Association of Medicaid Expansion With Health Insurance Coverage Among Persons With a Disability

Abstract

Key Points Question Was the Patient Protection and Affordable Care Act Medicaid expansion associated with an increase in health insurance coverage among persons with a disability? Findings In this cross-sectional analysis of more than 2.5 million US adults aged 26 to 64 years with incomes up to 138% of the federal poverty level, Medicaid expansion was significantly associated with lower uninsurance rates and higher Medicaid and private insurance coverage for persons with a disability. Meaning These findings suggest that Medicaid expansion was associated with improved health insurance coverage among persons with a disability.

Disability, Federal Disability Benefits, and Health Care Access After the Affordable Care Act

“…We find that, in the post-ACA era, there are still unmet needs for working-age adults with a disability, in general, but that individuals with a disability who are receiving federal disability benefits have improved access over those who are not. Our results are consistent with pre-ACA findings that individuals with a disability who are receiving federal disability benefits have improved access to care (Livermore et al, 2009), but that this difference persists even after an overall increase in health care access and utilization for all individuals with a disability in the ACA era (Kennedy et al, 2017; Stimpson et al, 2019). In 2018, approximately 9 and 5 million individuals aged 18–64 were enrolled in the SSDI and SSI programs, respectively (Social Security Administration, 2019a, 2019e).…”

“…Additional research is necessary to explore the root causes of these differences in health care access and utilization, which would help toward the policy goal of equitable access to health care for all individuals with disabilities. Our research and related studies (Kennedy et al, 2017; Stimpson et al, 2019) make clear that although ACA insurance expansions have improved health care access for individuals with disabilities, these expansions alone are not enough to ensure that all individuals with disabilities have sufficient access. Continuing to research different subgroups within the population of individuals with disabilities, such as we have done here with the population receiving federal disability benefits, may identify high priority populations and policy levers.…”

“…Previous research, using data from 1998, suggests that SSDI recipients, in particular, differ from the broader population of individuals with disabilities in that they use more health care and have better access than individuals with disabilities who do not receive SSDI (Livermore et al, 2009). More recent research suggests that health care access and utilization improved for individuals with a disability after the Affordable Care Act (ACA), with increases in health insurance coverage (Kennedy et al, 2017; Stimpson et al, 2019) and declines in delaying care due to costs (Kennedy et al, 2017). However, these studies—similar to much of the literature on health care access and utilization for individuals with disabilities (Havercamp & Scott, 2015; Krahn et al, 2015; Lin et al, 2016; Olfson et al, 1997)—define disability broadly rather than limiting to the subgroup of individuals with a disability receiving SSDI and/or SSI.…”

Association of the Comprehensive Care for Joint Replacement Model With Disparities in the Use of Total Hip and Total Knee Replacement

“…We used the triple-differences approach to isolate the independent association of the CJR model with THR or TKR use. 32 , 33 We addressed the violation of the parallel trends assumptions for the triple-differences models by including interactions of the year with MSAs with the CJR model or MSAs without the CJR model and race/ethnicity dual-eligibility indicators (eMethods 2 in the Supplement ). 34 , 35 , 36 We obtained the adjusted estimated probabilities from these regression models and used tests for linear combinations to examine the hypotheses.…”

How did the Affordable Care Act Medicaid Expansion Affect Coverage and Access to Care for Low-Income Parents Who Were Eligible for Medicaid Before the Law Was Passed?

“… 9 McInerney, Mellor, and Sabik found that the ACA Medicaid expansion increased the share of Medicare enrollees with secondary Medicaid coverage, 10 and Stimpson and colleagues found positive Medicaid enrollment effects for disabled adults who were likely eligible prior to ACA expansion. 11 None of these studies examined outcomes other than insurance coverage for previously eligible populations, however.…”