Effects of Enhanced Insurance on Health Outcomes of People with Potentially Disabling Conditions

The Kansas Demonstration to Maintain Independence and Employment (DMIE) examined the effects of a health care intervention for working individuals enrolled in the state's high-risk pool health insurance program. All DMIE participants had potentially disabling conditions and had been denied insurance coverage in the private market due to these pre-existing conditions. The intervention, which included low-cost Medicaid-like coverage and nurse case management as wraparound to the state high-risk pool plan, was hypothesized to increase access to care and consequently delay or forestall progression to full Social Security disability. Half of the 412 study participants received intervention benefits while the other half continued with coverage as usual through the high-risk pool. Outcomes were measured through data from telephone surveys, focus groups, and claims analysis. The cost of insurance premiums and medical care was persistently identified as a barrier to effectively managing health conditions for control group members, while intervention group members reported increased access and approximately doubled utilization of appropriate health services. Results indicate that physical health status remained stable for intervention group members while it declined significantly for control group members. Health insurance plans with low actuarial value, including high-risk pools and entry-level plans proposed under health care reform, may be a poor match for people with serious health conditions and increase their risk of disability. These findings suggest that by providing adequate health benefits to high-risk individuals prior to disability, the greater cost of supporting federal disability beneficiaries may be reduced or avoided altogether.