Association for Public Policy Analysis & Management

Panel: Interactions Between Healthcare and Social Insurance Programs

(Health Policy)

Two of the nation’s largest social insurance programs, Social Security Disability Insurance (DI) and Workers’ Compensation (WC) insurance, have significant interactions with the healthcare system. Since eligibility for both DI and WC depend on a health event (i.e., a disability or work-related injury or illness), health insurance expansions or medical innovations can impact entry to the programs. Evidence from these papers can inform policymakers of the expected impacts of expanded access to health insurance and medical innovation on new claims. Individuals remain eligible for DI only if they are unable to return to work, and evidence regarding medical spending and access to care can inform the likelihood an individual with a disability will be re-employed. As policymakers consider ways to encourage re-employment among DI recipients, evidence from these papers can guide which barriers to employment need to be addressed. The four papers in this panel examine interactions between health insurance and medical innovation on program entry, as well as interactions between health care and program exit. The first paper examines whether access to health insurance impacts the likelihood an individual with an injury claims WC by examining Massachusetts health care reform. Uninsured individuals who experience an injury may assert that the injury was work-related so that the cost of the medical care will be paid for by WC. If this has been the case, we might expect the Affordable Care Act to reduce program costs for WC; however, preliminary evidence finds no impact of Massachusetts health care reform on WC claims. The second paper also examines how healthcare interacts with social insurance claims with a case study of the introduction of antiretroviral drugs in 1995 and their impact on DI claims. The finding that the introduction of antiretroviral drugs reduces DI applications shows that medical innovation can impact program entry; however, the finding that antiretroviral drugs do not increase program exit suggests the presence of barriers to re-employment. The next two papers use data on healthcare use to confirm the presence of barriers to re-employment and identify one barrier. The third paper in the panel uses a measure of Medicare spending to quantify health status and finds that DI recipients use more health care, on average, than rejected applicants, providing additional evidence of barriers to re-employment for DI recipients. The fourth paper in the panel identified one such barrier for low-income adults with disabilities: access to care. The authors show that older adults with disabilities who are dual-eligible for Medicaid and Medicare have reduced access to care relative to younger adult dual-eligibles, and reduced access to care may be an additional barrier to re-employment. Together, the papers in this panel provide evidence for policymakers relevant for the expected effects of the ACA and proposals to reform DI and encourage work among adults with disabilities.