Health gaps narrow with Medicare coverage

Universal health coverage in the form of Medicare eligibility narrowed the health gaps between Americans of different races, ethnicities, and education levels, a new study from Harvard shows. The results are seen as part of the national debate on revamping healthcare to cover uninsured Americans.

Disparities between people of different socioeconomic groups persist through middle age, with some groups healthier than others. Then, after age 65, when near-universal Medicare coverage kicks in, "we found a reduction in disparities," said Dr. J. Michael McWilliams, lead author of the study appearing in tomorrow's Annals of Internal Medicine.

Previous research by McWilliams and others has shown that people with insurance are healthier than those without it. The people most likely to lack coverage are black, Hispanic, and have less education.

In this study, McWilliams and colleagues from Brigham and Women's Hospital, Harvard Medical School, the Harvard School of Public Health, and the Cambridge-based National Bureau of Economic Research analyzed records from the National Health and Nutrition Examination Survey from 1999 to 2006. They tracked health measures in adults who were 40 to 85 years old and had high blood pressure, coronary heart disease, stroke, or diabetes.

After eight years, measures related to blood pressure, blood sugar, and cholesterol were all better, ranging from a 10 percent lowering of blood pressure and a 21 percent improvement in blood sugar. But differences between socioeconomic groups remained: there was an 8 percent gap in blood pressure rates between white and black people and a 15 percent gap in diabetes control rates between people who had completed high school and people who had not.

After age 65, when all the adults in the study were eligible for Medicare, the racial gap in systolic blood pressure -- the top number in the reading -- dropped by 60 percent. For blood sugar levels, the racial gap fell by 78 percent and the education gap by 83 percent. For cholesterol, the educational gap disappeared.

"With national healthcare reform back on the agenda, I certainly think this study, along with our prior work and a lot of other studies at this point, really support the notion that universal coverage would improve health outcomes for a lot of adults with chronic conditions who are in vulnerable groups," McWilliams said.

Covering the uninsured is the key to eliminating persistent gaps, Dr. Ashwini R. Sehgal of Case Western Reserve University writes in an editorial also appearing in the Annals.

"Simply improving quality of care will not eliminate disparities," Sehgal writes. "Because minority, socioeconomic, and insurance status often overlap, providing universal health coverage has the potential to reduce several types of disparities."

In Massachusetts, near-universal coverage is only one part of the solution, Camille Watson, coordinator of the Disparities Action Network at Health Care For All, said in an interview.

"Access to quality healthcare is important but not singular to managing chronic disease," she said. "Massachusetts can be really proud we extended coverage the way we have, but there are some additional things we can do."

Other barriers that low-income people face when trying to control diabetes, for example, are poor access to fresh fruits and vegetables or few opportunities for exercise, she said.

"I think the challenge for us is to translate this research paper into something policy makers and others take home and understand," she said. "We are worried about the absolute outcomes for all people and we are worried about those gaps."