Political scientists who study the American welfare state tend to focus on a small number of social programs. Social Security and “welfare” (now called Temporary Assistance for Needy Families) are probably the best known. Typically, the goal is to show how much one or two factors—for example, public opinion, institutional design, policy elites, race, gender—influence these programs. This book is different. It focuses on two programs for the disabled, Disability Insurance (DI) and Supplemental Security Income (SSI), which are studied less often. And it tries to account for a wide range of influences on their development. The book is a genuine addition to our understanding of U.S. social policy and a fine example of how to create a rich explanation of policy change.

The basic puzzle of Disability Rights and the American Social Safety Net is how DI and SSI managed to expand in recent decades. Between 1974 and 2003, total spending on SSI increased from $4 billion to $35 billion. Spending on DI grew even faster. Although some of this growth was due to recipients living longer, some of it reflected broader eligibility rules and a larger number of recipients. The latter trend, Jennifer Erkulwater argues, was by no means inevitable. Many of the new people eligible for benefits had disabilities that were hard to verify medically and, therefore, suspect. As DI and SSI covered more individuals with chronic pain, drug addiction, and a variety of mental disorders, some policymakers worried that they had gone too far. Moreover, as these programs grew larger, they became a more visible target for critics of government spending. Consequently, the overall record of expansion includes periods of rapid growth and periodic cutbacks.

Specialists in disability policy will find much of this story to be familiar. Retrenchment occurred in the early 1980s when Reagan officials tightened up on eligibility for disability benefits, and in 1996 as part of welfare reform. Interest groups hoping to expand eligibility and increase benefits turned often to litigation, rather than legislation, and stressed the rights of the disabled. Debates over disability programs were generally limited to a small number of policy elites and seldom attracted national attention. Growth did not always translate into more coherent policymaking; programs for the disabled remained quite fragmented and in some cases embodied conflicting objectives. Anyone who has read work by Edward Berkowitz, Thomas Burke, Martha Derthick, Jerry Mashaw, and Deborah Stone will likely know these lessons.

What Erkulwater does so well is to synthesize many of their insights. Some studies of disability programs, for instance, have concentrated on Congress, the courts, or bureaucracies; this book covers all three. Some studies concentrate on the role of medical professionals or lawyers; this book does both. If readers are concerned that the author tries to do too much, rest assured that she weaves these different strands together into a concise and coherent narrative. For those who do not know this literature (which is the vast majority), this is probably the first book I would suggest reading in order to understand the contemporary politics of disability in the United States.

The book also has something to say about the politics of social policy more generally. We have been told, for example, that programs for the poor are poor programs, meaning that they are slow to grow and vulnerable to attack. Yet the means-tested SSI program has expanded substantially in recent decades, and it joins Medicaid and the Earned Income Tax Credit as big exceptions to the rule. Likewise, we usually think of institutional fragmentation as a major reason why the American welfare state started late and remained small. There are simply too many veto points in the system. Erkulwater shows that veto points can also be access points. In the case of DI and SSI, fragmentation gave advocates for expansion more options for achieving their goals. In response to retrenchment under Reagan, advocates worked hard to shift the debate to the courts and won a number of important victories. They also turned to Congress and found legislators on several committees who were willing to hold hearings and introduce legislation. These moves not only helped to slow down retrenchment but also ultimately succeeded in broadening eligibility. Anyone looking for a prime example of “venue shopping” will find it here.

Near the end of the book, the author reiterates how much of this history resulted from a certain measure of luck and miscalculation. Senator Russell Long did not propose creating SSI in the early 1970s because he was unsatisfied with how government helped the disabled. He hoped that SSI would help him siphon off support for the more sweeping Family Assistance Plan. Reagan officials never imagined how much backlash they would generate when they tried removing people from the disability rolls. The judges who paved the way for expansion inadvertently left DI and SSI open to charges of fraud and abuse. Disability Rights and the American Social Safety Net tells us what happened to DI and SSI, explains why, and shows that it did not have to happen that way. This is what historically informed political analysis is supposed to accomplish, and Jennifer Erkulwater does it well.