Access to Care

Extending health insurance coverage to older working adults may substantially improve their health

Most older working adults (45 to 64 years) obtain their health insurance coverage through employer-sponsored and other private insurance plans. Extending health insurance to this older group of workers may improve their health, perhaps substantially, concludes a new study. An additional benefit is better health by the time they qualify for Medicare at age 65, accruing potential savings to Medicare. Preliminary results from the study suggest that expanding coverage for this group benefited the health of all older workers, including those with chronic illnesses such as diabetes and hypertension.

Investigators analyzed 1992 and 1996 data on older workers from the Health and Retirement Study (HRS), a household survey of mostly working age adults. They examined health insurance status and a health index for 1992 (baseline) and 1996. The health index is a summary measure of self-reported overall health, two measures of physical limitations (mobility and agility), and a measure of pain, with higher values indicating better health. They also examined baseline socioeconomic variables, past health behaviors such as smoking, and number of chronic conditions.

Overall, lack of insurance had a significant 2 to 11 percent negative impact on workers' health over the 4-year period. This insurance effect increased up to six-fold after adjustment for State union membership (which affects likelihood of insurance coverage) and State unemployment rate. Results were consistent across various models, with no significant difference in the insurance effect for subgroups with and without major chronic conditions. Ultimately, policy choices for expanding coverage would depend on the tradeoff between programmatic costs for extending coverage and worker health benefits, conclude the researchers. Their work was supported in part by the Agency for Healthcare Research and Quality (HS10283).

More details are in "The effect of private insurance on the health of older, working age adults: Evidence from the health and retirement study," by Avid Dor, Ph.D., Joseph Sudano, Ph.D., and David W. Baker, Ph.D., in the June 2006 HSR: Health Services Research 41(3), pp. 759-787.

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