New Study Connects Medicare with Reductions in Racial and Ethnic Disparities in Insurance Coverage

Medicare is associated with significant reductions in “racial and ethnic disparities in insurance coverage, access to care, and self-reported health,” according to a new study led by the Yale School of Public Health and published in JAMA, the Journal of the American Medical Association.

Evidence has long linked Medicare eligibility with increases in coverage and utilization, and with narrowing racial and ethnic disparities in these areas. However, information on Medicare’s role in reducing disparities in health outcomes, and on how these associations might differ across the country, was less established.

To better understand how the access to insurance that Medicare confers impacts diverse populations, the authors compared coverage and health data for adults above and below age 65, breaking it down by race, ethnicity, and state.

Their findings were clear—Medicare eligibility translates into meaningful reductions in access and health disparities. For example, racial and ethnic differences in coverage fell by more than 50% at age 65, significantly improving upon pre-Medicare imbalances. Black and Hispanic respondents experienced greater gains in coverage—from 86% to 96% and 77% to 91%, respectively—than white respondents, for whom coverage rates grew from 92% to 99%.

In the other studied measures, Black and Hispanic individuals similarly closed gaps with their white counterparts. Medicare eligibility generally narrowed disparities in access to a usual source of care, cost-related barriers to care, and influenza vaccination rates. The share of people in “poor” self-reported health decreased by four percentage points for Hispanic respondents, three percentage points for Black respondents, and 0.2 percentage points for white respondents.

These changes were widespread, occurring in economically, politically, and geographically diverse states. Areas with the highest uninsured rates and coverage discrepancies saw the largest gains, but those states were not confined to one region or to states that did not expand Medicaid under the Affordable Care Act.

Notably, the report shows that Medicare reduced but did not eliminate inequities. The authors attribute this to 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.”

Although a comprehensive solution is needed to bridge the remaining divides, understanding Medicare’s role in improving access to care and health outcomes across populations can help inform policymaker efforts.

The study concludes that Medicare “may be a viable means to reduce racial and ethnic disparities and advance health equity by closing gaps in insurance coverage.” At Medicare Rights, we understand that realizing this goal means all who are Medicare-eligible must be able to quickly and easily enroll and that the program’s coverage must be comprehensive, high quality, and affordable.

Accordingly, we continue to urge the Biden administration to ensure older adults and people with disabilities can access their earned benefits during the pandemic and its aftermath by reinstating two critical coverage pathways—Equitable Relief for Premium Part A and Part B and a Special Enrollment Period for Part C and Part D—and by allowing people to correct pandemic-related Medicare enrollment errors whenever they are discovered.

We also urge Congress to prioritize critical Medicare updates. As we and other leading beneficiary advocacy organizations recently stated, lawmakers must “seize the opportunity to modernize the program, deliver on the promises to improve coverage and reduce prescription drug prices and out-of-pocket costs so that beneficiaries can afford what their doctors prescribe. The significant gaps in coverage must be addressed, specifically regarding oral health, hearing, and vision services. And barriers to low-income assistance–which is particularly important to older adults of color–must be eliminated.”

These solutions are more important than ever. Medicare can only improve outcomes and equity if people are enrolled in the program and have access to the care they need. Join Medicare Rights in urging Congress to act now.

Read the study, Changes in Racial and Ethnic Disparities in Access to Care and Health Among US Adults at Age 65 Years.