Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code MDY-CHSE, Portland, OR, 97239, United States.
Urban Institute, 2100 M St. NW, Washington, DC, 20037, United States.
Disabil Health J. 2018 Jan;11(1):86-92. doi: 10.1016/j.dhjo.2017.04.003. Epub 2017 Apr 12.
The Affordable Care Act (ACA) has many provisions that could improve health care for people with disabilities, including Medicaid expansion and the ability to purchase qualified health plans (QHPs).
To explore how ACA provisions affected people with disabilities' health care experiences during the first enrollment period and to suggest hypotheses for future research.
We conducted semi-structured interviews with disability community leaders (N = 16) from a maximum variation sample of 10 U.S. states between March and April 2015. Our interdisciplinary team used qualitative description and a series of immersion-crystallization cycles to identify themes.
Four themes for people with disability emerged. (1) State-based climate influenced ACA implementation decisions (e.g., Medicaid expansion) and thus individual experiences. (2) Medicaid coverage was viewed as more relevant, affordable and comprehensive than QHPs. (3) Despite expanded coverage, pre-enrollment challenges included accessing enrollment resources (e.g., website, helpline) and obtaining detailed plan information and post-enrollment barriers to needed care due to inadequate provider networks, high co-pays, or visit/service limitations. (4) Navigators with prior experience working with people with disabilities attenuated the identified barriers.
Our results depict a complex interplay between the ACA, state efforts and community outreach that influenced people with disabilities' experience. While coverage gains were generally positive, challenges emerged in plan selection and accessing care following enrollment. Attending to contextual factors like state climate and navigator experience as part of ACA implementation may determine health care access, and, ultimately, the health status, of people with disabilities and other population groups.
《平价医疗法案》（ACA）有许多条款可以改善残疾人的医疗保健，包括医疗补助计划的扩大和购买合格的健康计划（QHPs）的能力。
探讨 ACA 条款在第一个参保期内如何影响残疾人的医疗保健体验，并为未来的研究提出假设。
我们对来自美国 10 个州的残疾社区领导人（N=16）进行了半结构化访谈，这些州是最大变化样本。我们的跨学科团队使用定性描述和一系列沉浸式结晶循环来确定主题。
有四个主题出现在残疾人中。（1）基于州的气候影响了 ACA 的实施决策（例如，医疗补助计划的扩大），从而影响了个人的体验。（2）医疗补助计划的覆盖范围被认为比 QHPs 更相关、更负担得起和更全面。（3）尽管扩大了覆盖范围，但预参保的挑战包括获取参保资源（例如，网站、热线）和获取详细的计划信息，以及参保后的障碍，如由于医疗服务提供者网络不足、高自付额或访问/服务限制而导致的所需护理。（4）有残疾人士服务经验的导航员减轻了已确定的障碍。
我们的研究结果描绘了 ACA、州政府努力和社区外联之间复杂的相互作用，这些因素影响了残疾人的体验。虽然覆盖范围的扩大总体上是积极的，但在计划选择和参保后获得护理方面出现了挑战。关注州级气候和导航员经验等背景因素，作为 ACA 实施的一部分，可能会决定残疾人及其他人群的医疗保健的可及性，并最终影响他们的健康状况。
