When Josie Badger was 21 and needed a job, her best bet for employment as a person with a disability was to create her own nonprofit — so she did.
Ten years later, the Ohio Township resident, who has a doctorate in health care ethics, works three jobs — but she has to be careful to make sure she is paid enough to eat, yet not enough to lose her government health care benefits. Ms. Badger uses a scooter for mobility and a ventilator to breathe and needs attendant care around the clock.
Medicaid — also known as Medical Assistance — a government program that covered 2.2 million Pennsylvanians as of January 2014, finances the care that Ms. Badger needs. While the program is not income dependent for children, as an adult there are income limits. And those mean she has to live on poverty wages of less than $1,040 a month to keep her benefits.
“Under this system, you can have a disability or you can have a job, but you can’t have both,” she said.
“It’s absolutely a disincentive to work,” said Michael Gamel-McCormick, the associate executive director for research and policy at the Association of University Centers on Disabilities in Silver Spring, Md.
He said no private insurance will provide the sort of coverage, particularly attendant care, that Medicaid will provide.
The problem is one that the government is well aware of, said Andrew Houtenville, a professor of economics at the University of New Hampshire in Durham.
There was a move to incorporate attendant care into the federal Affordable Care Act, but it was killed in the early stages of the bill because it was too expensive, he said.
He said few companies could take on the cost of providing the sort of care that the government will provide for people who have disabilities.
“You would have to have a very special employer,” he said.
There are stories of workers with disabilities who turned down raises or hours to maintain their medical benefits.
“When you’re on benefits, it takes a great deal of effort to manage your earnings,” Mr. Houtenville said.
Overall, the issue doesn’t don’t move the employment needle a great deal, said Monique Morrissey, an economist at the Economic Policy Institute in Washington, D.C., even though people with disabilities make up a huge swath of the country.
There are 29.2 million people over 16 in the civilian, noninstitutional population who have disabilities, according to the Bureau of Labor Statistics. Of those, 47 percent are 65 or older, leaving 15.6 million of traditional working age.
But a report released Tuesday by the bureau showed fewer than a third of the population of adults with disabilities under 65 are in the labor force. When they are, they have an unemployment rate of 13.9 percent vs. 6 percent for people in the same age group without a disability. In 2014, just 26 percent of the people over 16 and under 65 who are disabled had jobs.
People with disabilities tend to work part-time. Just 17 percent of adults under 65 without a disability usually work part-time, while 29 percent of people in that same age group with a disability do.
Perhaps because of the barriers to finding a job, people with disabilities tend to be more entrepreneurial. Just 6.2 percent of the population without a disability reports being self-employed, compared to 11.1 percent of people with disabilities who are working.
As the youth director of the Peal Center, which helps families of children with disabilities and special health care needs, Ms. Badger works to empower young people to advocate for themselves and tries to help them gain employment before they are out of school.
“If a young adult has a job before graduation, they are 2.5 times more likely to have an adult job,” she said.
As the campaign manager of the #IWantToWork Campaign, she is hoping to help young people with disabilities enter the workforce. She is also the co-director of Raise, a technical assistance center that supports parent training and information centers such as the Peal Center.
A later battle, she said, will be making sure young people who have disabilities do not have the same barriers to employment that she faced when she came into the workforce.
“I want to see the income limits on Medical Assistance for all workers with disabilities taken off,” she said.