Study: Uninsured Workers Cost Medicare More

Article excerpt

When Sen. Ron Wyden, D-Ore., goes to town hall meetings to talk about health insurance reform, some of the most poignant pleas for relief he hears are from older workers. They want to keep hanging on to their jobs in order to maintain their health insurance, and they worry every day that their employers may decide to drop this most prized of all benefits.

"They sound desperate," Wyden ruefully remarked at a recent seminar in Washington, D.C. Wyden presented his plan to dismantle the current health insurance system, which depends on most people getting coverage through work, and replace it with a system in which individuals get coverage on their own.

The closest approximation of universal healthcare in the United States is Medicare, which kicks in at age 65. However, millions of aging workers who might like to retire are too young for Medicare. If they have coverage on the job, they will try to hold on as long as they can, like the worried people in the audiences at Wyden's Oregon meetings. Some lucky people have been able to leave their jobs before age 65 because their companies offer health insurance to retirees, but this benefit is becoming increasingly rare.


For older workers who have no coverage at all through their jobs, the price they pay in ill health is very high. When they enroll in Medicare at age 65, they will begin getting treatments for ailments they couldn't afford to deal with before. Their cost to the Medicare system between ages 65 and 72 will be 51% higher than for their contemporaries who did have health insurance. Elders who had been unable to afford healthcare before they became eligible for Medicare tend to need a lot of catch-up care due to chronic health problems-such as high blood pressure, diabetes and heart disease-that often go untreated because uninsured older workers can't afford essential care, according to a new study by researchers at the Harvard Medical School.

The Harvard researchers made these disturbing conclusions based on their analysis of a nationwide sample of 5,158 adults ages 59 through 64, from 1992 through 2004. The data, drawn from the National Institute on Aging (NIA) Health and Retirement Study, covered the period before and after survey participants became eligible for Medicare. Among those in the study, 73% had continuous coverage before they enrolled in Medicare and the other 27% lacked insurance at some period between ages 59 and 65. More than half of the total group had been diagnosed before age 65 with one or more chronic conditions. The research team compared Medicare health spending for people who had coverage with spending for those who were uninsured before age 65. Once covered by Medicare, the group without health insurance had 20% more hospitalizations and 13% more trips to their doctors' offices than the people who did have health insurance before age 65.

Older adults in the study "who lacked regular care were probably undertreated before age 65 for often asymptomatic but poorly controlled conditions, such as hypertension and hyperlipidemia [high cholesterol], and the undertreatment probably contributed to health declines and a greater need for services after age 65," according to J. Michael Mc Williams, lead author of the study report. Titled "Use of Health Services by Previously Uninsured Medicare Beneficiaries," the report appeared hi the New England Journal of Medicine; the study was supported by the Commonwealth Fund. …