Collaborative on Health Reform and Independent Living (CHRIL)

The Collaborative on Health Reform and Independent Living (CHRIL) is funded by a 5-year Disability and Rehabilitation Research Program (DRRP) from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DP0075-01-00).  The CHRIL brings together disability advocates and researchers from 4 institutions (Washington State University, the University of Kansas, George Mason University, and the Independent Living Research Utilization program at TIRR Memorial Hermann Hospital) to systematically investigate and disseminate essential findings about how the Affordable Care Act’s implementation affects working age adults with disabilities.

CHRIL Institutional Members and Strategic Partners

Institutional members:

Strategic partners:

photo of jean hall, jae kennedy, karl cooper and gilbert gimm

Left to right: Jean Hall, Jae Kennedy, Karl Cooper and Gilbert Gimm

CHRIL Research Activities

The CHRIL research activities are organized into 5 discrete but complementary research projects. Two projects collect original data from health insurance consumers with disabilities and Centers for Independent Living, and three projects use large publicly-available population health surveys. These research projects will complement an ongoing program of dissemination and utilization, training, and technical assistance.

Research Project 1: Health insurance outcomes for working-age consumers with disabilities

Project 1 is led by Dr. Jean Hall at the University of Kansas, with the assistance of Dr. Gilbert Gimm and Noelle Kurth. The project will describe in detail the experiences of working-age adults with disabilities in obtaining and maintaining health insurance coverage, and identify the impact of health insurance on consumer community living and integration. It begins with a secondary analysis of the Urban Institute’s Health Reform Monitoring Survey (HRMS) in project year 1, followed by interviews with working-age consumers with disabilities in years 2 and 4, and surveys of working-age consumers with disabilities in years 3 and 5.

Research Project 2: Health insurance information, training and technical assistance needs of CILs

Project 2 is led by Dr. Lex Frieden at ILRU, with the assistance of Dr. Jae Kennedy and Richard Petty. The project will determine the information, training, and technical assistance needs of CILs as they help their clients obtain or maintain insurance coverage. Internet surveys will be sent to all CIL directors in years 2 and 4. Survey findings will be clarified and extended with follow-up interviews in years 3 and 5. The ILRU team will use these survey and interview findings to develop themes for health reform roundtable discussions, to be held at the annual NCIL meetings in project years 1, 3 and 5, and the annual APRIL meetings in years 2 and 4.

Research Project 3: Trends in health insurance coverage and healthcare access for working-age adults with disabilities

Project 3 is led by Elizabeth Wood at WSU, with the assistance of Dr. Jae Kennedy and Dr. Gilbert Gimm. Through the analyses in project 3, we will develop current national profiles of how well the new health insurance system meets the needs of working-age adults with disabilities, including measuring changes in uptake rates for various insurance programs and tracking changes in the prevalence of access problems. This project will use the National Health Interview Survey (NHIS) in years 1 through 5 to track annual changes in important measures of insurance coverage, healthcare access, and health and functional status among working-age adults with disabilities, and compare these measures to those of non-disabled adults.

Research Project 4: Costs of health insurance and healthcare for working-age adults with disabilities

Project 4 is led by Dr. Gilbert Gimm at George Mason University, with the assistance of Elizabeth Wood, Dr. Jae Kennedy, and WSU graduate research assistants. Project 4 will identify gaps in coverage and potential areas of undue cost burden for people with disabilities. Multiple ACA policy changes are intended to reduce the price of coverage, limit out-of-pocket and total costs, and reduce the overall number of uninsured individuals. In Project 4, we will assess the impact of these policies on working-age adults with disabilities by conducting cross-sectional and longitudinal analyses of the Medical Expenditure Panel Survey (MEPS) in project years 1 through 5. The CHRIL will use these analyses to measure how healthcare spending and utilization, payer mix, and coverage for the uninsured are changing among working-age adults with disabilities.

Research Project 5: State participation in the Medicaid expansion and SSI program enrollments

Project 5 is led by Dr. Jae Kennedy at WSU, with the assistance of Elizabeth Wood and WSU graduate research assistants. The project will use data from the Social Security Administration and from the American Community Survey (ACS) in project years 1-5 to assess whether the provision of new health insurance coverage options, in combination with other state policy factors, reduces disability program application and enrollment rates.