Before the Patient Protection and Affordable Care Act (ACA) – also
known as Obamacare - was passed in 2010, people with disabilities
and low income jobs were often unable to afford their expensive
medical care. So many chose unemployment in order to be poor enough
to qualify for Medicaid coverage, researchers report in the American
Journal of Public Health.
“Policy makers in states that have not expanded Medicaid often
suggest that making Medicaid available to more people will increase
their dependence on public insurance and discourage them from
working to obtain insurance through an employer,” said lead author
Jean Hall, a health and disability policy researcher at the
University of Kansas Medical Center in Kansas City and the
University of Kansas, Lawrence.
“Our results show just the opposite for people with disabilities,
who are much more likely to work in states that expanded Medicaid,”
Hall told Reuters Health by email.
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In 2014, states were given the option to expand Medicaid’s coverage
under the ACA, allowing people earning up 138 percent of the poverty
rate to receive Medicaid coverage.
In the 19 states that have not expanded Medicaid, the earnings limit
for people with disabilities is 85 percent of the poverty rate, or
$834 dollars per month, Hall’s team writes.
To examine how Medicaid expansion affects employment rates among
people with disabilities, researchers used data from a nationally
representative quarterly phone survey conducted 10 times between
early 2013 and late 2015.
The analysis included 2,740 participants who answered yes when asked
if they had a mental or physical condition or impairment that
affects daily activities or requires the use of special equipment
such as a wheelchair or communication devices.
Participants were also asked about their work status in each survey
round, and researchers compared the employment rates of people with
disabilities in states that expanded Medicaid eligibility under the
ACA and those that didn’t, before and after the law went into
effect.
After the ACA was implemented, people with disabilities living in
states with expanded Medicaid were significantly more likely to be
employed than those in non-expansion states. In the expansion
states, 38 percent of the disabled survey respondents were working
compared to 32 percent in the states that didn’t expand coverage.
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The proportion of people who said they were not working because of
their disability was 40 percent in expansion states and 48 percent
in non-expansion states.
In states that didn’t expand Medicaid, employment rates among the
disabled fell slightly after the ACA went into effect, but
researchers said they didn’t have enough data from the years before
the law’s implementation to explain why that happened.
“People with disabilities desperately need health insurance because
of chronic health conditions,” Jae Kennedy, chair of the health
policy and administration department at Washington State University
in Pullman, said by email.
Medicaid expansion requires more funding from states and the federal
government, but the result is that newly insured people are able to
pay for their care with insurance, said Kennedy, who wasn’t involved
in the study.
“Medicaid matters. Expanding it without extra requirements helps
people with disabilities remain in or return to work,” Kennedy said.
“Expanding Medicaid empowers people with disabilities to work
instead of applying for cash assistance, being dependent on the
government, and living in poverty,” Hall said. “Moreover, research
has shown that working, even part-time, improves health.”
SOURCE: bit.ly/2h6OMGI The American Journal of Public Health, online
December 20, 2016.
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