A story recently aired on National Public Radio (NPR) has sparked a national conversation on a federal government benefit program, including passionate defenses and calls for its overhaul.

The program is Social Security Disability Insurance (SSDI), and as the NPR series “Unfit For Work” described, its payroll, after sharp growth in recent years, now numbers over 14 million. This growth is in spite of medical advances and laws banning employment discrimination based on disability.

NPR reporter Chana Joffe-Walt found that declining real wages, a stagnant economy, and limited employment opportunities create powerful incentives for disabled workers to seek SSDI. She visited Hale County, Alabama, where nearly a quarter of working-age adults are SSDI beneficiaries. There, openings for jobs not requiring physical labor are almost completely unattainable for many due to a lack of education. The states with the highest percentages of disability beneficiaries are also the states with the lowest percentages of college-educated population, including West Virginia, Alabama, and Mississippi.

Joffey-Walt also visited the family of a 10-year-old boy with a learning disability in the Bronx. That disability makes him eligible for $700 per month in Social Security, the family’s primary source of income. If Jahleel were to completely overcome his disability and excel in his education, it would threaten his family’s livelihood. The story illustrated the conflicting motivations some families with benefit income struggle with.

A group of eight former Social Security Administration (SSA) commissioners wrote an open letter to the public responding to the NPR story. The commissioners pointed out that analysts at the SSA had predicted the current uptrend in SSDI’s growth for decades. Two demographic swells combine to account for the majority of the growth in SSDI: the baby boom and the influx of women into the American workforce in the 1970s and 1980s. These groups are now entering their high-disability years.

The letter added that the growth in children receiving Supplemental Security Income (SSI) benefits is due to the nationwide growth in poverty. Less than four percent of low-income children receive SSI benefits – a figure that has held steady, according to the commissioners.

Advocacy group the Consortium for Citizens with Disabilities (CDC) also published an open letter shortly after the story aired. They called attention to the strictness of the eligibility requirements, saying only about 40 percent of adult applicants are approved.

SSDI ensures the livelihood of millions of Americans, but has swelled at an eyebrow-raising rate in recent years. Congress may reform the program in the coming years to help those on the margin remain gainfully employed. But they must take care to ensure the economic security of the most vulnerable Americans.