Relation between health insurance and health care disparities among adults with disabilities

Background: This study examines disparities among adults with disabilities and the degree to which health insurance attenuates disparities by race, ethnicity and SES. Study Methods: We pool data from five panels of the Medical Expenditure Panel Survey. Our analytic sample includes approximately 11, 500 respondents age 18-64 who report a disability, following the ICF approach to defining disability. Drawing from Andersen's Behavioral Model of Health Care Access, we model measures of access and use as functions of predisposing (i.e., race, ethnicity, education, age, gender, marital status), enabling (i.e., income), need (i.e., type of disability) and contextual (i.e., region, MSA) factors, examining whether effects related to minority status and SES remained after accounting for covariates. We then include health insurance (i.e., Medicare, Medicaid, and uninsured, with private insurance as the reference) and examine the extent to which health insurance attenuates remaining disparities. Findings: We found evidence of disparities in access and use of services by race, ethnicity, education, and income among adults with disabilities. While adjusting for health insurance reduced the disparities experienced by Hispanic adults, it did not reduce most disparities experienced by Black adults with disabilities relative to their White counterparts. Adjusting for health insurance largely reduced the SES effects on access and use of services. Discussion and Implications: Health insurance expansions under the Affordable Care Act will likely reduced SES-related disparities among adults with disabilities. Further research exploring the effects of factors such as patient-provider interactions and cultural competency on disparities among Black adults with disabilities is warranted.