It’s Good Business

Just about a year ago, I wrote a blog entry entitled The Words We Choose Matter. In it, I waxed occasionally eloquent in an effort to expand our thinking when it comes to people with intellectual and/or developmental disabilities (IDD) and their pursuit of lives of quality. Inevitably, I touched on ‘jobs’ versus ‘careers’ and why the distinction really matters.

“Getting a job is a tick-box exercise for the vast, overwhelming majority of people with IDD. We’ve not asked folks with IDD when they’re kids about what they dream of becoming someday. Our school-to-life transition programs don’t focus on preparing folks for entry into careers—even while they do a lot of work in finding people jobs. And, our so-called ‘supported employment’ programs across the country, which have effectively been in place for 30+ years, continue to produce few lasting outcomes, with unemployment rates among working-age adults long hovering at 70-80%. Why? Because supported employment is about a JOB. It is not about a career.”

I stick by that sentiment and the words I chose to portray it. But wait. There’s more.

October is Disability Employment Awareness Month. If you’ll indulge me through the balance of this blog, I’ll call it Disability Careers Awareness Month. This isn’t a new thing. In fact, Disability Employment Careers Awareness Month was born in 1945—79 years ago—when it started its life as “National Employ the Physically Handicapped Week.” Today, the Library of Congress describes the purpose of the month as “paying tribute to the accomplishments of the men and women with disabilities whose work helps keep the nation’s economy strong and by reaffirming their commitment to ensure equal opportunity for all citizens.”

I like this part: “…reaffirming [our] commitment to ensure equal opportunity for all citizens.” Yessir, I’ll have some of that! And, if you’ll indulge me, let’s assess the evidence to understand whether or not there is a commitment that’s delivering real opportunity for ALL citizens, not least citizens with IDD.

The Institute for Community Integration reports on employment outcomes for people with IDD across the country. In their most recently published report, the data are pretty illuminating, and not in altogether flattering terms. In 2021, for example, 78% of American, working-age adults with IDD who were receiving State IDD services were being served “in facility-based and non-work settings.” That means not in jobs, not working, nowhere near a career. Eight years earlier (2014), that number was 81%. In eight years, we moved the needle by a paltry 3%. Put another way, 22% of working-age adults with IDD who were receiving State IDD services were in integrated employment, in jobs, working, perhaps building a career.

By the way, I talk to a helluva lot of people with IDD, and in the overwhelming majority, their aspirations sound uncannily like everyone else’s. People dream about the perfect job, about a career in which they can do work they love. Yeah, people with IDD, too.

And, there are a robust set of demonstrable, compelling economic benefits for our communities and our businesses. Say what? Yeah, you read that right. Here are just two:

REALITY: According to Gallup, replacing a full-time employee can cost from 50% to 250% of that employee’s annual salary. So, if your company employs someone at $50,000, for example, and you lose your incumbent, the total costs of replacing the incumbent can range from $25,000 to more than $100,000 in recruiting, training/onboarding, lost productivity, and other direct/indirect costs. In 2023, nearly 51 million Americans left their jobs. In a number of industry sectors, turnover reaches and even exceeds 50%—construction, for example, and hospitality and leisure. The cost of this turnover to business is astronomical.

SOLUTION: Research consistently and repeatedly demonstrates that employees with disabilities are less likely to leave their jobs, are absent from work less frequently, and tend to be fiercely loyal to their employer and less likely to engage in a job search while employed. A more stable workforce means lower costs associated with turnover. Clear, compelling economic advantage to employing people with disabilities. (Source: Aichner, T. (2021). The economic argument for hiring people with disabilities. Humanit Soc Sci Commun, 8, 22.)

REALITY: Approximately 60% of the more than 8.1 million Americans with IDD rely on Medicaid for health insurance and to pay for long-term services and supports. Medicaid is just as you’ve heard—it’s health insurance for the poor. People with IDD are chronically and institutionally poor, owing in no small part to unemployment rates of up to 80%. This also means that 4.9 million Americans with IDD are not paying income taxes—not because they don’t want to, but because they have to be poor to qualify for Medicaid, which in turn is a lifeline without which they can’t live. A review of IRS income tax returns from 2021 shows the average American taxpayer paid $14,279 in income taxes. Imagine those nearly 5 million Americans with IDD paying the average income tax and what it would mean in economic impact for the communities in which they want nothing more than to be given opportunity? Even if we discount the average tax paid by half, it would tally to—are you sitting down?—just under $70 billion. With a B. Imagine what communities could do with that kind of money. Imagine the depth and breadth of the investments possible.

SOLUTION: Create and proliferate Medicaid “buy-in” options for people with IDD. Some states have them, most don’t. Without a buy-in option, which simply allows a person to make as much income as their talent and drive merit, and over a certain, reasonable limit they start paying part of the premiums, there’s a longstanding and profound disincentive to work. It manifests as follows: “If I work and I make too much money, I lose Medicaid with which I access both my healthcare AND my community supports, without which I can’t survive.” Any wonder why we see virtually NO movement in unemployment rates among people with IDD?

I see nothing but win-win solutions here. Great for business, great for workers, great for communities—not because it’s moral or ethical or even nice. It’s great economics, and it’s good business.

So, this Disability Employment Careers Awareness Action Month, for its 79th birthday, I challenge us to take action. Work at a business that’s struggling with turnover? Tell your HR folks to stop the churn, strike up a B2B partnership with a local organization that works with adults with IDD, and create a workforce solution that leverages this segment of the labor force. Will it be odd and different and maybe even a little uncomfortable? Yeah, maybe. Is what you’re doing now any odder, different, or uncomfortabler? Remember, friends, that doing the same thing over and over again and expecting a different outcome is, well, you know.

Know a policy wonk or a person with lived experience who would love to have a career but can’t because of draconian Medicaid income and asset caps? Willing to pick up the phone and call an elected official in your state? Tell ‘em we want a Medicaid buy-in option, and we want it now! Tell ‘em that people with IDD want to be tax-paying, contributing members of their communities. Tell ‘em that it’s not hard, and that there’s a whole, amazing workforce out there, waiting to be tapped, waiting to pay their fair share. Tell ‘em that Medicaid costs can be offset by the very taxpayers who benefit from the benefits!

Next year, on the 80th birthday of Disability Careers Action Month, let’s look back and celebrate our shift from awareness to action. It’s good business.