Assessing improvements to health care coverage for persons with disabilities using the Patient Protection and Affordable Care Act and Healthy People 2020 as a guide

Healthy People 2020 (HP 2020) set out to make more realistic targets for health objectives as compared to the idealistic targets set 10 years prior. Our overall goal was to assess how the PPACA will further HP 2020 goals for all people regardless of their disability status? We hypothesized that the PPACA will advance HP 2020 goal 2 (to achieve health equity, eliminate disparities and improve the health of all groups) and goal 3 (to create social and physical environments that promote good health for all). We conducted a qualitative assessment of the PPACA, using HP 2010 data as a baseline, we assessed whether PPACA provisions supported the stated HP 2020 objective of 10% improvement in health care access and coverage for persons with disabilities. We found that the PPACA will advance the goals of HP2020 through the implementation of several key provisions including creation of high-risk pools, insurance rescission ban, and to a lesser extent the CLASS Act. However, when considering equity vs. equality, equitable outcomes are not evident for the adolescent and elder disabled populations as evidenced by their ineligibility for the CLASS Act (long-term care). Short-term increases in private health insurance cost will perpetuate discrimination for the disabled. The larger implications will be evident as the PPACA provisions occur in the context of HP 2020 programs. It is questionable to what extent other policy interactions, such as immigration reform, will cause the PPACA to promote HP 2020 goals.