ROCK HALL -- In a drafty little house on the edge of the frozen bay in this sleepy Eastern Shore fishing town, Elizabeth Carlough works on her "pluses and take-aways" with a calculator -- determined to master the basic math she'll need to live on her own as a "normal person."
The 26-year-old woman with mental retardation knows that the day will soon come when her aging parents won't be able to care for her and she'll have to move out of their rented frame house into "the real world."
"I have to get myself ready for when that happens," she says. "I have to be able to figure all this stuff out. How to pay my bills. How to save enough money for food. It's hard. But at least I have a start. I have my check."
Now, Ms. Carlough has to worry about that, too.
Her check comes from a $25 billion Social Security program called Supplemental Security Income that gives cash payments to poor adults and children who are too disabled to fend for themselves -- a program that the Republican-led majority in Congress is proposing to slash.
For Elizabeth Carlough and thousands of other disabled people, where the ax falls could be the difference between living on their own or being forced into an institution. On the Eastern Shore and in other economically deprived parts of the country, it could also be the final blow that pushes many families over the edge.
"People out here in the sticks are terrified," says Elizabeth's mother, Barbara Carlough, 53. "You're not talking about welfare cheats and con men. You're talking about some of the hardest-working people you'll find anywhere. But the local economy is shot, and SSI is the only thing keeping a lot of families from losing their kids, their homes, everything."
House Speaker Newt Gingrich says those who cannot work because they have severe handicaps or seriously disabled children at home have nothing to fear from budget-cutting measures to be considered this week by a House subcommittee looking into fraud and waste in SSI.
But thousands of other disabled poor people will be subjected to "across-the-board" cuts with little or no evaluation of their individual circumstances. And when they lose their SSI eligibility, they will also lose the free health insurance that goes along with ++ it.
On the Eastern Shore, such a stroke could be devastating.
In a region with more than 4,300 people on the disability rolls, SSI pours as much as $23 million per year into a shaky economy built on seasonal jobs that revolve around the fragile Chesapeake Bay.
Declining fishery yields, slackened construction and the steady retreat of light industry give the Shore the highest unemployment numbers in the state. At a time when only 4.5 percent of Maryland's work force is jobless, some Shore towns are still posting unemployment rates as high as 11, 12 or even 14 percent.
Where to turn?
"If they lose those checks, where are these people going to turn?" asks Barbara Carlough.
Critics charge that such troubling questions are being left for later as Republican leaders push their staffs to produce $40 billion in savings from SSI and scores of other welfare programs in time to meet their mid-April deadline in the "Contract with America."
Some who have been targeted -- such as the 120,000 drug addicts and alcoholics who get SSI simply because they have disabled themselves through substance abuse -- are not expected to generate much sympathy or controversy.
But one Republican measure that aims to stop fraud by parents who coach their children to fake mental problems so they can get checks could have serious implications for poor families on the Shore and elsewhere.
It would deny cash payments to children who apply for aid for marginal mental and physical disabilities, but allow them to have free health care. And it would cut off all aid to some 200,000 children diagnosed with psychological or learning disorders.
Douglas Nelson, executive director of Baltimore's Annie E. Casey Foundation for children, says that while fraud surely exists, such "behavioral disorders" are often early symptoms of serious handicaps that do not become apparent for years.
"A broad cut-off of that category is bound to hit tens of thousands of kids who have a permanent disability that has simply been misdiagnosed," he says. "A lot of them are going to have trouble reading and doing basic math problems -- or even holding still in class -- long before they are diagnosed with mental retardation, dyslexia or some other biologically based disorder."
Diagnose and classify
Such was the case with Elizabeth Carlough. Shortly after she was born, her mother noticed that the apparently healthy infant was lethargic and could not master basic learning toys such as blocks, pegboards and ring cones. Later, she faltered in simple arithmetic, Dick and Jane books and sports.
"The other kids called me a freak and a mental case," Elizabeth Carlough recalls. "Then, the teachers stuck me in a class with all the handicapped kids, even though I wasn't in a wheelchair or anything."
It was years, her mother says, before a doctor identified Elizabeth's problem as a form of retardation. By then, it was hard to miss. Sporadic seizures that began when she was a baby were intensifying.
"As soon as she hit puberty, she started having these epileptic-type attacks all the time," says Barbara Carlough. "At one point, she was taking seven different medications. And all the time, she was falling further and further behind in school."
Along the way, her daughter had been classified as everything from "a problem student" to "a slow learner" -- descriptions that would place her in the group of children now being eyed by Congress for a wholesale cut-off of SSI benefits.
The chances of such a misdiagnosis rise sharply in places like the Eastern Shore that are far removed from big-city physicians and high-tech diagnostic centers, says Robin Murphy, the mother of an 8-year-old disabled son in Preston.
It's one of the consequences, she says, of life "on the other side of the Big Ditch," alluding to the Chesapeake Bay, which separates them from the state-of-the-art facilities at Johns Hopkins Medical Center and leaves them largely dependent on a few local doctors.
"That's how most people out here find out about SSI," says Mrs. Murphy, who runs a support network for Shore families with disabled children. "Some small-town doctor or teacher will say, 'Your kid is learning disabled -- and, oh, by the way, did you know there's a federal program for people like him?' Then, they fill out the paperwork for you and send it in.
"A lot of parents out here don't even know what disability their kids are diagnosed with. They're going to be very surprised if they get a letter in the mail telling them the SSI checks they depend on to pay the bills are being cut off because their retarded child is listed in some government file as learning-disabled."
Her son, Michael Murphy II, will be exempt from the cut-off because he suffers from spastic quadriplegia -- an obvious physical disability of the sort that Mr. Gingrich says will still qualify once the cutting is done.
Bureaucratic requirements
But Congress has no plans to address a welter of bureaucratic requirements in the SSI rules that leave Mrs. Murphy's family struggling to get by, paycheck to paycheck.
Her husband drives hundreds of miles every week to construction jobs so he can pull down a hand-to-mouth living for his family, but she has forbidden her 13-year-old son from getting a part-time job so he can have some spending money.
The reason: The government would count it as household income, and the family would earn too much for 8-year-old Michael to stay on SSI. And without the free health care, the Murphys would be unable to pay the $30,000 for surgery Michael needs, Mrs. Murphy says.
"It's not the monthly check that most families out here care about," she says. "It's the fact that most employers on the Eastern Shore don't offer health insurance, and this is the only way to get it. So you really have no choice but to intentionally keep yourself below the poverty level."
Or worse.
Anita Chalupa and her husband, Roman, of Queen Anne's County have considered divorcing because he sometimes earns too much as a car mechanic for their 14-year-old son, J. R., to remain eligible -- despite a neurological disorder that keeps him in a wheelchair.
"If there's five pay periods in a month, we go just a few dollars xTC over the income limit," she says. "We could earn a lot more if I got a job, but then J. R. would lose his health insurance and we'd have to go bankrupt or put him in an institution."
Elizabeth Carlough has been there. In 1987, while her mother had hip-replacement surgery, she stayed in a home for people with mental retardation. She does not ever want to go back.
She has a quick smile and a toughness common among those who live hard by the banks of the bay. She knows how to make a "mean Caesar salad," and she's proud of her part-time summer job as a dishwasher at a restaurant. But she must guard against earning too much for fear that losing her monthly SSI check would shake her tenuous grip on the "real world."
"I would try to get by, but I just don't know if I could," she says. "I worry about that all the time."