The Patient Protection and Affordable Care Act of 2010 fundamentally altered the avenues for obtaining health insurance in the United States, especially for those with low incomes or without insurance provided by an employer. These changes may be particularly salient for workers with disabilities, who may not have enough of an attachment to the labor force to obtain employer-sponsored benefits, yet potentially be ineligible for public programs due to earnings that are too high. A better understanding of which individuals might participate in the health insurance exchanges now being established may help tailor the package of benefits to the needs of those likely to apply for coverage.

Before knowing where we are heading, it is important to document where we have been. In this study, we will generate statistics on health insurance coverage and access to care for employed adults with disabilities over a 15-year period (1997—2011) using data from the National Health Interview Survey (NHIS). During this name, changes from the Americans with Disabilities Act (ADA) were widely in place and policies stemming from the Ticket to Work and Work Incentives Improvement Act of 1999 were being implemented to encourage employment among adults with disabilities. Yet, at the same time, the employment rate of individuals with disabilities relative to their non-disabled counterparts fell.  Thus, workers with disabilities may have faced an ever-changing landscape of coverage options and consequently, access to care.

Along with documenting trends over time, this study seeks to determine the extent to which changes in coverage and access can be attributed to changes in personal (demographics, health status) and employment characteristics (full-time status, salary/hourly work, industry and occupation) among workers with disabilities. We will assess these outcomes for working adults with disabilities based on whether they are federal disability beneficiaries (SSDI or SSI), and will also compare their outcomes to others with disabilities who are not working, as well as to their non-disabled counterparts.