Get access

Commentary: Assessing the Health Effects of Medicare Coverage for Previously Uninsured Adults: A Matter of Life and Death?

Authors

  • J. Michael McWilliams,

    1. Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115
    2. Department of Health Care Policy, Harvard Medical School, Boston, MA
    3. Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
    Search for more papers by this author
    • Address correspondence to J. Michael McWilliams, M.D., Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115; e-mail: mcwilliams@hcp.med.harvard.edu. J. Michael McWilliams, Ellen Meara, Alan M. Zaslavsky, and John Z. Ayanian are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. J. Michael McWilliams and John Z. Ayanian are with the Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Ellen Meara is with the National Bureau of Economic Research, Cambridge, MA. John Z. Ayanian is with the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA.

  • Ellen Meara,

    1. Department of Health Care Policy, Harvard Medical School, Boston, MA
    2. National Bureau of Economic Research, Cambridge, MA
    Search for more papers by this author
  • Alan M. Zaslavsky,

    1. Department of Health Care Policy, Harvard Medical School, Boston, MA
    Search for more papers by this author
  • John Z. Ayanian

    1. Department of Health Care Policy, Harvard Medical School, Boston, MA
    2. Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
    3. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA
    Search for more papers by this author

Abstract

In contrast to a previous study we conducted and other evidence, a recent study found no significant effects of Medicare coverage after age 65 on overall health for previously uninsured adults and significant adverse effects on survival for some of these adults. We discuss explanations for these inconsistent findings, particularly the different ways in which deaths were handled, a key methodological challenge in longitudinal analyses of health. We demonstrate that analytic approaches suitable for examining effects of coverage on health measures may not be suitable for effects on mortality. Thus, estimates may be misleading when these different outcomes are jointly modeled. We also present new survival analyses that suggest Medicare coverage significantly attenuated the rising risk of death for previously uninsured adults.

Ancillary