Reliable Health Coverage: The Key to
Employment for Many People with Disabilities

By Mary R. Anderlik
Health Law & Policy Institute

A paper released this fall by the Kaiser Family Foundation concludes that people with disabilities do less well than their non-disabled peers on a range of measures, including employment. Access to adequate health care is the foundation for peace of mind and productivity for people with disabilities, yet roughly 4.4 million working-age disabled adults lack health insurance. A job is not necessarily an escape from a precarious existence; over half of the 4.4 million are employed. See "Profiles of the Disabled: Employment and Health Coverage,"

Current law provides a social safety net, but the net only protects those who meet stringent definitions of disability and refrain from income-generating activity. Those who earn more than $700 a month are ineligible for Social Security Disability Insurance and, after three years, for Medicare. Even a modest income can result in the loss of Medicaid, which provides more comprehensive coverage than Medicare and most private insurance. For a person with a disability who considers a job search, fear of the fall-out from a serious health problem, especially following a loss of government benefits, adds to fear of rejection or misunderstanding by potential employers. The American ethos puts a high value on work and self-sufficiency, but the present benefit structure discourages work and fosters dependency.

Fortunately, change appears imminent. Both the Senate and House have passed bills that would eliminate or at least diminish the perverse incentives. S. 331, the "Work Incentives Improvement Act of 1999," would extend Medicare coverage indefinitely for individuals who enter the workforce in a six-year period beginning on or near the date the bill is enacted into law. The bill would permit states to use federal matching funds to extend Medicaid coverage to employed individuals with disabilities who would otherwise be ineligible for benefits due to standard income, asset, and resource limitations, or due to a medical improvement (referred to as a "buy-in" option because individuals at higher income levels would be permitted to purchase Medicaid coverage). Under H.R. 3070, the "Ticket to Work and Work Incentives Improvement Act of 1999," people with disabilities would be eligible for Medicare for ten years from the date of employment. H.R. 3070 would also create a Medicaid buy-in option. Both bills contain additional provisions that would fill in other gaps. Both bills would establish grant programs aimed at strengthening the infrastructure for employment of people with disabilities.

The House and Senate have appointed conferees who will meet to reconcile the two bills. The two major items on the agenda are resolving the disparity over time periods for extension of Medicare coverage and identifying sources of funding for the program expansion. This effort enjoys support across the political spectrum, and prospects for success are excellent.

John Hockenberry, an award-winning journalist and author of Moving Violations: War Zones, Wheelchairs, and Declarations of Independence, made two important observations in a Houston appearance on October 26.

Many people with disabilities have the potential to make significant contributions -- if only they are given the opportunity. Passage of a "Work Incentives Improvement Act" would be a big step toward realization of that potential.