A new article in Inquiry: the Journal of Health Care Organization, Provision, and Financing looks at how the insurance coverage rates, access to care and health care utilization have been affected by the Affordable Care Act (ACA) in the populations of those with and without disabilities among working age adults (18-64 years old). The research shows that rates of health insurance coverage have improved for both populations. People with disabilities rates of uninsurance have fallen below 10% (8.5%) while the rates for those without a disability have also fallen but is slightly higher at 12.6%. Where these populations get their insurance varies greatly as the vast majority of people without a disability (73.1%) have coverage through a private insurance plan whether through an employer or purchased individually through the exchange. People with a disability have coverage through various sources: private (36.1%), Medicare (27.1%) and Medicaid (37.7%).*
Not surprisingly, the research also demonstrates that people with disabilities are greater users of health care. People with disabilities are more likely to have 10 or more doctors visits in a year (38%) than those without disabilities (6%), and people with disabilities are more likely to have been admitted to the hospital in the last year (19.4%) than those without disabilities (4.7%). This also means that the average annual cost for a person with a disability ($13,492) is significantly higher than for a person without a disability ($2,835), including out-of-pocket costs which are more than twice as high ($1,053 v. $486).
Unfortunately, these costs do affect access as people with disabilities are over twice as likely to delay needed medical care due to cost than those without a disability (18.6% v. 7.1%) and are over three times as likely to completely forgo care due to cost (15.3% v. 4.9%). The silver lining is that the data shows that the ACA has helped ease the affordability access issue with 21.2% of people with disabilities reporting problems after full ACA implementation (2015-16), down from 26.9% of people with disabilities reporting problems immediately prior to full implementation (2012-13).
The article entitled “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” was written as part of the Collaborative on Health Reform and Independent Living (CHRIL) with which the NDNRC is involved.
* Note: many people with disabilities who have coverage through Medicare are also eligible for Medicaid. These “dual eligibles” are counted in both of these numbers.