Access to Medicare Insurance Coverage Linked to Reduction in Cancer Mortality

In collaboration with Schaeffer Center Fellow Reggie Tucker-Seeley, Director Dana Goldman and Director of Research Darius Lakdawalla, Schaeffer Center Nonresident Fellow Rebecca Myerson explored whether cancer detection and mortality rates shifted at age 65, when Americans become eligible for Medicare in a study that was published in the Journal of Policy Analysis and Management. The results of the study were featured in a recently released podcast hosted by the journal—JPAM’s Closer Look.

As the COVID-19 pandemic has intensified, calls for expanded health care access, including the potential for a public option, have increased among policymakers and the public, making the study findings even more relevant.

“Given that the Medicare population is projected to increase from 54 million in 2015 to 80 million by 2030, and might increase further under current policy proposals, understanding the influence of Medicare coverage is vital for public policy,” said Myerson, who is an assistant professor of Population Health Sciences at the University of Wisconsin-Madison.

Medicare is one of the largest insurance programs in the United States and provides for near universal access at the eligibility age of 65. The study examined data from the National Cancer Institute’s Surveillance, Epidemiology and End Results program on patients aged 59-71 to analyze what happens when near universal coverage is available.

The researchers focused on breast, colorectal and lung cancer because guidelines recommend screenings for those conditions before — as well as after — age 65. They operated under the hypothesis that, in the absence of Medicare, outcomes would remain steady throughout the age group analyzed.

The findings show access to Medicare coverage increases cancer detection and reduces cancer mortality. Cancer detection increased by 10% at age 65 compared to people just one or two years younger.

In terms of survival, the analysis revealed a 4.5% decrease in cancer mortality for women age 65 when contrasted with women age 63-64. The results were even better for black women, who saw cancer mortality drop by 9% compared to their slightly younger peers.

“Our results are consistent with community-based research that suggests African American women with inconsistent insurance coverage may be delaying needed healthcare,” said Tucker-Seeley, who holds the Edward L. Schneider Assistant Professor of Gerontology Chair at the USC Leonard Davis School of Gerontology. “We know that African Americans generally present for cancer care with later stage disease and are more likely to be uninsured, compared to their white counterparts. Our study highlights the importance of universal insurance coverage for reducing cancer disparities and improving cancer outcomes for African American women.””

To ensure the validity of their findings, the investigators also examined cancer detection and mortality rates in Canada, a country with similar demographics to the U.S. but that offers universal care throughout the lifespan. The statistics showed cancer fatality rates before age 65 to be nearly equal between the nations. However, after age 65 rates declined among Americans but remained steady for Canadians — suggesting that Medicare accounts for the difference.

If heeded by policymakers, the study’s findings have important ramifications for the future of Medicare and the need for widely available healthcare insurance.

“For patients needing urgent access to medical care, such as patients with cancer, high-quality insurance can save lives,” said Myerson.

Myerson is Assistant Professor in the Department of Public Health Sciences at the University of Wisconsin-Madison School of Medicine and Public Health. The study was supported by the Leonard D. Schaeffer Center for Health Policy & Economics and the National Institute on Aging of the National Institutes of Health under award 2P30AG043073. Tucker-Seeley additionally reports funding from a National Cancer Institute K01 Career Development Grant (K01 CA169041).