Sunday, February 1, 2015

Disability and Obamacare: New freedom to return to work

One of the biggest challenges facing disabled people is how to enter the workforce and still maintain the health care coverage they need.

Disability and Obamacare: New freedom to return to work

One of the biggest challenges facing disabled people is how to enter the workforce and still maintain the health care coverage they need.

According to the 2000 Census, there are 33.1 million working age people with disabilities between the ages 16 and 64 in the United States. For those individuals, the current framework of health care coverage provides a disincentive to work.

Public health insurance for the disabled is usually contingent on not working. In Pennsylvania, a disabled person seeking coverage under Medicaid must be receiving Supplemental Security Income (SSI) benefits. An individual only qualifies for those benefits if they maintain no more than insubstantial work activity. In other words, because of the link to SSI, individuals with disabilities who need Medicaid coverage often have to choose between working and having insurance.

Private insurance coverage has either been entirely unavailable to the disabled or extremely costly. This is because insurance companies have traditionally denied individual policies or charged excessively high premiums to those with pre-existing medical conditions.

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Experts say that is about to change under Obamacare.

The health reform law brings changes to the individual insurance market’s practices regarding pre-existing conditions. Insurance companies are prohibited from using them to deny, rescind, or refuse to renew insurance policies. They also may not charge higher premiums. This gives disabled individuals the freedom to buy coverage on the private market.

Obamacare also allows more disabled people to work in other ways. It give states the option to expand Medicaid to cover single adults with incomes up to 133% of the federal poverty level. This means that many people who are partially disabled and not dependent on SSI can now qualify for Medicaid, which they could not have received under current rules

Pennsylvania Governor Tom Corbett has opted not to expand Medicaid in the state, but has left the door open for reconsideration in the next legislative session. This decision, if not changed, could have grave implications for many disabled individuals in Pennsylvania.

Obamacare also contains provisions for maintaining more disabled individuals in the community through the Money Follows the Person program (MFP). That initiative reduces reliance on institutional care for individuals needing long-term services by permitting funds to be shifted to outpatient community programs for their care. The law extended MFP through 2016 and provided an additional $2.25 billion in funding.

Work is an essential part of life for most people - both for those with and without disabilities. Work not only provides economic value, it builds self-esteem and provides a sense of purpose within one's community. People with disabilities who want to work should be allowed that opportunity. The choice between working and health insurance is one that no one should have to make. Hopefully, it will soon be a thing of the past.

From Obamacare to Medicare to managed care, read more of The Field Clinic here >>

About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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