Affiliations: Division of Adult Studies, University of Kansas, KS, USA | Nebraska Center for Research on Children, Youth, Families and Schools, University of Nebraska, Nebraska, USA
Note: [] Address for correspondence: Dr. Jean P. Hall, 1122 West Campus Road, Rm 517, Lawrence, KS 66045-3101, USA. Tel.: +1 785 864 7083; Fax: +1 785 864 7799; E-mail: jhall@ku.edu
Abstract: Health conditions that prevent individuals from working full time can restrict their access to health insurance. For people living in the 35 states that offer high-risk pools, coverage is available but premiums are 125–200% of standard rates. Additionally, high cost-sharing means enrollees often defer needed care because they must pay large amounts out of pocket. Lack of access may lead to poor health outcomes and disability. The Kansas DMIE investigated whether improving insurance coverage for such a group would improve their health status and reduce their risk of transition to full Social Security disability. Half of the 508 participants received enhanced benefits and nurse case management, the other half received usual risk pool coverage. Outcomes were measured through telephone surveys, focus groups, and claims analysis. Utilization of services increased and health status stabilized for the intervention group, while health status of the control group significantly declined. These findings have broad implications because some plans to be offered under the Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) have similarly high out-of-pocket costs. Considering the long-term cost of full disability, providing adequate health insurance benefits for individuals at high risk of disability may be cost effective.
Keywords: High-risk pool, disability, chronic condition, health care, employment
