Health improves for previously uninsured adults after receiving Medicare coverage

Previously uninsured adults who received Medicare coverage reported improvements in health, especially those with cardiovascular disease or diabetes, according to a study in the December 26 issue of JAMA: The Journal of the American Medical Association.

“Uninsured near-elderly adults, particularly those with cardiovascular disease or diabetes, experience worse health outcomes and use more health services as Medicare beneficiaries after age 65 years than insured near-elderly adults. Because chronic diseases are prevalent and insurance coverage is often unaffordable for older uninsured adults, the impact of near-universal Medicare coverage at age 65 years on the health of previously uninsured adults may be substantial,” the authors write.

J. Michael McWilliams, M.D., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues assessed the association of acquiring Medicare coverage at age 65 years with trends in self-reported health outcomes from ages 55 through 72 years for previously uninsured adults, especially those with cardiovascular disease or diabetes. The researchers analyzed survey data, collected from 1992 through 2004, from the nationally representative Health and Retirement Study, which included 5,006 adults who were continuously insured and 2,227 adults who were persistently or intermittently uninsured from ages 55 to 64. Changes in health trends were compared for previously uninsured and insured adults after they acquired Medicare coverage at age 65 years. The areas of health surveyed included general health, change in general health, mobility, agility, pain, depressive symptoms, and a summary measure of these, along with adverse cardiovascular outcomes.

The researchers found that before age 65 years, summary health scores worsened at a greater rate for uninsured adults than for insured adults and were significantly worse at age 65 years. Compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65 years for the summary measure and several component measures. Relative to previously insured adults with cardiovascular disease or diabetes, previously uninsured adults with these conditions reported significantly improved trends in summary health, change in general health, mobility, agility, and adverse cardiovascular outcomes but not in depressive symptoms. Previously uninsured adults without these conditions reported improvement in depressive symptoms but not in summary health or any other measure. By age 70 years, the expected difference in summary health between previously uninsured and insured adults with cardiovascular disease or diabetes was reduced by 50 percent.

“Our findings have important policy implications. Proposals to extend insurance coverage to uninsured near-elderly adults have been introduced in the U.S. Congress and endorsed by the American College of Physicians. Providing earlier health insurance coverage for uninsured adults, particularly those with cardiovascular disease or diabetes, may have considerable social and economic value for the United States by improving health outcomes,” the authors conclude.

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