Will the ACA reduce the disability rolls?

Two years ago, I was riveted by TNR reporter Alec MacGillis' chat with a woman on line for a free REM medical clinic in rural Tennessee. Notwithstanding that she knew nothing about the ACA, she offered a stunning instant analysis, once the basics were described to her, of one likely economic effect:

..it it was hard to find visitors to the clinic who would not benefit directly from the law. Barbara Hickey, 54, is a diabetic who lost her insurance five years ago when her husband was injured at his job making fiberglass pipes. She gets discounted diabetic medication from a charity, but came to the clinic to ask a doctor about blood in her urine.

Under the law, she would qualify for Medicaid. Her eyebrows shot up as the law was described to her. "If they put that law into effect, a lot of people won't need disability," she said. "A lot of people go onto disability because they can't afford health insurance."

Lo, Ms. Hickey was a prophet (perhaps). In Arkansas, which has sliced its uninsured rate almost in half since ACA enactment, mainly by enrolling nearly 200,000 Arkansans in the state's "private option" Medicaid alternative, disability claims seem to be dropping.* Modern Healthcare's Paul Demko reports:**

When SSI is the only route to health insurance

Re that Nicholas Kristof column alleging skewed incentives in the children's Supplemental Security Income (SSI) program: in a prior post, I looked at a study Kristof cited that does not clearly demonstrate what Kristof implies it does --that an undue proportion of children on SSI transition directly to adult SSI when their eligibility for the children's benefit ends at age 18.

The 2009 study, by Jeffrey Hemmeter, Jacqueline Kauff, and David Wittenberg, does indicate a variety of incentives, some of them potentially perverse, for staying on children's SSI while eligible and for transitioning to adult SSI if possible.  One set of incentives is indeed skewed, thanks to a dearth of resources outside the program.  It's this: SSI, for children and adults alike, can be the only source for health insurance and specific health services:

When Nick Kristof stretches a study

They say that three times is a trend, so I will have to make do with two thirds of a trend regarding Nicholas Kristof's use of social science research. Or more precisely, regarding Kristof's use of research to back what he presents as inconvenient truths regarding the behavior of poor people or the efficacy of attempts to help them.

Instance 1: Kristof is currently taking a lot of heat from liberal social policy experts for using anecdotal evidence to suggest that significant numbers of parents of children receiving Supplemental Security Income (SSI) deliberately keep their children illiterate to avoid losing the child's disability check.  More precisely, Kristof uses anecdotal evidence supported by statistical sleight-of-hand.

Harold Polllack rather gently points to the questionable deployment of data. I'd like to elaborate a bit. Pollack's case first: