Of the many alarmist commentaries on U.S. disability benefits in recent
memory, few have explored state and local governments’ efforts to channel
needy residents toward disability-based income support programs—and to
thereby shift the cost of care onto the federal government. This Essay
documents the rich history of such efforts, going back to the 1980s.
This Essay also emphasizes an inflection point in this history: Starting
in the early 1990s, private, for-profit consulting companies began securing
contracts from states for the “shifting” work that legal aid organizations had
been doing. Simultaneously, these companies marketed their “revenue
maximization” services, encouraging state officials to see federal health and
welfare programs as a resource to be mined. This Essay connects this
extractive mindset to today’s “extractive federalism,” which scholars have
documented in both the foster care and nursing home contexts.
From the state and local perspective, extractive federalism may be
rational: In a context of real or perceived resource scarcity, it secures funds
for public purposes. But these tactics have come at the expense of vulnerable
people. Those whose needs make the federal spigots turn do not necessarily
benefit from the resulting federal dollars. Meanwhile, these tactics obscure
from the public the true nature of federal spending.
