Another day and yet another study on the benefits of the Affordable Care Act and what we risk losing if Trump and the Republicans get their way. This time it’s a study on the ACA’s Medicaid expansion, which researchers say is actually working as an employment incentive for people with disabilities.
“Our argument is that, over time, those who are better able to manage their health would have a better ability to be employed,” said study co-author Jean Hall, director of the University of Kansas Institute for Health and Disability Policy Studies, in a university news release.
The new study, published this month in the American Journal of Public Health, is an update to an older one conducted two years into the ACA-authorized Medicaid expansion. That older study, based on data from the Health Reform Monitoring Survey, also found that employment rates for people with disabilities were higher in Medicaid expansion states than in states that chose not to expand Medicaid coverage. But the difference wasn’t considered statistically significant.
Researchers noted that in the years before expansion, “many Americans with disabilities were locked into poverty to maintain eligibility for Medicaid coverage” and thus, access to needed health services. The Medicaid expansion, however, increased enrollment eligibility to 138 percent of the federal poverty level (that’s about $33,000 a year for a family of four), eliminated the asset test and allowed people to qualify for coverage solely based on income without waiting for a disability determination. About 40 million Americans were living with a disability in 2015, according to the U.S. Census Bureau.
The ACA’s Medicaid expansion has definitely expanded access to care for people with disabilities. This new study — contrary to heartless political notions that people who can’t afford health care in the most expensive health care economy in the world are just lazy — shows the expansion also supported fellow Americans in going to work.
The updated study gathered more data from the Health Reform Monitoring Survey over a longer time period, 2013 to 2017. Respondents were considered to have a disability if they answered “yes” to this question: “Do you have a physical or mental condition, impairment, or disability that affects your daily activities OR that requires you to use special equipment or devices, such as a wheelchair, TDD [telecommunications device for the deaf], or communications device?” Researchers estimated that the rate of employed or self-employed people with disabilities living in Medicaid expansion states went from just over 41 percent in 2013 to 47 percent in 2017. Also in expansion states, those who reported not working due to a disability dropped from 32 percent to 27 percent.
The same declines weren’t found in states where policymakers rejected the ACA’s Medicaid expansion. Researchers said the particular reason for the employment difference is that in expansion states, “one might reasonably expect” that adults with disabilities who obtained adequate coverage without first having to declare an inability to work would be more likely to seek out employment.
“These findings are particularly timely given recent decisions by some states to impose work requirements on enrollees in Medicaid expansion programs,” wrote study co-authors Hall, Adele Shartzer, Noelle Kurth and Kathleen Thomas. “Our research indicates that coverage through Medicaid expansion by itself acts as a work incentive program for people with disabilities, without imposition of work requirements.”
Hall added in the news release: “And I think we need to move away from a system where health coverage is predicated on living in poverty and not working. That’s counterproductive.”
To date, policymakers in 33 states and Washington, D.C., have adopted the ACA’s Medicaid expansion, which studies show has expanded access to care, improved health outcomes and reduced uncompensated care. For a copy of the new employment study, visit the American Journal of Public Health.