Disparities in Insurance Coverage, Health Services Use, and Access Following Implementation of the Affordable Care Act: A Comparison of Disabled and Nondisabled Working-Age Adults

Abstract

The objective of this study was to assess trends in health insurance coverage, health service utilization, and health care access among working-age adults with and without disabilities before and after full implementation of the Affordable Care Act (ACA), and to identify current disability-based disparities following full implementation of the ACA. The ACA was expected to have a disproportionate impact on working-age adults with disabilities, because of their high health care usage as well as their previously limited insurance options. However, most published research on this population does not systematically look at effects before and after full implementation of the ACA. As the US Congress considers new health policy reforms, current and accurate data on this vulnerable population are essential. Weighted estimates, trend analyses and analytic models were conducted using the 1998-2016 National Health Interview Surveys (NHIS) and the 2014 Medical Expenditure Panel Survey. Compared with working-age adults without disabilities, those with disabilities are less likely to work, more likely to earn below the federal poverty level, and more likely to use public insurance. Average health costs for this population are 3 to 7 times higher, and access problems are far more common. Repeal of key features of the ACA, like Medicaid expansion and marketplace subsidies, would likely diminish health care access for working-age adults with disabilities.

Coverage for Adults With Chronic Disease Under the First 5 Years of the Affordable Care Act

“…These findings build on earlier data suggesting Medicaid contributed to initial coverage gains under the ACA for people with chronic disease or disability. 18 , 19 These data can inform ongoing state-level policy discussions about Medicaid eligibility expansions.…”

“…Early data show small coverage gains for people with chronic disease or with a disability after ACA implementation. 16 – 19 Medicaid contributed disproportionately to coverage gains for people with chronic disease or with a disability, suggesting the importance of Medicaid eligibility expansions for reaching this group. 18 , 19 Although informative, early studies may not capture the full effect of ACA implementation.…”

“… 16 – 19 Medicaid contributed disproportionately to coverage gains for people with chronic disease or with a disability, suggesting the importance of Medicaid eligibility expansions for reaching this group. 18 , 19 Although informative, early studies may not capture the full effect of ACA implementation. For example, additional states elected to expand Medicaid eligibility over time, and awareness of new coverage options increased.…”

Health Care Accessibility for Individuals With Disabilities: Barriers and Risk Factors Impacting Care

“…PRELIMINARY RESULTS: ACCESS BARRIERS Figure 2. Commonly cited barriers preventing access to healthcare evaluated in current literature 3,[5][6][7][8][10][11][12]15,[20][21] PRELIMINARY RESULTS: RISK FACTORS Figure 3. Commonly cited risk factors potentially resulting in healthcare disparity evaluated in current literature 3-5, 8-11,13-14,16-22.…”

A brother’s memoir

“…I imagine he would be encouraged by the advances in the accessibility of public places and transportationexcept for New York City's inaccessible subway system (Stringer 2018)but equally disappointed in the low employment rates. Having a comprehensive vision on civil rights, Drew would likely be encouraged by legislation in multiple countries favoring assisted-dying (Emanuel et al 2016), a divisive issue within the disability community, but impatient on progress toward attaining accessible and affordable healthcare in the United States (Kennedy, Wood, and Frieden 2017).…”