As politicians continue to wrangle over the future of the Affordable Care Act, newly published research shows the law has been clearly beneficial for at least one group of Americans – working-age adults with disabilities.
People in that group are more likely to have health insurance under the ACA than they were before the law took effect, and are less likely to encounter problems obtaining health care.
The research was led by Jae Kennedy, chair and professor at Washington State University’s Department of Health Policy and Administration. It was published in the Journal of Health Care Organization, Provision, and Financing, and is part of a five-year, multi-site disability and rehabilitation research project called the Collaborative on Health Reform and Independent Living.
Expanded Medicaid programs in 33 states are responsible for much of the improvement in health coverage for people ages 18-64 who have disabilities, the study suggested. Medicaid participation in that group jumped to 28.5 percent in 2016, from 22.9 percent in 2013, the year before the state-and-federal insurance program was expanded under the ACA.
Kennedy said it’s fair to assume that if Medicaid had been expanded in all 50 states as the law intended, the benefits would have been even more widespread for adults with disabilities.
“People with disabilities are very reliant on health insurance and need good coverage,” Kennedy said. “Both the Affordable Care Act and the Medicare Part D program disproportionately helped people with disabilities,” he added, referring to the prescription drug benefit added to the Medicare program in 2003.
People with disabilities use more health care than their nondisabled counterparts, and the Affordable Care Act didn’t change that. Their average annual health care cost in 2014 was nearly five times that of people without disabilities – $13,492 vs. $2,835. “However, the largest difference was in the area of prescription costs,” the study said. Adults with disabilities filled an average of 34 prescriptions annually, vs. 6.4 prescriptions for people without disabilities, and spent $4,006 a year for them compared with $599 for the non-disabled group.
Working-age adults with disabilities total about 23.6 million people, according to the study. Well over half that group are aged 50 or older.
Health care costs caused working-age people with disabilities to have trouble paying medical bills, or to delay or skip care, at rates more than double those of people without disabilities. The Affordable Care Act improved those access issues slightly, although the study notes that a rebounding economy after the Great Recession also could have been a factor.
The study said gains made in coverage and access for people with disabilities under the Affordable Care Act could be reversed by changes to the law, such as caps on Medicaid funding.
Said Kennedy, “People with disabilities are significantly more vulnerable to changes in the healthcare system. Any modification of programs that reduces access would disproportionately impact them.”
- Addy Hatch, WSU College of Nursing