Insurance Coverage and Access to Care for Workers with Disabilities, 2001–2017

Publisher: Disability and Health Journal (online ahead of print)
Oct 04, 2019
Anna Hill and Jody Schimmel Hyde

Background. Workers with disabilities have different options than their peers for obtaining health insurance, and face unique barriers in accessing care. The Patient Protection and Affordable Care Act (ACA) led to sweeping changes in the availability and affordability of health insurance in the United States beginning in 2010, and may have had important effects for workers with disabilities.

Objective. Document how the ACA changed insurance coverage and access to care for workers with disabilities, and compare those changes to changes among other groups.

Methods. We document health insurance coverage and access to care among workers with disabilities using the 2001–2017 National Health Interview Survey.

Results. The share of insured workers with disabilities increased from 79.9% in 2009 to 87.8% in 2017. This gain resulted from an 11 percentage point (pp) increase in the share with Medicaid coverage in 2014–2017 compared with 2001–2009 and a 5 pp increase in privately purchased coverage over those periods. These were accompanied by an 11 pp decline in the share with employer-sponsored coverage. Despite coverage gains, cost-related barriers to accessing medical care did not change much after the ACA, for any group. Workers with disabilities experienced an increase in structural access barriers, from 18.4% before the ACA to 24.8% after.

Conclusions. The gain in insurance coverage for workers with disabilities is an important benefit of the ACA, but more investigation and monitoring should be considered to understand whether such coverage will translate into improvements in access to needed health care.