“I’ve been kept financially sort of in this cage,” Mr. Crelia said. “Just basic things that people rely upon, having a normal life, aren’t things that are really accessible. And won’t be.”

People like Mr. Crelia — ill, but ambitious, motivated and able to work the majority of the time — don’t fit into a rigid system set up primarily to provide support for those who will never be able to enter the workplace in any capacity. Instead of accounting for a spectrum of ability and administering a benefits package accordingly, the system offers a one-size-fits-all plan: you can either work and not qualify for financial assistance, or you’re sick, and barred from earning any substantial income.

“Instead of helping people achieve their full potential,” David Stapleton, who directs the Mathematica Center for Studying Disability Policy, testified before Congress last month, “the current disability support system has created a poverty trap.” The employment rate for people with disabilities, he said, is just 21 percent of the rate for people without disabilities, down from 32 percent in 1981. The problems stem from the Social Security Administration’s failure in 1974 to structure a program that motivates work. It is relatively easy to accept cash benefits but very hard to get into the workplace. Mr. Stapleton said that Congress had the power to push to change the structure of the program, but that it had not done so.

Today, 70 percent of people with disabilities live in poverty. The Affordable Care Act may eventually ease the burden for some individuals with disabilities, namely those who rely on Medicaid through the S.S.I. program, by eliminating exclusions based on pre-existing conditions and annual or lifetime benefits caps. But the impact on the disabled is not yet clear, and experts are calling for additional targeted reforms.

Richard Burkhauser, a professor at Cornell, and Mary Daly, a government economist, have studied the welfare of people with disabilities for more than three decades, and offer some solutions. They suggest a work-first approach that would help people get job training or employment before they go through the red-tape-ridden path of getting on S.S.I. Now people must go through the lengthy process of proving that they cannot work before they are given access to job training and other programs.

Instead of enrolling Mr. Crelia in S.S.I., the Social Security Administration could have helped him apply for a loan to finish his bachelor’s degree, increasing his chances of finding a flexible, high-paying job with health insurance.

Mr. Burkhauser and Ms. Daly borrow another idea from the lessons learned from the 1996 welfare overhaul. Welfare moved from a federal program that did not encourage single mothers to work to a state-run program that offered the incentive of an earned-income tax credit for working mothers. They say S.S.I. should copy this model by allowing people like Mr. Crelia to hold a paying job as often as possible — whether for 20, 25 or 30 hours a week — and having the federal or state government chip in with tax credits to round out his income.

For now, Mr. Crelia is doing his best to stay busy. He clocks far more than 40 hours most weeks, mostly in unpaid writing. “When I work, I thrive both physically and emotionally,” Mr. Crelia said. “When I am not sick and can control my disease with medication — like now — I want to be able to contribute to society, have a family, grow my business. But not as a volunteer; I want to be paid like everyone else.”