Perspectives of adults with disabilities on access to health care after the ACA: Qualitative findings

Although health insurance gains are documented, little is known about personal experiences of adults with disabilities in accessing health care after coverage expansions of the Affordable Care Act (ACA) in 2014. We interviewed 22 adults across the U.S. with a variety of disabilities and health insurance types to document remaining barriers to health care after ACA coverage expansions. Telephone interviews were conducted from May to August 2017. Participants were recruited via disability-related organizations and were demographically and geographically diverse. Content analysis of interview transcripts was used to identify major themes related to accessing health care. Five major themes emerged: 1) information and understanding of coverage; 2) out-of-pocket costs; 3) prescription medications; 4) provider networks; and 5) transportation. Barriers in these areas led participants to delay or forgo health care and interfered with their ability to participate in paid employment. The ACA was intended to expand access to insurance coverage, not necessarily meet all health care related needs for people with disabilities. Many barriers remain to accessing needed care for this population, regardless of insurance status. Limited prescription coverage, limited provider networks and steep out-of-pocket costs may be addressed by policy makers at the state or national level. Similarly, having timely and accurate plan information is important in facilitating access to care and insurers should be aware that outdated information can result in missed care. Finally, transportation to appointments can be especially challenging for people with disabilities and insurers should consider options to address this issue.