Gina A. Livermore

Health Care Costs Are A Key Driver Of Growth In Federal And State Assistance To Working-Age People With Disabilities

A large and rapidly growing share of US government expenditures pays for assistance to working-age people with disabilities. In 2008 federal spending for disability assistance totaled

Income Security for Workers: A Stressed Support System in Need of Innovation

357 billion, representing 12 percent of all federal outlays. The states share of joint federal-state disability programs, more than 90 percent of it for Medicaid, was

Employment and Economic Well-Being of People With and Without Disabilities Before and After the Great Recession

71 billion. The increased cost of health care-which represented 55 percent of combined state and federal outlays for this population in 2008-is one of the two main causes of spending growth for people with disabilities. Health care is already likely to be a target of further efforts by states and the federal government to contain or reduce spending, and it is therefore probable that spending restraints will affect the working-age population with disabilities. In fact, unless ways can be identified to make delivery of health care to this population more efficient, policy makers may be unable to avoid funding cuts that will further compromise its well-being.

Gaps in Timely Access to Care Among Workers by Disability Status

The current mix of public and private programs to support workers after they experience disability onset provides benefits to millions of workers and former workers. Yet, despite the large and growing costs of these programs, the inflation-adjusted household incomes of workers with disabilities have been falling for more than two decades, both absolutely and, especially, relative to the incomes of those without disabilities. The aging of the baby boom generation is likely to make matters worse, and the governments fiscal circumstance will make it increasingly difficult to sustain existing public programs. Current public policy initiatives might eventually improve the disability support system, but they are not likely to ward off the adverse consequences of the pending crisis. Policy changes that leverage existing private sector practices and capabilities might achieve greater success but have received little attention and are far from proven.

Finding alternatives to disability benefit receipt

The latest U.S. economic recession, commonly referred to as the Great Recession, has had a far-reaching impact, but its effects may be disproportionately experienced by working-age people with disabilities, given their already tenuous attachment to the labor force. We used data from the Current Population Survey both to describe the experiences of working-age people with disabilities during 2006–2012 (a period beginning before and ending after the Great Recession) and to compare the experiences of this population with those of working-age people without disabilities. We found few significant differences in the characteristics of people with disabilities before and after the Great Recession. The employment rate of people with disabilities was low both before and after the recession, though the decline in employment among people with disabilities was somewhat greater than for people without disabilities. The employment declines observed during this period for people with disabilities reflect a long-term downward trend that has persisted for decades, raising concerns that people with disabilities are permanently exiting the labor force. Job loss after the recession was particularly concentrated among people with disabilities in blue-collar and goods-producing jobs. People with and without disabilities experienced similar increases in poverty. Ongoing surveillance of the characteristics and employment of people with disabilities is needed to identify trends and develop policies to promote their independence and economic security.

Premium Increases in State Health Insurance Programs: Lessons from a Case Study of the Massachusetts Medicaid Buy-in Program

The Patient Protection and Affordable Care Act (ACA) is salient for workers with a disability because of their significant health care needs, relatively low incomes, and the complex interactions among work, federal disability benefits, and eligibility for public health insurance. Using data from the 2006–2010 National Health Interview Surveys, in this study, we document the characteristics and health insurance profiles of workers with a disability and consider the extent to which these factors are correlated with the ability to access adequate and timely health care. We find significantly higher rates of reported difficulties accessing timely health care for cost-related and structural reasons among employed adults with self-reported health conditions limiting the ability to work than among their non-work-limited peers, even after controlling for personal characteristics and health insurance coverage. The findings suggest that although the ACA will improve access to health insurance, it remains to be seen whether it will substantially reduce the likelihood that workers with disabilities will experience barriers to health care access relative to their non-disabled peers.

Material Hardship, Poverty, and Disability Among Working-Age Adults†

AbstractThis introduction offers a context for the articles in this thematic series by providing an overview of the programs that provide cash and in-kind supports to people with disabilities in the United States, summarizes the increasing reliance on these programs, and describes the challenges associated with reducing dependency on these programs. It then briefly discusses the articles in this thematic series in light of these issues.JEL codesH5, I3, J2, J14

Social Security Disability Beneficiaries with Work-Related Goals and Expectations

In March 2003, Massachusetts increased the premiums it charges to most enrollees in its CommonHealth-Working (CH-W) program. This study evaluates the impact of the premium change on disenrollment using a comparison group methodology. The findings indicate that the premium change had only a small, but statistically significant impact on program exits. The CH-W experience differs from other state programs that saw substantial enrollment declines in response to new or increased premiums. This is likely due to factors that make CH-W different from other programs, key of which are administrative procedures intended to minimize disenrollment due to premium nonpayment.