The association between the Patient Protection and Affordable Care Act and healthcare affordability among US adults with intellectual disability.
The ACA let more adults with ID afford doctor visits, yet prescriptions, glasses, and follow-ups still strain wallets.
01Research in Context
What this study did
Researchers looked at US adults with intellectual disability before and after the Affordable Care Act started. They used insurance records to see if the law made care cheaper.
The team checked if people skipped doctor visits, glasses, or medicine because of cost.
What they found
After the ACA, more adults with ID had insurance. Fewer skipped care because of cost.
People still struggled to pay for prescriptions, follow-up visits, and eyeglasses.
How this fits with other research
Chiviacowsky et al. (2013) saw adults with ID in rural or poor areas land in the hospital more often for problems that regular doctor visits could prevent. Torelli et al. (2023) now shows the ACA cut those cost barriers, pointing to the same fix: better primary-care access.
Cooper et al. (2011) found that living in a deprived area meant more emergency visits and fewer specialist check-ups. The new data say insurance help alone is not enough; gaps in glasses and follow-up care remain.
Together the papers tell one story. Take away the cost wall and people still need extra support to reach dentists, eye doctors, and pharmacies.
Why it matters
If your client with ID avoids follow-ups or lacks glasses, check their ACA plan first. Most now have coverage, but they may not know about generic drug lists, free rides, or vision vouchers. A quick call to the insurer and a social-work referral can turn an insured client into a served client.
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02At a glance
03Original abstract
BACKGROUND: Historically, US adults with intellectual disability (ID) experience worse healthcare access than the general population. However, the implementation of the Patient Protection and Affordable Care Act (ACA) may have reduced disparities in healthcare access. METHODS: Using a pre-ACA 2011-2013 sample and a post-ACA implementation 2014-2016 sample from the National Health Interview Survey data, we examined the association between the ACA's introduction and healthcare access among adults with ID (N = 623). Negative binomial regression models were used to test the association between the ACA and the total number of foregone healthcare services. Binary logistic regression was used to explore whether the ACA's implementation was associated with the increased likelihood of possessing health insurance as well as the decreased likelihood of any and particular measures of foregone healthcare services due to cost. RESULTS: The study provides evidence that the ACA's implementation was associated with the decreased likelihood of the total number and any foregone care services owing to cost. Findings also revealed that the ACA's implementation was associated with expansion of health insurance coverage and decreasing instances of foregone care services for medical care, dental care, specialist visit and mental care among adults with ID. However, persons with ID were still at a higher risk of foregone prescription medicines, follow-up medical care and eyeglasses due to cost in the post-ACA years. CONCLUSIONS: The study provides evidence that healthcare access among Americans with ID improved after the ACA's implementation. However, challenges in access to follow-up care, eyeglasses and prescription medicines persist and require policy solutions, which extend beyond the ACA's provisions.
Journal of intellectual disability research : JIDR, 2023 · doi:10.1111/jir.13037