Health Care Costs Are A Key Driver Of Growth In Federal And State Assistance To Working-Age People With Disabilities
ABSTRACT A large and rapidly growing share of US government expenditures pays for assistance to working-age people with disabilities. In 2008 federal spending for disability assistance totaled $357 billion, representing 12 percent of all federal outlays. The states' share of joint federal-state disability programs, more than 90 percent of it for Medicaid, was $71 billion. The increased cost of health care-which represented 55 percent of combined state and federal outlays for this population in 2008-is one of the two main causes of spending growth for people with disabilities. Health care is already likely to be a target of further efforts by states and the federal government to contain or reduce spending, and it is therefore probable that spending restraints will affect the working-age population with disabilities. In fact, unless ways can be identified to make delivery of health care to this population more efficient, policy makers may be unable to avoid funding cuts that will further compromise its well-being.
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ABSTRACT: Objective To estimate cumulative DI, SSI, Medicare, and Medicaid expenditures from initial disability benefit award to death or age 65.Data SourcesAdministrative records for a cohort of new CY2000 DI and SSI awardees aged 18–64.Study DesignActual expenditures were obtained for 2000–2006/7. Subsequent expenditures were simulated using a regression-adjusted Markov process to assign individuals to annual disability benefit coverage states. Program expenditures were simulated conditional on assigned benefit coverage status. Estimates reflect present value of expenditures at initial award in 2000 and are expressed in constant 2012 dollars. Expenditure estimates were also updated to reflect benefit levels and characteristics of new awardees in 2012.Data CollectionWe matched records for a 10 percent nationally representative sample.Principal FindingsOverall average cumulative expenditures are $292,401 through death or age 65, with 51.4 percent for cash benefits and 48.6 percent for health care. Expenditures are about twice the average for individuals first awarded benefits at age 18–30. Overall average expenditures increased by 10 percent when updated for a simulated 2012 cohort.Conclusions Data on cumulative expenditures, especially combined across programs, are useful for evaluating the long-term payoff of investments designed to modify entry to and exit from the disability rolls.Health Services Research 08/2014; 50(2). DOI:10.1111/1475-6773.12219 · 2.49 Impact Factor
Article: Disability Data in National Surveys
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ABSTRACT: We use a dynamic modeling strategy to evaluate two potential avenues through which health differences generate a wage gap: directly through reductions in health capital and indirectly through employment transitions that reduce human capital (specifically, occupation and employer tenure). Our results suggest that male workers with a moderate disability are 23 percent more likely to change occupations or employers than nondisabled men. Compared to those who do not make a transition, workers with a moderate disability who change occupations and employers experience an immediate $0.30 decline in hourly wages on top of a $0.57 decline associated with the disability onset.Journal of Human Capital 01/2014; 8(3):235-279.