Medicare eligibility can help reduce disparities in health coverage, study finds
Eligibility for Medicare at age 65 was associated with reductions in racial and ethnic disparities in coverage, access and health, but not mortality.
Expanding eligibility for Medicare can increase health equity by closing gaps in insurance coverage.
“Medicare provides nearly universal health insurance to individuals at age 65 years,” according to a study reported by JAMA Network. “How eligibility for Medicare affects racial and ethnic disparities in access to care and health is poorly understood. By comparing individuals before and after age 65 years, we found that eligibility for Medicare coverage was associated with reductions in racial and ethnic disparities in insurance coverage, access to care and self-reported health.”
During the 2020 presidential campaign, Joe Biden proposed lowering the Medicare eligibility age from 65 to 60, in part to help workers who lost employment-based health insurance during the pandemic. Some members of Congress have advocated expanding Medicare to cover all Americans.
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Understanding the association of Medicare with access to care and health outcomes, and by race and ethnicity, informs the ongoing debate over Medicare expansion. Previous studies show the introduction of Medicare was associated with increases in health care utilization and that entry into Medicare at age 65 increases access to care and improves health for those previously without insurance.
Earlier research also found reductions in racial and ethnic disparities in access at the national level at age 65 years. However, evidence of Medicare’s associations with racial and ethnic disparities in health outcomes and on how associations with health and access differ across the United States was lacking. Moreover, it remained unclear whether Medicare’s effects on disparities persisted after the Affordable Care Act was implemented, given that the ACA is associated with reduced racial and ethnic disparities in coverage and access.
By comparing individuals just before and after age 65, a narrow band of years in which observable and unobservable characteristics of the populations are similar, researchers estimated effect sizes for the associations between Medicare eligibility with coverage, access to care and health by race, ethnicity and state.
In this study, eligibility for Medicare at age 65 was associated with reductions in racial and ethnic disparities in coverage, access and health, but not mortality.
“Reductions in disparities were associated with racial and ethnic minority groups closing gaps with the white population within states, rather than Medicare having larger associations in states with greater racial and ethnic minority populations or in states that did not expand Medicaid under ACA,” researchers concluded. “Eligibility for Medicare was associated with reductions in racial and ethnic disparities in economically, politically and geographically diverse states.”
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