Uninsured Benefit Once They Are Covered by Medicare

More than 60 percent of all the participants said they had been diagnosed with high blood pressure, heart disease, stroke, and/or diabetes prior to 65. Almost 70 percent of these patients had been insured, while the remainder were not.

Health status for the uninsured worsened at a much faster rate in the pre-Medicare years than for the insured, with the uninsured ultimately entering Medicare with far lower overall health scores than the insured.

However, once covered by Medicare, the health of the previously uninsured improved markedly, regardless of whether prior coverage had been non-existent or spotty. In fact, the uninsured group experienced no further declines in overall health during the Medicare years.

As a result, by age 70, the difference in overall health between the uninsured and the insured was half what had been expected, based on pre-Medicare trends. Agility and depression were two areas in which the previously uninsured showed greater significant improvement.

The researchers noted that much of the post-Medicare improvement in health among the previously uninsured was concentrated in the approximately 60 percent of people who'd been diagnosed with heart disease and/or diabetes before age 65.

Ayanian and his colleagues suggested that much of the improvement found among previously uninsured patients might derive from the improved management of blood pressure, glucose levels, and cholesterol levels. They concluded that offering earlier health coverage for people 55 and older would lead to substantial economic and social rewards.

"This clearly shows the benefits of Medicare coverage at age 65 for people who have been uninsured in their late 50s and early 60s, and it suggests that health coverage should be extended to all near-elderly adults before they become eligible for Medicare," Ayanian said.

Ayanian said the American College of Physicians has endorsed making Medicare coverage available to people before the age of 65.

David Schulke, executive vice president of the nonprofit, nonpartisan American Health Quality Association, said the study highlights a basic flaw in the current system.

"There is lasting harm done to the health of people who are uninsured, and they are sicker when they enter the Medicare program," he said. "This suggests that there will be a savings to the Medicare program if insurance coverage is created by Congress for people under the age of 65, because health care of the otherwise uninsured will improve, and they won't be so debilitated by the time they become eligible."

More information

To learn more about Medicare and the near-elderly, visit the Urban Institute.

SOURCES: John Z. Ayanian, M.D., M.P.P., professor, health policy and management, Harvard School of Public Health, and director, General Internal Medicine Fellowship, Brigham and Women's Hospital, Boston; David Schulke, executive vice president, American Health Quality Association, Washington, D.C.; Dec. 26, 2007,Journal of the American Medical Association