labor market toward more part-time jobs, which have traditionally carried no health insurance. People with disabilities are overrepresented in part-time jobs. Moreover, the ADA has civil rights protections for getting a job, but health insurance protection was not included in the final legislation.

  • When all these factors are put together, two questions arise: What do they mean for program growth, and what could they mean for the Health Care Financing Administration, which manages the Medicaid and Medicare programs? Accelerating health care costs and the growing difficulty for a person with severe medical problems in getting health insurance in the private market are likely to be contributing to the growth of the disability rolls. However, empirical analysis does not provide hard evidence of that relationship. On the other hand, people with disabilities use part-time jobs as a mechanism to restrain their earnings in the SSI programs in states where they can retain their Medicaid benefits. Therefore, in some ways all roads to public policy are linked through the health insurance mechanism.

  • Some have suggested that if the system is not broken, why try to fix it. The system may not be broken, but there certainly is room for bringing it up to date and making it ready for the next century. The system would benefit from incremental improvements, both in the medical listings and in the functional assessment measures. The concern of this workshop is how to measure or improve the measurement of functional capacity as it relates to work. The decision process is complex, requiring a great deal of evidence and assessment. It is important to continue to update the medical listings and perhaps incorporate, as appropriate, assistive technology or changes in the environment that have become pervasive enough that they may warrant altering the threshold within the medical listings. Also, the quality of assessments of residual functional capacity as well as the assessment of age, education, work experience, and the demands of jobs in the national economy all need reexamination.

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