Access to care and health insurance coverage for workers with disabilities: Outcomes by state-level responses to the ACA.

BACKGROUND

States had flexibility in their implementation of the Patient Protection and Affordable Care Act (ACA) Medicaid expansions, which may have led to variation in coverage and changes in access to care for workers with disabilities.

OBJECTIVE/HYPOTHESIS: To examine differential trends in health insurance coverage and access to care among workers with disabilities by states' decisions about expanding Medicaid under the ACA.

METHODS

We aggregated data from the National Health Interview Survey into groups by time period relative to ACA implementation: pre-ACA (2006-2009), early ACA (2010-2013), and later ACA (2014-2017). We produced health insurance and access statistics for each time period, by state-level Medicaid expansion status.

RESULTS

Uninsurance rates decreased after 2014 in all states, regardless of the state's decision whether to expand Medicaid. There was a substantial increase after 2014 in the share of workers with disabilities covered by Medicaid in states that expanded in that year; in other states, workers with disabilities experienced larger increases in privately purchased coverage. At the same time, the share of workers with disabilities reporting cost-related barriers to care declined markedly in 2014 Medicaid expansion states, but it increased slightly in the non-expansion states. Structural barriers to accessing care increased in all states, with the smallest increase in 2014 expansion states.

CONCLUSIONS

Medicaid coverage and cost-related access to care improved significantly among workers with disabilities in 2014 Medicaid expansion states, both overall and relative to workers with disabilities in non-expansion states.