Disabled and Poor Still Have Access Barriers Under ACA

Marcia Frellick

September 30, 2015

One fourth of insured, disabled people in the United States have been unable to afford care or have had trouble getting insurers to pay for care in the last 12 months compared with 13.6% of insured Americans without a disability, new data show.

Also, compared with adults who did not report a disability, those who did were significantly more likely to have had trouble finding a physician (7.4% vs 3.5%, respectively) and getting an appointment as soon as needed (20.5% vs 9.7 %).

Problems with getting to appointments also make adults with disabilities nearly twice as likely as other adults to report unmet needs (16.8% vs 9.2%). Those problems include difficulty getting to a physician's office or clinic when it is open, taking too long to get to a physician from home or from work, and not having a way to get there.

The data are from an issue brief published online September 24. The brief is one in a series of reports based on data from the Urban Institute's Health Reform Monitoring Survey and funded by the Robert Wood Johnson Foundation that tracks the effects of the Affordable Care Act, now that access to insurance has been expanded.

The findings indicate that issues beyond expanding coverage, such as provider supply and provisions for transportation, need to be addressed to bridge gaps.

"Because a disproportionate share of full-year insured adults with disabilities reported being enrolled in public coverage, policies targeting Medicaid reimbursement levels, covered benefits, provider networks, and transportation may have a greater effect on these disparities than reforms targeting adults with private coverage," write authors Michael Karpman and Sharon K. Long from the Urban Institute, Washington, DC.

Poor Also Fare Worse

A second brief, also published online September 24, reports that low-income people with insurance are nearly four times as likely as their higher-income counterparts to have trouble finding a physician. In addition, note authors Laura Skopec and Stephen Zuckerman, also from the Urban Institute, among adults uninsured for part or all of the past 12 months, low-income adults were more likely than higher-income adults to report difficulty finding a general physician or specialist (8.5% compared with 3.8%, respectively).

Overall, the aim of the Affordable Care Act to increase the number of insured has been successful. Recent Health Reform Monitoring Survey data show that about 15 million (95% confidence interval, 11.9 million - 18.1 million) adults aged 18 to 64 years gained coverage between the first open enrollment and after the second one in March 2015.

During that period, the uninsured rate for those with income at or below 138% of the federal poverty level fell 16.2 percentage points, going from 39.0% to 22.7%. However, low-income adults continue to have more difficulty accessing providers than higher-income adults (those with family income at or above 400% of federal poverty level), the researchers found.

The researchers used data on a nationally representative sample of adults aged 18 to 64 years from the March 2015 round of the Health Reform Monitoring Survey. They focused on adults who reported being insured for a full year to analyze access barriers that were not the result of differences in coverage status.

Funding for the Health Reform Monitoring Study is provided by the Robert Wood Johnson Foundation and the Urban Institute.

"QuickTake: Even with Coverage, Many Adults Have Problems Getting Health Care, with Problems Most Prevalent among Adults with Disabilities." Urban Institute. Published online September 24, 2015. Full text

"QuickTake: Few Adults Have Difficulty Finding a Doctor, but the Problem Is More Common for Low-Income Adults Than for Higher-Income Adults." Urban Institute. Published online September 24, 2015. Full text

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