People with Disabilities: Poverty and Health Care Costs in Tucson, Arizona MSA

In the first and second articles of the disability series, we explored how disability status in the US, Arizona, and Tucson MSA populations relate to educational access and attainment, employment opportunities, and earnings. This third and last article provides a closer examination of how the multifaceted nature of poverty, access to the healthcare system, and infrastructure are interrelated, and how their intimate connection to education, employment, and earnings combine to affect the disabled community.

Poverty

Disability can be both a cause and a consequence of socio-economic instability. Often, it leads to job loss, reduced earnings, substantial disability-related costs, and barriers to education and training. As highlighted in the Economic Justice is Disability Justice report by the Century Foundation, disability can also be a consequence of economic insecurity because poverty and economic instability impede access to health care and increase the likelihood of living and/or working under unhealthy conditions. In this way, disability and poverty are profoundly interconnected.

According to a report by the National Disability Institute, disability and poverty reinforce each other, contributing to increased vulnerability and exclusion. One purpose of tracking these data is to provide visibility to people with disabilities who are living in poverty and enable making the decisions that will mitigate and ultimately eradicate this situation. As the United Nations in the 2030 Agenda for Sustainable Development", disability cannot be a reason or criteria for lack of access to development programming and the realization of human rights.

In 2022, the poverty rate of individuals with disabilities aged 18-64 years in the U.S. was 24.9%, while the poverty rate of individuals without disabilities was 10.2%- a difference of 14.7 percentage points (Figure 1). The poverty gap was smaller in Arizona and Tucson compared to the Nation, where the differences were 11.7 and 10.8 percentage points, respectively.

Figure 1: Poverty Rate by Disability Status: U.S, Arizona, and Tucson MSA (18-64 Years Old) 2022

Individuals with disabilities 65 years and over experienced lower poverty rates in Arizona (12.7%) and Tucson (12.0%), compared to the U.S. (13.8%). In Tucson, the poverty rates for the working-age population (18-64 years) were 2.3 percentage points higher than the state (22.9%). In 2022, people with disabilities in Arizona experienced lower poverty rates across all age groups compared to their counterparts in the United States (Figure 2).

Figure 2: Poverty Rate Among People With Disabilities by Age Group in the U.S., Arizona, and Tucson (2022)

Healthcare

As maintained by the Centers for Disease Control and Prevention (CDC), people with disabilities face many barriers to good health. They are more likely than people without disabilities to report having poorer overall health, have less access to adequate health care, and more frequently engage in risky health behaviors such as smoking and physical inactivity. In this sense, it is essential to track healthcare data for people with disabilities to assure progress is made towards disability inclusion.

In 2022, 89.1% of individuals with disabilities in Arizona (ages 19-64 years) had health insurance coverage. That was a difference of 0.8 percentage points less than the nation. In contrast, 84.8% of individuals without disabilities had health insurance coverage -a gap health insurance coverage between those with and without disabilities of 4.3 percentage points. That gap was less in Tucson MSA (2.8 percentage points).

In 2022, the Tucson MSA (at 94.5%) and the state of Arizona (at 93.9%) had health insurance rates for children with disabilities that were lower than the nation (96.1%). (See Figure 3).

Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant), resulting in a high rate of coverage.

Figure 3: Percentage of Disabled Population with Health Insurance by Age in the U.S, Arizona, and Tucson (2022)

Disability Healthcare Costs

According to the National Disability Institute, adults with disabilities are less likely to lack health insurance than those without disabilities because they are much more likely to be covered by Medicare or Medicaid. Nevertheless, they are more than twice as likely to have difficulty paying their medical bills. These bills may be the result of out-of-pocket expenses for co-payments and deductibles or uncovered services.

As reported by the National Council on Disability (NCD) in the Impact of COVID-19 on People with Disabilities, many people with disabilities excluded from the labor market are in a “poverty trap”; they rely on federal public assistance programs, and cannot work without losing essential healthcare.

Disabled people have a wide range of health and support requirements. In comparison to people who are not disabled, they frequently require long-term services and support to address functional limitations and fully participate in society.

In 2015, disability-associated healthcare expenditures (DAHE) for all US totaled $868 billion. That was 340 billion more than in 2003. Of the national total, the DAHE was $324.7 billion for Medicare expenditures, $277.1 billion for Medicaid expenditures, and $ 266.1 billion for nonpublic sources.

The state-level DAHE varied by the state due to differences in demographic characteristics, access to and quality of care, the severity of the disability, the prevalence of chronic conditions, and coverage and payment policies. For instance, in Arizona, the DAHE percentage was 37% of total expenditures (14.8 billion), and in Utah was 29% of total expenditures (4.8 billion).

The mean state-level DAHE per person with disabilities (PWD) in 2015 was $17,431. Among ten western states, Arizona ranked seventh ($14,326). The highest mean DAHE per PWD was California ($19,949), followed by Texas ($17,189). Idaho posted the lowest mean DAHE per PWD ($14,059). Figure 4 shows the estimated mean DAHE per PWD by western states.

Figure 4: Mean Disability-Associated Health Care Expenditures (DAHE) Per Person with a Disability (PWD) (2017 Prices) by States

Infrastructure

The term infrastructure encompasses all the facilities, resources, and tools that people use on a daily basis to live a safe, equitable, and healthy life. Americans with disabilities depend on the disability workforce infrastructure, which consists of health, education, and social services programs. The need for these services is expected to increase significantly in the coming decades, and according to the BLS projects workers in health and medical services will be in high demand over the next ten years. The single highest increase in demand expected is for home health aides, which directly affects the quality of life of people with disabilities.

The American Association of People with Disabilities (AAPD) maintains that the current infrastructure of the nation is still inaccessible for people with disabilities and leaves these individuals behind, although they see the Infrastructure Investment Jobs Act as an encouraging shift of policy. The Act includes $550 billion in new spending and reauthorizes surface transportation funds until 2026, representing a roughly $1.2 trillion overall commitment. This bill will create historic levels of investments in our national infrastructure and promote an equitable economic recovery that will improve the quality of life for people with disabilities. For instance, this bill will increase investment in public transit programs, such as the Enhanced mobility of seniors and individuals with disabilities with a budget of $2.1 billion.

According to the Department of Transportation, transportation is essential for people with disabilities to participate in society. It impacts access to healthcare, essential goods and services, interactions with friends and family, and the ability to work or attend school, as well as a host of other activities. Among modes of transportation to work in 2022, commuters with disabilities driving alone in the U.S., Arizona, and Tucson posted rates lower than those without disabilities driving alone. The Tucson MSA posted a rate of 65.7% of commuters with disabilities driving alone to work, which was 6.6 percentage points less than for commuters without disabilities.

In contrast, people with disabilities carpooled more and were more likely to use public transportation than those without disabilities. However, Tucson and Arizona lagged behind the U.S. in the percentage of commuters using public transportation to work, at 3.1% and 2.2%, respectively, in comparison to 4.2% for the nation. The state of Arizona posted a higher rate of commuters with disabilities working from home than Tucson or the U.S., at 15.0% - 3.7 percentage points ahead of the U.S. and 2.9 percentage points ahead of Tucson. Figure 5 highlights the percentage of commuters with and without disabilities in the U.S., Arizona, and Tucson by modes of transportation. Click on the drop-down menu to view the mode of transportation.

Figure 5: Percentage of Commuters With and Without Disabilities in the U.S., Arizona, and Tucson by Modes of Transportation (2022)

In March 2022, the National Highway Traffic Safety Administration (NHTSA) finalized a new rule that improved equity and mobility for drivers and passengers with disabilities. This final rulemaking allows specific modifications to vehicles to allow for adaptive equipment.

While social and political changes have been made to improve the living conditions and employment opportunities for people with disabilities, the data indicate a need for expansion of policies, continuity in good practices, and additional research to continue closing the gaps that still exist relative to those without disabilities. As individuals living in a community, all of us can participate in improving disabled people's lives in different ways, such as increasing equitable access to education, work, community living, healthcare, and more.

Source

Disability status data come from the 2022 American Community Survey (ACS) 5-year estimates published by the U.S. Census Bureau. The Census Bureau changed the way they handled questions on disability in the 2008 ACS, so current data are not comparable to previous ACS releases or to the Census 2000. This article utilizes data from the Centers of Disease Control and Prevention (CDC) and Public Health Report SAGE Journals to estimate healthcare costs.