Good Health Insurance is What Counts

Having health insurance is no guarantee that medical care is affordable.

Some families, despite being covered by the Affordable Care Act (ACA) or employer policies, say that high premiums and deductibles mean they can’t afford to see a doctor. This distinction – between having insurance and receiving care – will be crucial as Congress considers proposals for ACA’s replacement.

One comprehensive 2003 study demonstrates how individual medical decisions change when they receive one longstanding, and what the researchers called “generous,” type of insurance: Medicare. Their study focused on changes in the use of the health care system – more so than improved health – by comparing people who’ve recently gone on Medicare with people a couple years away from turning 65 and becoming eligible. The analysis adjusts for the fact that some, though not all, people under 65 have employer coverage and that many people also retire around this age, sometimes receiving special retiree health benefits.

Once people turn 65 and are on Medicare, the researchers found that:

• The probability of seeing a doctor at least once a year increased, based on data from the National Health Interview Surveys, which track the frequency of routine medical care.
• Medicare eligibility led to a “surprisingly large” 5-10 percent increase in hospitalizations in California and Florida, particularly among white Americans. The increase was driven by elective surgeries such as joint replacements and heart bypass surgeries.
• There were large increases in preventive care for less-educated whites, such as getting flu shots and cholesterol tests, based on analyses of the Behavioral Risk Factor Surveillance System, which tracks preventive care use.
• Minorities, who are at much higher risk of untreated high blood pressure, were more likely to receive this diagnosis after going on Medicare.
• Hispanic men were more often screened for prostate cancer.
• Despite the fact that health declines with age, minorities, when asked to rate their health from poor to excellent, reported improvements after turning 65. Medicare, the researchers concluded, helped to close the gap that exists between minorities’ and whites’ health.  Medicare coverage did not, however, seem to reduce death rates, which are typically higher for minorities.

Similarly, a brand new study showed benefits from the federal expansion of Medicaid: the use of disease-managing prescription drugs rose 19 percent in just over one year in expansion states. The effects were largest for medications for diabetes, birth control, and heart conditions.

Medical outcomes are extremely difficult to analyze, and the Medicare researchers were careful not to overstate the strength of their findings.

But they felt comfortable concluding that improvements occurring after 65 “are driven by features of the Medicare system … rather than to the fact that coverage rises” after 65.

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