September 2021 Industry Updates
Medicare Expansion Associated With Improved Coverage, Health Disparities Reduction
Expansions in Medicare eligibility could reduce coverage and access disparities for racial and ethnic minority groups, according to findings published in JAMA Internal Medicine.
Researchers conducted a cross-sectional study using regression discontinuity from January 2008 to December 2018 to compare racial and ethnic disparities before and after age 65 years.
Data was sourced from the Behavioral Risk Factor Surveillance System as well as state-age-year observations in the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Data.
The research involved 2,434,320 respondents and 44,587 state-age-year observations. Demographic data for the participants indicated that 192,346 individuals were Black, 104,294 were Hispanic, and 892,177 were male.
Once participants reached eligibility age, coverage increased more significantly among Black respondents (from 86.3% to 95.8% or 9.5 percentage points; 95% CI, 7.6-11.4) and Hispanic respondents (from 77.4% to 91.3% or 13.9 percentage points; 95% CI, 12.0-15.8) than White respondents (from 92.0% to 98.5% or 6.5 percentage points; 95% CI, 6.1-7.0).
There was a 53% reduction in the coverage gap between White and Black respondents when participants reached age 65 years (5.7% to 2.7% or 3.0 percentage points; 95% CI, 0.9-5.1; P=.003). There was also a 51% reduction in coverage disparities between White and Hispanic respondents (14.6% to 7.2% or 7.4 percentage points; 95% CI, 5.3-9.5; P<.001).
“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,” authors noted.
Medicare eligibility was associated with decreased disparities for:
- access to consistent sources of care (from 10.5% to 7.5%, P=.05);
- cost-related barriers to care access (from 11.4% to 6.9%, P<.001); and
- influenza vaccination rates (from 8.1% to 3.3%, P=.01).
The number of beneficiaries self-reporting poor health decreased by 3.8% among Hispanic respondents, 2.6% among Black respondents, and 0.2% among White respondents. Disparities in mortality after age 65
remained unchanged.
“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,” researchers concluded.
“However,” the researchers noted, “racial and ethnic disparities were not eliminated by Medicare, supporting the view that disparities are shaped not only by policy decisions but also other social determinants of health, such as structural racism, that persist among elderly individuals.”—Maria Asimpoulos
Fewer Hospitals Sue Patients for Unpaid Bills After Researchers, Media Expose the Practice
A year after a 2019 JAMA study and media coverage in The New York Times, The Wall Street Journal, and other national outlets publicized that Virginia hospitals were suing patients for unpaid medical bills, the number of medical debt lawsuits filed by hospitals in the state dropped 59%. Researchers from Johns Hopkins University, Northwestern University, and the University of Oklahoma published their findings online in JAMA Network Open.
“To investigate how aggressive hospitals can be in pursuing medical debt, we previously reported in JAMA that 36% of Virginia hospitals collectively filed 20,054 warrant in debt lawsuits and 9232 wage garnishment cases,” the team explained in the new study. “We found that hospitals pursued patients for inflated medical charges in court and garnished paychecks from US residents with low income. Through popular news and media outlets, this research article helped to start a national conversation on aggressive hospital billing practices.”
To gauge the effect of the original study and accompanying press coverage on hospital billing practices, researchers compared the number of lawsuits filed by 67 Virginia hospitals for unpaid medical bills a year before and after the initial media attention.
Compared with 30,760 such lawsuits filed against patients the year before the study’s publication, the year afterward hospitals filed just 12,510 lawsuits for unpaid medical bills, representing a 59% drop, the study showed. The dollar amount pursued in court, meanwhile, fell from roughly $38.7 million to $13.9 million, reflecting a 64% decrease.
Over the course of the study, 11 hospitals completely banned the practice, researchers reported, including one large health system that in a press release referenced the 2019 article that exposed what study authors described as its “excessive number of medical debt lawsuits.”
“These findings suggest that research and public health initiatives rooted in media exposure can increase public accountability for hospital billing practices and result in meaningful changes that benefit patients,” researchers advised. —Jolynn Tumolo
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