemented with additional analysis

from online convenience samples. Specifically, we begin by

measuring knowledge and perceptions of those receiving

disability benefits. We find that, on average, individuals

report being uncertain about whether those who receive dis-

ability could have worked. Thus, despite the social insurance

features of the SSDI program, individuals do have beliefs