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Medicaid expansions: The work and program participation of people with disabilities.

机译：医疗补助扩展：残疾人的工作和计划​​参与。

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摘要

People with disabilities are economically disadvantaged compared to the non-disabled, experiencing lower employment rates, lower wages and higher poverty rates. The steady rise in Social Security Disability Insurance (DI) participation over the past two decades suggests that people with disabilities are working less. One potential explanation for the low employment rates and increasing DI participation rates relates two key factors, an unmet need for health care services and the negative work incentives of two public health insurance programs, Medicare and Medicaid. People with disabilities in need of health insurance face a tradeoff between substantial work and the alternatives, the combined cash and health coverage benefits of either Supplemental Security Income (SSI) and Medicaid, or DI and Medicare.;Recent federal legislation affects the tradeoff. The Balanced Budget Act of 1997 and the Ticket to Work and Work Incentives Improvement Act of 1999 gave states the authority to expand Medicaid coverage to include persons with disabilities at higher income levels. The expanded Medicaid coverage is the Buy-In Program. The Buy-In program alleviates the tradeoff by providing health insurance without the work limits and, if desired, without the associated SSI or DI participation. By de-linking health insurance from cash benefits and by increasing earnings limits, Buy-In provides new opportunities for people with disabilities to obtain health insurance while working at substantial levels.;This dissertation evaluates whether the new opportunities increase employment and/or to decrease disability benefit participation. The economic static labor supply model is used to determine the theoretically predicted effects of the Buy-in program. The static labor supply model is a utility maximization model where individuals balance their labor and leisure to maximize utility under their wage constraint. Cash disability and Medicaid benefits are included in the model through the wage constraint. The static labor supply model predicts an increase in employment for DI recipients. The effect on DI participation is indeterminate. The Buy-in program is not predicted to affect SSI participation or SSI recipients' employment participation.;Two data sources, the March Supplement to the Current Population Survey and the Survey of Income and Program Participation, are used for samples of individuals with disabilities for 1995 through 2005. Three samples are identified, SSI recipients, DI recipients and individuals with a disability. A separate analysis is conducted to determine if samples based on self-reported work limitation are appropriate for use in evaluations of disability program effects on employment. I conclude that use of self-reported work limitation samples is not appropriate because of bias; individuals' self-report of work limitation are dependent on work status.;The Buy-In effects on employment and disability benefit participation are identified by four sources of exogenous variation. The first source is state variation in program implementation; only thirty two states have Buy-In programs. The second is the extent of the Buy-In expansion; some state programs are more expansive than others. The third is variation in the receipt of disability cash benefits; the Buy-in program work incentives differ for Supplemental Security Income (SSI) recipients compared to Social Security Disability Insurance (DI) recipients. The fourth is individual access; some disabled individuals are eligible for the expansions and some are not. There is considerable variation in all four sources. Buy-In effects are estimated using difference-in-difference (DID) and difference-in-difference-in-difference (DDD) methods.;State Buy-In programs have been able to fill gaps in health insurance and healthcare services without large increases in Medicaid enrollment. I am not able to detect statistically significant Buy-In effects on work or disability program participation. The empirical findings and the low numbers of national Buy-In participants suggest that the Buy-In effects on employment and disability benefit participation relative to DI recipients, SSI recipients, or people with disabilities if existent, are small. There is considerable state variation in Buy-In programs and a conclusion based on national data may not apply to some state programs. It is also possible that there may be effects within subgroups that are not apparent in estimates for the broad groups studied. Most Buy-In participants are also DI participants. The lack of participation among non-DI recipients is likely due two barriers: a lack of program awareness and a Buy-In disability definition that is contingent on an inability to work.;The findings of this study have important policy implications. The findings should allay any remaining state fears that new or expanded Buy-In programs will result in large increases in Medicaid participation. To alleviate program awareness barriers, states should target outreach efforts to working persons with severe disabilities who are not already disability program applicants or participants. Congress should change the disability definition to remove the work contingency. Resolution of the barriers will provide an insurance alternative to disability benefits and, for some, will prevent job loss and deter DI participation.
机译：与非残疾人相比，残疾人在经济上处于不利地位，其就业率，工资和贫困率较低。在过去的二十年中，社会保障残疾保险（DI）参与人数的稳定增长表明，残疾人的工作量有所减少。就业率低和直接投资参与率提高的一种可能解释涉及两个关键因素：对医疗服务的需求未得到满足以及两个公共医疗保险计划Medicare和Medicaid的负面工作激励。需要医疗保险的残疾人面临着大量工作与其他选择之间的权衡，这是补充安全收入（SSI）和Medicaid或DI和Medicare的现金和健康保险福利的总和；最近的联邦法律影响着这种权衡。 1997年的《平衡预算法案》和1999年的《工作及工作激励措施通票》赋予各州权力，将医疗补助覆盖面扩大到收入较高的残疾人。扩大的医疗补助覆盖范围是买入计划。买入计划通过提供无工作限制的健康保险减轻了权衡，如果需要，还没有相关的SSI或DI参与。通过将健康保险与现金福利脱钩，并通过增加收入限额，买入为残疾人提供了在实质性工作中获得健康保险的新机会。本论文评估了新机会是否增加了就业和/或减少了就业残疾福利参与。经济静态劳动力供给模型用于确定买入计划的理论预测效果。静态劳动力供给模型是效用最大化模型，个体在工资约束下平衡劳动和休闲以最大化效用。通过工资约束将现金残疾和医疗补助福利纳入模型。静态劳动力供给模型预测直接投资接受者的就业将增加。对DI参与的影响不确定。买入计划预计不会影响SSI参与或SSI接收者的就业参与。；两个数据源，即《当前人口调查的3月补编》和《收入与计划参与度调查》用于以下方面的残疾人样本：从1995年到2005年。确定了三个样本：SSI接收者，DI接收者和残疾人。进行了单独的分析，以确定基于自我报告的工作限制的样本是否适合用于评估残障计划对就业的影响。我得出结论，由于偏见，使用自我报告的工作限制样本不合适。个人对工作自我限制的自我报告取决于工作状态。购买对就业和残障利益参与的影响通过四个外源性变化来确定。第一个来源是程序执行中的状态变化。只有三十二个州有买入计划。第二是买入扩展的程度；一些州计划比其他州计划更广泛。第三是残疾现金补助金的收入差异；与社会保障伤残保险（DI）接收者相比，补充安全收入（SSI）接收者的买入计划工作激励措施有所不同。第四是个人访问；一些残疾人有资格参加扩展，有些则没有资格。所有四个来源都有很大的差异。买入效果是使用差价差（DID）和差额差价差（DDD）方法估算的；州买入计划已经能够填补健康保险和医疗保健服务中的空白，而无需花费很多医疗补助人数增加。我无法检测到对工作或残疾计划参与有统计学意义的买入效应。经验发现和全国买入参与者的数量较少表明，相对于直接投资接受者，SSI接受者或残疾人（如果存在），买入对就业和残障利益参与的影响很小。买入计划的州差异很大，基于国家数据的结论可能不适用于某些州计划。也有可能亚组内的影响在所研究的广泛群体的估计中并不明显。大多数买入参与者也是DI参与者。非直接投资接受者之间缺乏参与可能是由于两个障碍：缺乏计划意识和取决于无法工作的买入式残疾定义。这项研究的结果具有重要的政策含义。该调查结果应可以消除任何剩余的州担心新的或扩展的买入计划将导致医疗补助参与的大幅增加。减轻计划意识障碍，州应将外展工作的目标人群定位为尚未成为残障计划申请者或参与者的重度残疾人。国会应更改残疾定义以消除工作意外情况。解决障碍将为残疾福利提供替代保险，并且对于某些人而言，将防止失业和阻止直接投资参与。

著录项

  • 作者

    Gettens, John W.;

  • 作者单位

    Brandeis University, The Heller School for Social Policy and Management.;

  • 授予单位 Brandeis University, The Heller School for Social Policy and Management.;
  • 学科 Economics Labor.
  • 学位 Ph.D.
  • 年度 2009
  • 页码 253 p.
  • 总页数 253
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 劳动经济;
  • 关键词

  • 入库时间 2022-08-17 11:38:26

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