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Will the ACA Reduce Public Disability Coverage?

Posted by John McDonough  September 24, 2012 10:24 PM

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I've seen no comment or coverage about a most provocative commentary in this week's New England Journal of Medicine. The article, "Health Insurance-Motivated Disability Enrollment and the ACA," by Jae Kennedy and Elizabeth Blodgett, suggests that a positive and unintended impact of the Affordable Care Act (aka: ObamaCare) will be a slowdown in the number of Americans claiming public disability insurance coverage.

How come?

"Disabled workers often apply for public financial disability benefits in part to obtain public health insurance -- a uniquely American phenomenon that we call health insurance-motivated disability enrollment (HIMDE)."

What difference would the ACA make in relation to any of this?

"The ACA contains multiple major reforms that should affect HIMDE more than previous efforts have done. Most important, it will increase insurance-coverage options for disabled workers, which could both reduce new health insurance-motivated applications for disability benefits and increase the percentage of enrollees who return to work. The law contains several policy changes that benefit various subgroups of people with disabilities. Extending parents' health insurance coverage for children to the age of 26 may encourage young adults with developmental disabilities to enter the workforce. Prohibiting insurance rescission and eliminating lifetime caps on insurance payouts may make private insurance more attractive for adults with progressive chronic conditions. Eliminating preexisting-condition exclusions will open the private insurance market for the first time to many adults with chronic illness and disability. Offering premium credits and cost-sharing credits will improve coverage and affordability for all workers, including those with disabilities. Capping annual deductibles at $2,000 for individuals and $4,000 for families should help to reduce out-of-pocket costs. Consequently, fewer disabled workers will need to rely on public insurance obtained through disability benefits."

Not many Americans know this, but the part of the Social Security Trust Fund tied to disability insurance is facing a financial crisis and its insolvency is now predicted within the next four years if no reforms are made. This should be a topic for both President Obama and Republican nominee Mitt Romney, and it is to their discredit that neither discusses this.

The ACA, at least, holds the potential to reduce the growth in disability insurance claims, thus lengthening the life of the fund. Not so for Mr. Romney whose determination to repeal the entire ACA would eliminate the only mechanisms at work now to extend the life of the fund.

The more you know...

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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