How Health Insurance Status Affects Persons with Disabilities

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DESCRIPTION: Health insurance provides critical financial access to the U.S. health care system. In 2003, an estimated 45 million persons (15.6% of the population) lacked health insurance, generating enormous personal and societal costs related to diminished health and lowered life expectancies. Certain subpopulations are particularly susceptible to being uninsured. One such subgroup is working-age adults with disabilities that prevent them from "gainful" employment. According to the 2000 decennial census, 21.3 million persons (11.9%) age 16-64 report having some physical or mental condition that makes it hard for them to work. Recognizing their needs, social "safety net" health insurance programs target this population - Medicare and Medicaid, obtained after persons meet Social Security disability and other eligibility criteria. However, our preliminary analyses using the 2000 Medical Expenditure Panel Survey (MEPS) found that 18.7% of working-age persons reporting major sensory or physical disabilities (difficulties with vision, hearing, or using legs, arms, or hands) had no health insurance during some part of the prior year, compared with 14.7% of those without any such impairment. Nonetheless, on average, these individuals have greater health-related needs and generate higher costs than do other persons. The overall specific aims of this two-year study are to use MEPS data from 1998 through 2003 to: (1) explore fully the health insurance experiences of working age persons with sensory and physical impairments; and (2) examine how their health insurance status relates to service use, expenditures, access to and satisfaction with care, and self-reported health and functional outcomes. We shall focus on the Household Component portion of MEPS, which enrolls a nationally-representative sample of civilian, noninstitutionalized, U.S. residents and administers 5 rounds of surveys to them over 2 1/2 years. Using the richness of the data gathered by MEPS and its longitudinal design, we shall look also for trends over time in health insurance experiences for persons with sensory and physical impairments, as well as the consequences for individuals of transitioning on and off health insurance. Our ultimate goal is to use this information to improve the efficiency and quality of care provided to this potentially expensive population. This goal addresses the objectives of the Agency for Healthcare Research and Quality, which has identified persons with disabilities as one of its priority populations.