Association for Public Policy Analysis & Management

Panel: Assessing the Impacts of Recent Health Insurance Policies for People with Disabilities

(Health Policy)

This panel includes three papers that assess how recent broad-scale policies that changed health insurance options affected the subset of people who have disabilities, a group that faces particularly high out-of-pocket costs in the absence of insurance. Two of the papers focus on the consequences of provisions in the Affordable Care Act (ACA), while the third focuses on state-level privatization in Medicaid, likely to become more prevalent based on recent reform proposals. The papers examine a range of health and employment outcomes, as well as participation in Social Security Administration (SSA) long-term disability programs, each using a rigorous quasi-experimental method to estimate policy impacts. Taken together, they provide a broad examination of how people with disabilities have been affected by these recent policies.

The first paper considers the impact of state-level Medicaid expansions through the ACA on the employment of adults with disabilities. For those with an attachment to the labor force, increased Medicaid coverage may increase employment (by reducing reliance on SSA disability benefits, a route to Medicare/Medicaid) or decrease it (by reducing reliance on employer-sponsored plans). The authors estimate the employment impacts of newly available Medicaid coverage by carefully constructing a matched comparison sample of individuals in states that did not expand the program. The paper builds on earlier work producing national estimates by assessing state-level variation in the impact of the expansion.

The second paper considers the implications of partially privatizing Medicaid on a range of health, employment, and disability program participation outcomes using data from Texas and New York. Medicaid may be the only available source of health insurance coverage for people with disabilities who do not a strong labor force attachment. This group may neither qualify for employer-based insurance nor Medicare via the Social Security Disability Insurance (SSDI) program. Privatization through a managed care plan could improve the efficacy of Medicaid, but might also introduce hurdles to obtaining insurance in the first place. The authors estimate the net impacts using a natural experiment comparing outcomes in contiguous counties where private Medicaid plans were and were not introduced.

The third paper considers how the flow of young adults into the Supplemental Security Income (SSI) disability program is affected by access to parental health insurance, focusing on the 2010 ACA provision allowing such coverage through age 26. One benefit of SSI receipt is that it comes hand-in-hand with Medicaid coverage. For young adults without a strong work history, coverage through a parent’s plan presents an alternative that may reduce the incentive to obtain SSI benefits. The authors therefore hypothesize that there may have been a sharp increase in SSI claims and awards near age 26 since the 2010 ACA provision went into effect, and they use a regression-discontinuity design to estimate the impacts of losing parental coverage at that age.