Working-Age Persons with Disabilities Share in the Gains of Massachusetts Health Reform

Prior research has demonstrated that the Massachusetts health reform substantially reduced uninsurance and cost-related problems obtaining care among working-age persons. However, there is a lack of research on the effects of the Massachusetts reforms on working-age persons with disabilities. In this study, we estimate the effects of the Massachusetts reform on persons with disabilities. Separate estimates for the population of persons with disabilities are warranted because the effects may be different for persons with disabilities compared to persons without disabilities. Persons with disabilities are much poorer on average and have much lower employment rates compared to persons without disabilities. Thus, we expect persons with disabilities to be more affect by reform changes targeted to low-income persons and less affected by changes aimed at increasing employer-sponsored-insurance. Using data from the national Behavioral Risk Factor Surveillance System survey and a difference-in-difference method to accommodate for the unobserved effects of time, we estimate the Massachusetts health reform reduced the uninsurance rate for working-age persons with disabilities by nearly half. We find that enrollment in Medicaid and subsidized insurance accounts for most of the insurance gain. The reduction in uninsurance was greatest among young adults with disabilities. 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 persons with disabilities.