Since many people are talking about raising the medicare eligibility age (e.g. Maya MacGuineas vs. Aaron E. Carroll, Matt Yglesias, Jared Bernstein, etc), I thought I’d highlight an AER paper by David Card, Carlos Dobkin, and Nicole Maestas that uses Medicare eligibility rules (i.e. you are eligible when you turn 65) to identify its impact on health behavior and outcomes. Some compelling figures and a short summary are below the fold.
Medicare eligibility is associated with a sharp increase in average coverage rates at age 65 and a narrowing in coverage disparities across different groups in the U.S. population.
Our estimates show that insurance coverage has a significant causal effect on self- reported access to health care and on health care utilization. Race and education groups that experience the largest gains in insurance coverage at age 65 experience large reductions in the probability of delaying or not receiving medical care, and relative increases in the probability of an annual doctor visit…
The impact of Medicare eligibility on health outcomes is harder to assess, both because of difficulties in measuring health, and because health is less likely to change discretely in response to insurance coverage. Perhaps surprisingly, we find a statistically significant impact of reaching age 65 on self-reported health, with the largest gains among the education and race groups that experience the largest increases in insurance coverage at age 65. On the other hand, we find no evidence of a discrete change in mortality rates at 65, nor do we see any shift in the rate of growth of mortality after 65. These findings have to interpreted cautiously since it is difficult to identify a plausible comparison group for post-65 mortality rates in the absence of Medicare. Taken as a whole, we believe our findings point to a significant but relatively modest impact of health insurance coverage on health.