Have Working-Age People with Disabilities Shared in the Gains of Massachusetts Health Reform?

Abstract

The Massachusetts health reform, implemented in 2006 and 2007, reduced the uninsurance rate for working-age people with disabilities by nearly half. Enrollment in Medicaid and subsidized insurance accounted for most of the gain in insurance coverage. The reduction in uninsurance was greatest among younger adults. The reform also reduced cost-related problems obtaining care; however, cost remains an obstacle, particularly among young adults with disabilities. The Massachusetts outcomes demonstrate that insurance subsidies, Medicaid expansions for low-income adults, individual insurance mandates, and enrollment initiatives can lead to substantial reductions in uninsurance and cost-related problems obtaining care among working-age people with disabilities.In 2006, Massachusetts enacted legislation to provide near-universal health insurance coverage. The health reform decreased the uninsurance rate among Massachusetts children and working-age adults, improved access to health care, and reduced the burden of health care costs among working-age adults (Long and Stockley 2010;Kenney, Long, and Luque 2010; Long and Massi 2009;Tinsley et al. 2010). These positive effects of the reform are well known; however, there has been only limited study of the effects of the reform on a large (up to 18% of working-age people) and particularly vulnerable subgroup: working-age (19-64) people with disabilities (Tinsley et al. 2010).1 In this paper we examine the effects of the Massachusetts health reform on people with disabilities, a subgroup that is frequently omitted from health reform discussions and research.The Massachusetts reform includes extensive changes that potentially affect workingage adults with and without disabilities, including Medicaid expansion, a new health insurance exchange, health insurance subsidies for low-and moderate-income people, mandates that adults who can afford insurance obtain insurance, new employer requirements intended to increase employer-sponsored coverage, insurance market reforms, and enrollment initiatives.2 Whether the changes affect people with and without disabilities similarly is not known and the potential for different effects exists.John Gettens, Ph.D., is a research scientist; Monika Mitra, Ph.D., is an assistant professor of family medicine and community health; Alexis D. Henry, Sc.D., is a research associate professor of psychiatry; and Jay Himmelstein, M.D., is a professor of family medicine and community health, all at

Juvenile justice, mental health, and the transition to adulthood: A review of service system involvement and unmet needs in the U.S.

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Identifying Young Adults at Risk of Medicaid Enrollment Lapses After Inpatient Mental Health Treatment

“…Each step of preventing disenrollment or obtaining alternative health care coverage requires individuals to engage in the application process, which may be a substantial barrier for this group. Indeed, studies of the Massachusetts health care reform have found increased enrollment for young adults in Medicaid and through health care exchanges, (41, 42) but worse enrollment among adults with behavioral health problems (43). …”

Massachusetts Health Reform and Access for Children With Special Health Care Needs

“…Our findings of increased OOP spending postreform concur with longer term findings for adults: although gaining insurance initially increased financial protection, many families and individuals have faced higher-than-expected OOP spending postreform. 23,45,[59][60][61][62] Because OOP spending increased in Massachusetts and other states for CSHCN, the increase may reflect a national trend toward decreased financial protection.…”