Employee benefits for individuals with disabilities: the effect of race and gender.

Individuals with disabilities should expect employee benefits similar to those expected by all employees (Gilbride, Thomas, & Stensrud, 1998; Hart Research Associates, 2001; Rehabilitation Act Amendments, 1998; Shoob, 2001). The lack of availability of employee benefits, specifically health insurance, can be a deterrent for individuals considering employment (Golden, 1998; West, Kregel, & Banks, 1990). The benefit package available to employees is an important issue in employee satisfaction for all employees including those with disabilities (Hart Research Associates, 2001; Mitchell, 1983; West et al., 1990). While preliminary data suggests that access to typical employee benefits by individuals with disabilities is restricted relative to workers in the general population (Lustig, Strauser, & Donnell, in press), an important issue is the effect of race and gender on access to employee benefits. This study considers the impact of race and gender on access to typical employee benefits for individuals with disabilities.

Vacation, sick leave, health insurance, and retirement benefits are considered a significant aspect of job satisfaction and viewed as very important by employees (Blau, Merriman, Tatum, & Rudman, 2001; Hart Research Associates, 2001; Golden, 1998). In addition, research investigating quality employment outcomes for individuals with disabilities have used employee benefits as an indicator of valued employment (Gilbride et al., 1998; Rehabilitation Services Administration, 1998; Rumrill & Roessler, 1999; Shoob, 2001).

For most American workers, health insurance is the key employee benefit (Alston & Bell, 1997). While two-thirds of Americans are employed in jobs with health insurance, workers at the lower end of the salary scale are much more likely to have jobs without health insurance (Budetti, Shikles, Duchon, & Schoen, 1999; Duchon et al., 2001; Duchon, Schoen, Simantov, Davis, & An, 2000). For example, workers earning less than $35,000 annually are four times as likely to be uninsured than those earning over $35,000 (35% vs. 7%; Budetti et al., 1999). One-fifth of workers lack access to employer sponsored health insurance either because their employer does not offer insurance or they are ineligible due to limited work hours or a waiting period (Duchon et al., 2000).

Employer and Employee Expenditures

Employer expenditures on benefits are significant, accounting for 41% of employer's payroll in 1993 (Blau et al, 2001). The significant cost of health insurance to the employer has "caused employers to tighten or drop health insurance benefits, perhaps making jobs less appealing to people with disabilities and discouraging employers from employing people with disabilities who have high health care costs" (p. 2, Stapleton, Houtenville, & Goodman, 2001). Health insurers are passing the increased cost of health care to the employer with the average health cost increasing to $6000 per employee in 2003 (Clark & Fischman, 2001). The costs, in turn, are shifted to employees through reduced coverage, higher employee out-of-pocket costs, and less choice (Clark & Fischman, 2001; Lambrew, 2001; Levit, Smith, Cowan, Lazenby, & Martin, 2002). Out-of-pocket (OOP) costs are health insurance related expenses such as premiums, deductibles/co-pays, prescriptions, inpatient care, and medical equipment incurred by workers. For workers with employer sponsored health insurance OOP costs are a significant financial burden (Merlis, 2002).

Almost one-third of families with incomes between $15,000 and $29,999 spend greater than 5% of family income on OOP expenses (Merlis, 2002). Families members with health problems are also at risk for increased OOP expenditures. Families with any health problem, regardless of family income are twice as likely (13% vs. 7%) to spend 5% or more on health related costs. For example, the likelihood of spending 5% or more on OOP expenses doubles for individuals with diabetes or mental disorder.

Healthcare Coverage for Individuals with Disabilities

Individuals with disabilities tend to earn less and are more likely to use health insurance services than other workers (Rehabilitation Services Administration, 1998; Stapleton et al., 2001). Approximately 62% of competitively employed vocational rehabilitation clients in both private and public employment, earn less than $7 per hour and most clients (65%) earning between $5 and $7 per hour do not have health insurance (Rehabilitation Services Administration, 1998). Low paying jobs also affect the worker's ability to afford health insurance when it is offered by the employer. For workers with disabilities, the cost of premiums and OOP expenditures may make employer-based health insurance too expensive.

Healthcare Coverage for Newly Employed Workers and Workers between Jobs

The requirement of a waiting period for preexisting conditions before employer-based health insurance could be obtained has been partially addressed through passage of the Health Insurance Portability and Accountability Act in 1997 (HIPAA; U.S. Department of Labor, n.d.). HIPAA limits health insurance exclusions for preexisting medical conditions to a maximum of twelve months with a new employer. Under HIPAA an employer is not required to offer health insurance however, if it is offered to everyone, they cannot deny coverage on the basis of health status, medical condition (physical or mental illness), claims experience, receipt of medical care, medical history, genetic information, evidence of insurability, or disability ("Agencies jointly release" 2001). HIPAA does not reduce the costs of employer-based health insurance for employees or increase the number of employers offering health insurance to low wage earners. For workers unemployed for longer than 63 days the Consolidated Omnibus Budget Reconciliation Act (COBRA) allows the former employee to purchase health insurance from their former employer by paying 102% of the plan premium for up to eighteen months (Duchon et al., 2001). For most unemployed workers and especially those previously earning low wages with their former employer the cost of premiums under COBRA is often too expensive. While 65% of unemployed workers are eligible for COBRA, the other 35% are ineligible because they work for small employers who are either exempt from COBRA, have insurance that is not employer-based, or they are currently uninsured (Duchon et al., 2001).

Although problems associated with access to benefits effects all workers, workers with disabilities are often affected mo because (a) the likelihood that wages will be low, (b) many benefits are nonportable (e.g., pensions, vacation leave), (c) health needs will be higher, and (d) workers will change jobs more often (Mitchell, 1983; Stapleton et al., 2001; Szymanski, Ryan, Merz Trevino, & Johnston-Rodriguez, 1996). While Lustig et al. (in press) found that individuals with disabilities had access to fringe benefits at a significantly lower rate than workers in the general population, there are no current studies investigating the impact race and gender on access to employee benefits.

Differences in Race and Gender

There is research suggesting that both race and gender affect vocational rehabilitation services. Research related to the relationship between acceptance rates for services and race is ambiguous. For example, Wilson (1999) and Wheaton (1995) found no relationship between African American status and vocational rehabilitation acceptance, while other studies have found Africa Americans accepted at a lower rate that European American (Dziekan & Okacha, 1993; Wilson, 2000; Wilson, 2002; Wilson, Harley, & Alston, 2001). In general, the association between African American status and vocational rehabilitation acceptance was small. In another study, Wilson, Alston, Harley, and Mitchell (2002) found that African Americans with disabilities were twice as likely to be accepted for services as European Americans. African Americans were less likely to receive college/university services and more likely to receive adjustment services than European Americans (Wheaton, Wilson, & Brown, 1996; Wilson, Turner, & Jackson, 2002). African Americans tended to earn les at closure (Alston & Mngadi, 1992; Feist-Price, 1995; Wilson 1999). Capella (2002) found that African Americans were at disadvantage compared to European Americans in terms of acceptance rate and competitive closure. Finally, Rosenthal and Berven (1999), in an analog study of counselor clinical judgment found that rehabilitation counseling graduate students judged African American clients as having less potential for education am employment than European American clients. After a review o extant literature, Rosenthal and Kosciulek (1996) stated that one factor that may influence the rehabilitation counseling process is racial background.

Gender has been studied as a relevant rehabilitation counseling issue. Wheaton et al. (1996), in a study of vocational rehabilitation clients, found that men were more likely to receive on-the. job training, job training, and job placement services than women Moore et al. (2002) in a study of vocational rehabilitation clients with mild/moderate mental retardation, found no differences in income at closure based on gender. Capella (2002) found than males were more likely to be closed in at least a minimum wage job than females.

The current study focuses on the impact of race and gender on access to benefits by workers with disabilities. The authors analyzed data on the proportion of employers in the private sector offering specific benefits. The authors assume that workers with disabilities are entitled to the same fringe benefits as all workers. It should be noted that access is defined as the availability of a particular benefit for the employee. This is an important distinction because it focuses on whether the employer offers a particular benefit not whether the employee decides to utilize the benefit. The authors assume that workers will automatically participate in paid vacation, paid sick leave, and retirement benefits since there is typically no expense to the employee. Participation in employee sponsored health insurance is more difficult to evaluate because of the associated employee expenses. In addition, whether the employee participates in a non-employer based health insurance (e.g., SSI or SSDI) does not effect whether the employer offers health insurance or other fringe benefits.

Six research questions were considered:

1. Is there a difference in the level of access to benefits between Caucasian and non-Caucasian workers with disabilities?

2. Is there a difference in the level of access to benefits between Caucasian workers with disabilities and nondisabled workers in the general population? Workers in the general population were divided into those working for small employers and medium/large employers.

3. Is there a difference in the level of access to benefits between non- Caucasian workers with disabilities and non-disabled workers in the general population? Workers in the general population were divided into those working for small private employers and medium/ large private employers.

4. Is there a difference in the level of access to benefits between male and female workers with disabilities?

5. Is there a difference in the level of access to benefits between male workers with disabilities and non-disabled workers in the general population? Workers in the general population were divided into those working for small private employers and medium/large private employers.

6. Is there a difference in the level of access to benefits between female workers with disabilities and nondisabled workers in the general population? Workers in the general population were divided into those working for small private employers and medium/large private employers.

Answers to these research questions provides a preliminary understanding of the level of access to employee benefits for individuals with disabilities. These answers can inform policy makers, administrators, and rehabilitation counselors as to the relative success in providing individuals with disabilities quality vocational placements.

Method

Participants

Three groups of participants were studied. The first group were 1326 employed Tennessee Division of Rehabilitation Services (TDRS) clients contacted by telephone during fiscal year 1999-2000. Individuals with traumatic brain injury were not included because of the small number of respondents. Group two were 39,816,173 workers in the general population working at small private establishments and group three were 38,409,120 workers in the general population working at medium and large establishments. The total sample of participants, including TDRS clients and workers in the general population at small, medium, and large private places of employment was 78,226,619. The second and third group of participants responded to a 1996-1997 Bureau of Labor Statistics, Department of Labor survey of the incidence of selected benefit plans in small private or medium and large establishments.(United States Department of Labor, 1999a; United States Department of Labor, 1999b). Employee benefit data for the Southern geographic region, which includes Tennessee, are nearly identical to the average benefit levels found nationwide (United States Department of Labor, 1999a, 1999b) and consequently can be reasonably used for comparison purposes.

Tennessee Division of Rehabilitation Services participants ranged in age from 18 to 72 (M= 30.2; SD = 11.5), with 49% (n= 654) between ages 18 and 24, 29% (n = 392) between ages 25 and 40, and 22% (n = 280) older than 41. Most participants were never married (65%; n = 717) with 19% (n = 216) married, 16% (n = 175) divorced, separated, or widowed. Most respondents were Caucasian (82%; n = 1090) with 17% (n = 229) African-American, less than 1% (n = 5) American Indian, and less than I% (n = 2) Asian and Pacific Islander. For the purposes of this investigation, African-American, American Indian, and Asian and Pacific Islander were considered non-Caucasian. Thus there were 82% Caucasian (n = 1090) and 18% non-Caucasian (n = 236). Participants could identify themselves as an individual of Hispanic origin (Cubans, Puerto Ricans, Mexicans, etc.) and also choose one of the racial categories. Forty- nine percent had completed less than a high school diploma (n = 648), while 39% (n = 514) had completed high school, 11% (n = 147) had completed post high school education, and 1% (n = 17) were in special education. More than half (56%; n= 748) of the respondents were male.

Survey researchers reported a primary and secondary (if any) disability, as well as the severity of their disability from the client's TDRS file. Severity of disability was determined by the client's counselor according to vocational rehabilitation regulations. Of participants reporting the severity of their disability, 77% (n = 854) reported a severe disability. Nineteen per cent (n = 212) of participants reported a secondary disability. Respondents reported the following primary disabilities: (a) 41% (n = 538) chronic medical conditions, (b) 22% (n = 290) psychiatric disorders, (c) 20% (n = 259) mobility and orthopedic impairments, (d), 9% hearing or visual impairment (n = 126), and (e) 8% (n = 113) mental retardation.

Instrument

Two existing data sources were used for analysis. Data on TDRS clients were collected by the Bureau of Business and Economic Research/Center for Manpower Studies (BBER/CMS) at The University of Memphis. The 47-item questionnaire included questions concerning clients' demographic data, satisfaction with TDRS programs and services, current employment status, and wages and benefits. Demographic data were collected by survey researchers from existing client files. Employed clients were asked "Which of these benefits does your employer provide?". Clients responded "yes", "no", or "don't know". Since the size of the employer was not the primary focus of the survey, the BBER/CMS survey did not collect data on the size of the employer for employed clients.

Benefit data on workers in the general population at small and medium/large establishments were collected by the Bureau of Labor Statistics, Department of Labor. Separate surveys were used for small establishments and medium/large private establishments. Both Bureau of Labor Statistics surveys used the same survey methodology. Small establishments were defined as workers at establishments with fewer than 100 employees. Medium/ large establishments were defined as workers at establishments with 100 or 250 or more employees.

Procedures

Staff at the BBER/CMS contacted clients 60 days after closure and administered the questionnaire by telephone. Six attempts were made to contact the client. Of the 10,387 clients the BBER/CMS attempted to contact, 46% (n = 4754) were contacted and completed the questionnaire. The BBER/CMS was unable to contact 47% (n = 4913), while 7% (n = 722) were contacted but refused to respond. Ninety-three percent of the individuals who completed the questionnaire were clients. In a small number of cases parents (5%) or family members/guardians (2%) completed the questionnaire for the client.

Of the 4754 clients who were contacted and completed the survey, approximately 43% of the questionnaires were unusable because greater than 5% of the items were marked (a) not sure, (b) does not apply, (c) no response answers or (d) no data was recorded. This reduced the usable surveys to a final sample of 2732 surveys (57% of completed surveys) consisting of both currently employed and unemployed clients.

Only employed clients, or participants responding for employed clients (i.e., parents, family members or guardians) were analyzed in this study. Of the 2732 clients, 1822 were employed. Clients receiving TennCare health insurance were not included. TennCare is a State administered managed health insurance program for individuals who are Medicaid eligible or who lack access to health insurance (Bureau of TennCare, n.d.). A final sample of 1326 full-time employed participants, not receiving TennCare, were used for analysis.

The Bureau of Labor Statistics conducted a two-stage probability sample of all employees in private non-farm industries in the United States. Employees were visited or contacted by telephone by Bureau of Labor Statistics staff and asked to provide documentation for their benefit plans. Sample selection was a probability sample of establishments stratified first by industry group using the Standard Industrial Classification and second by the Standard Occupational Classification and region. For the survey of small establishments 4,482 establishments were contacted with 2,202 responding (49%) and 2,208 establishments (a) refusing to respond, (b) were out of business or (c) out of the scope of the survey (e.g., farm business or too many employees). For the survey of medium/large establishments 3,640 establishments were contacted with 1,945 responding (53%) and 1,695 establishments (a) refusing to respond, (b) were out of business or (c) out of the scope of the survey (e.g., farm business or too many employees).

Data analysis

Access to benefits was defined as the proportion of individuals who were employed at an employer offering health insurance, paid vacation, paid sick leave, or retirement benefits. Workers at small and medium/large establishments were analyzed separately. For each comparison a two-sample test of proportions was conducted (Hinkle, Wiersma, & Jurs, 1988).

For each test of proportions the p-value and effect size are provided. Cohen's h, the difference between the arcsin transformations of the two proportions, is provided as a measure of effect size (Rosenthal & Rosnow, 1991). An h value of .20 is considered a small effect, an h value of .50 a medium effect, and an h value of .80 a large effect (Cohen, 1977). These standards for small, medium and large effect sizes are "convenient guidelines" (Rosenthal, Rosnow, & Rubin (2000, p.15). The central focus for interpreting results is on the "practical significance as judged by the effect size" (Rosenthal et al., p. 4). The proportion of employers offering a specific fringe benefit can also be interpreted directly as the chances that a particular client will find employment in a job offering the benefit. For example, if paid sick leave is offered by 75% of employers of vocational rehabilitation clients, then one can interpret this as a client having a 75% chance that their place of employment will offer health insurance. An alpha level of .05 was used for hypothesis testing. As with effect size interpretation, using an alpha level of .05 as "acceptable" is used for "guidance" (Rosenthal et al., 2000).

Results

Research question 1. Is there a difference in the level of access to benefits between Caucasian and non-Caucasian workers with disabilities? Caucasians with a disability had access to benefits at a similar level as Non-Caucasians with a disability in all four categories of benefits. Cohen's h, as a measure of effect size, did not exceed .20 which Cohen defined as a small effect size. Access to health insurance (h = .18) and paid sick leave (h = .18) for Non-Caucasians with disabilities did approach a small effect, with a 9% gap in access between Non-Caucasians with disabilities and Caucasians with a disability for both benefits. NonCaucasians with disabilities were less likely to have access to benefits than Caucasians with disabilities, with gaps ranging from 7% to 9% (see Tables 1 and 2).

Research question 2. Is there a difference in the level of access to benefits between Caucasian workers with disabilities and workers in the general population? Caucasian workers with disabilities had access to paid vacation benefits at a practically significant lower proportion than small employers 69% vs. 86%) but at a similar level for health insurance, paid sick leave, and retirement (see Tables 1 and 2).

Caucasian workers with disabilities had access to health insurance, paid vacation, and retirement benefits at a practically significant lower proportion than medium/large employers but at a similar level for paid sick leave. Two comparisons are noteworthy. First, Caucasians with disabilities were much less likely to have access to (a) paid vacation benefits than workers at medium/large employers with a 26% gap (h = .73) and (b) retirement benefits than workers at medium/large employers with a 35% gap (h = .74).

Research question 3. Is there a difference in the level of access to benefits between non- Caucasian workers with disabilities and workers in the general population? Non-Caucasian workers with disabilities had access to health insurance and paid vacation benefits at a practically significant lower proportion than small employers, with a 12% (h = .24) and 24% (h = .56) gap respectively. Non-Caucasian workers with disabilities had access to paid sick leave and retirement benefits at a similar level as small employers (see Tables 1 and 2).

Non-Caucasian workers with disabilities had access to health insurance, paid vacation, and retirement benefits at a practically significant lower proportion than medium/large employers but at a similar level for paid sick leave. Non-Caucasian workers with disabilities were much less likely than workers in medium/large employers to have access to health insurance (24% gap; h = .51), paid vacation (33% gap; h = .88), and retirement (42% gap; h = .88).

Research question 4. Is there a difference in the level of access to benefits between male and female workers with disabilities? Male workers with disabilities had access to health insurance, paid vacation, paid sick leave, and retirement benefits at a similar proportion as female workers with disabilities with gaps in access ranging from 0% to 6% (see Tables 1 and 3).

Research question 5. Is there a difference in the level of access to benefits between male workers with disabilities and workers in the general population? Male workers with disabilities had access to health insurance, paid sick leave, and retirement benefits at a similar proportion as workers at small employers with gaps in access ranging from 2% to 4%. Male workers with disabilities had access to paid vacation at a practically significant lower proportion than workers at small employers (68% vs. 86%; h = .44) (see Tables 1 and 3).

Male workers with disabilities had access to health insurance, paid vacation, and retirement benefits at a practically significant lower proportion than workers at medium/large employers. Male workers with disabilities were much less likely than workers in medium/large employers to have access to health insurance (16% gap; h = .35), paid vacation (27% gap; h = .76), and retirement (35% gap; h = .74). Male workers with disabilities had access to paid sick leave at a similar proportion as workers in medium/large employers.

Research question 6. Is there a difference in the level of access to benefits between female workers with disabilities and workers in the general population? Female workers with disabilities had access to health insurance, paid sick leave, and retirement benefits at a similar proportion as workers at small employers with gaps in access ranging from 4% to 8%. Female workers with disabilities had access to paid vacation benefits at a practically significant lower proportion than workers at small employers (68% vs. 86%; h = .44) (see Tables 1 and 3).

Female workers with disabilities had access to health insurance, paid vacation, and retirement benefits at a practically significant lower proportion than workers at medium/large employers. Male workers with disabilities were much less likely than workers in medium/large employers to have access to health insurance (17% gap; h = .37), paid vacation (27% gap; h = .75), and retirement (37% gap; h = .78). Female workers with disabilities had access to paid sick leave at a similar proportion as workers in medium/large employers.

Discussion

The following points summarize the results. First, Caucasian and Non-Caucasian workers with disabilities had access to benefits at similar proportions with no comparisons exceeding a small effect. Second, Caucasians and Non-Caucasians workers with disabilities had access to benefits at a lower proportion than workers at medium/large and small employers. Third, male and female workers with disabilities had access to benefits at similar proportions. Fourth, male and female workers with disabilities had access to benefits at a lower proportion than workers at medium/large and small employers.

A few gaps in access are noteworthy. First, Non-Caucasians had a 52% likelihood to find employment with health insurance while Caucasians had a 61% chance. Similarly, Non-Caucasians had a 47% chance to find employment with paid sick leave while Caucasians had a 56% chance. These gaps approach a small effect. Second, workers with disabilities had a much lower chance of finding employment with employers offering health insurance, paid vacation, and retirement than medium/large employers with gaps ranging from 15% to 42%. These gaps were evident whether one examined Caucasian and Non-Caucasian or male and female workers with disabilities.

In the current study, access to benefits was defined as an employer offering a specific benefit. There are no employee costs associated with paid vacation, paid sick leave, and retirement benefits and consequently one could assume that the employee would receive these benefits if offered by the employer. However, out-of-pocket costs associated with health insurance (e.g., premiums, co-pays) would typically lessen the number of employees that decide to enroll in health insurance plans. As discussed earlier, out-of-pocket costs particularly effect low wage earners.

Implications for rehabilitation counselors

Reduced access to benefits for vocational rehabilitation clients when compared with workers in the general population suggests that assisting clients in securing jobs with benefits should be a focus of the vocational counseling process. Just as benefits would be considered an important aspect of job satisfaction for all workers (Blau et al, 2001; Hart Research Associates, 2001; Golden, 1998), benefits should be considered one aspect of job satisfaction for workers with disabilities. Long term job retention is, to some extent, based on the employee's satisfaction with benefits. Health insurance may significantly impact job retention for workers with disabilities who do not have an external source of medical coverage(e.g., SSDI).

Benefits should be one aspect of the career counseling process. Counselors should assess whether benefits are an important part of the client's work values. One approach is to engage the consumer in a values clarification exercise, including guided fantasy and card sort exercises (Hood & Johnson, 2002). Pierce, Cohen, Anthony, Cohen, and Friel (1980) describe a method for understanding the consumer's value system. Pierce et al. assist the consumer in defining, scaling, and weighing career values and investigating occupations in relation to the identified career values. These approaches bring allow the consumer to express their interest in benefits as a significant aspect of choosing a job.

Limitations and further research

Conclusions about the results are limited by the following considerations. First, since this study utilized an ex post facto design, caution must be exercised in determining a causal link between variables. Second, although the interpretation of the results should be limited to the sample examined at the time of the study, benefit levels for Southern states which include Tennessee, are similar to the National average (United States Department of Labor, 1999a, 1999b). Third, 54% of potential respondents either were not contacted or refused to participate and half of the respondent's questionnaires were not used because of missing data or unusable responses. Whether respondents differ from nonrespondents is unknown. Fourth, two potentially significant moderator variables were not analyzed. The size of the employer was not known for workers with disabilities and wage information was not known for workers in the general population. Thus these two variables (employer size and employee wages) were not compared. Fifth, since the sample of workers in the general population may have included vocational rehabilitation clients, it is likely that the difference in benefit access would have been larger if these workers were not included.

There are a number of unanswered questions suggested by this research. First, the effect of academic levels on access to benefits should be examined. There is evidence that math and reading levels are related to the likelihood of an employee finding a job with health insurance (RSA, 1998; Shoob, 2001). Second, it would be informative to investigate the impact of out-of-pocket costs on participation in health insurance.

Conclusions

The rapidly changing nature of the benefit structure of employment in the United States has important implications for workers with disabilities (Duchon et al., 2001). As mentioned earlier, changes relative to health insurance have important implications for all workers but typically effect workers with disabilities to a greater extent because workers with disabilities are more likely to (a) secure employment in low paying jobs, (b) have higher health related costs, and (c) change jobs more often. At minimum, rehabilitation counselors should be knowledgeable about the health insurance market as well as laws effecting health insurance portability. Modifications to the Consolidated Omnibus Budget Reconciliation Act (COBRA) and the Health Insurance Portability and Accountability Act (HIPAA) may impact workers with disabilities in significant ways. More important may be employer's willingness to offer increasingly expensive health insurance to their employees. One aspect of this study is the higher proportion of medium/large employers offering benefits when compared with small employers. Health insurers charge employers for coverage based on the size and health of the workers and consequently larger employers can obtain health insurance at a lower per person cost ("The unraveling", 2002). This increases the chances that an employer will offer health insurance and, if offered, will be affordable. Nevertheless the problem of access to benefits is extending to individuals earning higher incomes because a greater number of employers cannot afford to offer affordable health insurance ("Problem of lost", 2002). Thus while individuals with disabilities have particular problems related to benefit access, legislative solutions for workers in the general population are likely to help workers with disabilities.

Table 1

Percentage of Individuals with Disabilities with Access to Employee
Benefits Workers with Disabilities Workers without Disabilities

Benefit      Caucasians   Non-Caucasians      Males

Health           61             52              60

PV               69             62              68

PSL              56             47              52

Ret              44             37              44

Benefit       Females         Small        Medium/Large
                            Employers       Employers

Health           59             64              76

PV               68             86              95

PSL              58             50              56

Ret              42             46              79

Note. Health = health insurance; PV = paid vacation;
PSL = paid sick leave; Ret = retirement benefits.

Table 2

Tests of Proportion for Access to Benefits between Caucasian
and Non-Caucasian Individuals with Disabilities and Small and
Medium/Large Employers

                                 Comparison

            Caucasian with     Caucasian with     Caucasian with
            Disability         Disability         Disability
            versus             versus Small       versus M/L
            Non-Caucasian      Employers          Employers
            with Disability

Benefit     h                  h                  h

Health      .18                .06 *              .33 (a) ***

PV          .15 *              .41 (a) ***        .73 (5) ***

PSL         .18 *              .12 (a) ***         0

Ret         .14 *              .04                .74 (b) ***

            Non-Caucasian      Non-Caucasian
            with Disability    with Disability
            versus Small       versus M/L
            Employers          Employers

Benefit     h                  h

Health      .24 (a) ***        .51 (b) ***

PV          .56 (b) ***        .88 (c) ***

PSL         .07                .18 ***

Ret         .18 ***            .88 (c) ***

Note. h = Cohen's h (effect size). Health = health insurance;
PV = paid vacation; PSL = paid sick leave; Ret = retirement
benefits.

(a) = small effect. (b) = medium effect. (c) = large effect.

* p < .05. ** p < .01. *** p < .001

Table 3

Tests of Proportion for Access to Benefits between Male and Female
Individuals with Disabilities and Small and Medium/Large Employers

                                Comparison

             Male with          Male with          Male with
             Disability         Disability         Disability
             versus             versus Small       versus M/L
             Female             Employers          Employers
             with Disability

Benefit      h                  h                  h

Health       .02                .08                .35 (a) ***

PV           0                  .44 (a) ***        .76 (b) ***

PSL          .12                .04                .08

Ret          .04                .04                .74 (b) ***

             Female             Female
             with Disability    with Disability
             versus Small       versus M/L
             Employers          Employers

Benefit      h                  h

Health       .10 **             .37 (a) ***

PV           .44 (a) ***        .75 (b) ***

PSL          .16 ***            .04

Ret          .08 *              .78 (b) ***

Note. h = Cohen's h (effect size). Health = health insurance; PV =
paid vacation; PSL = paid sick leave; Ret = retirement benefits.

(a) = small effect. (b) = medium effect. (c) = large effect.

* p < .05. ** p < .01. *** p < .001

Editor's Note

The Journal's previous Editor, Paul Alston, and his Editorial Review Board, reviewed this article.

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Daniel C. Lustig

The University of Memphis

David Strauser

The University of Memphis

Daniel C. Lustig, 113 Patterson Hall, The University of Memphis, Memphis TN, 38152-3510 Email: [e-mail]