The effects of the Americans with Disabilities Act on the health coverage and post-secondary education of people with disabilities

In 1990, Congress passed the ADA to address many of the larger issues related to discrimination and access that individuals with disabilities face. A rich and varied literature has emerged on the ADA's effects on employment, and this study builds on that literature by focusing on whether the ADA, as an environmental factor, affected the relationship between having an activity limitation and having a participation restriction in either health coverage or post-secondary education. The study uses a difference-in-differences modeling approach to compare outcomes for individuals with and without limitations before and after the ADA was implemented, and also capitalizes on a natural experiment resulting from differences in state laws protecting people with disabilities. The key results are as follows: 1) for the working-age population, individuals with limitations had a shift in their health coverage away from private health insurance (such as from an employer) and toward public coverage (such as Medicaid or Medicare) that was largely related to a rise in federal disability benefits rather than the ADA; 2) full-time workers with limitations (particularly those working for private for-profit firms) had a decline in their employer-based health insurance rates after the ADA was implemented, and the effect was larger in states where the ADA represented an addition to existing state law, which is consistent with the ADA having a perverse effect; and 3) the ADA did not improve post-secondary educational enrollment among individuals with limitations, though younger adults with a high school education had an increase in college enrollment after the ADA was implemented. While the ADA addressed barriers for people with disabilities regarding discrimination and access, it provided no supports to address additional barriers to participation, such as having less education and fewer resources. Future policies to promote the economic independence of people with disabilities should build on the ADA to address such barriers, particularly those regarding financial costs. Two such policies would be to implement broad health care reform (such as implemented in Massachusetts) and provide more post-secondary education funding.