Association for Public Policy Analysis & Management

The Affordable Care Act provides health insurance to many working-age adults with disabilities who were previously uninsured. We do not expect that the new ACA coverage will fully meet the employment-related healthcare needs of people with disabilities.  Secondary health insurance to wraparound primary coverage may be a viable policy solution to meet the healthcare demands of this population. We use Massachusetts, which implemented healthcare reform similar to the Affordable Care Act in 2006 and achieved near-universal coverage as a case study. We conducted representative survey of insured working-age persons with disabilities in Massachusetts. Respondents were grouped into three employment status categories: workers, potential-workers and non-workers. We estimated employment-related service use and unmet needs based on respondents’ reported service use, reported unmet need for services, and their assessment of the importance of services to their employment.  Regression methods were used to determine the association between employment-related service unmet need and individual characteristics.

 Among the study population, an estimated 70.1% of workers and 67.0% of potential-workers used employment-related healthcare services. Approximately 7% of workers and 34% of potential-workers had an unmet need for employment-related healthcare services. Among workers and potential-workers, the percentage having employment-related unmet needs by healthcare service category were the following: prescription medicine, 6.7%; mental health services, 4.0%; rehabilitation equipment, 7.1%; special equipment, 4.1%; personal care, 1.0%; complementary care, 8.4%; and care coordination, 0.9%. Higher level of employment-related unmet need was associated with health-related limitations, heart disease, rheumatic disease, depression, and difficulty concentrating, remembering or making decisions. The findings suggest that healthcare services play a key role in the employment and potential employment of persons with disabilities. Even though an overwhelming majority of workers and potential-workers reported use of employment-related healthcare services, there is a substantial unmet need, particularly among potential-workers. The findings suggest that alleviating the unmet need for employment-related services would increase the employment of persons with disabilities.