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.”

Reference:
Wallace J, Jiang K, Goldsmith-Pinkham P. Changes in racial and ethnic disparities in access to care and health among US adults at age 65 years. JAMA Intern Med. Published online July 26, 2021. doi:10.1001/jamainternmed.2021.3922