Unmet Healthcare Needs and Healthcare Access Gaps Among Uninsured U.S. Adults Aged 50-64

Background and Purpose: According to the OECD, universal health coverage improves health outcomes, including life expectancy, and provides financial protection against impoverishing health care costs. Though Medicare provides Americans aged 65+ with near-universal healthcare coverage, there is no such coverage for the rest of the population. Lack of health insurance (HI) is a particular problem for near-older Americans aged 50-64 (near older adults) because they have more chronic health conditions and are at greater risk of disability than younger age groups and thus may incur greater healthcare costs. Little research has, however, focused on HI coverage and healthcare utilization among this age group.

Methods: Using 2013-2018 U.S. National Health Interview Survey data, we compared HI coverage and healthcare utilization between those aged 50-64 and 65+. Then, among near older adults, we examined sociodemographic and health characteristics and past-year healthcare utilization of those with no HI compared to any private HI or public HI (VA/military HI, Medicare without Medicaid, dual Medicare and Medicaid, and Medicaid without Medicare). Finally, using logistic regression, we examined odds of eight types of healthcare use/nonuse among those without HI compared to those with different HI types.

Results: Of near-older adults, 69.2% had private HI, 4.2% had VA/military insurance, 6.6% had Medicare, 6.2% had Medicaid, 2.2% were dual Medicare-Medicaid beneficiaries, and 9.9% had no HI, compared to 0.7% of the 65+ age group. More than two-thirds of the near-older adults without HI worked in the past year, but 43.3% had income <200% of poverty. The odds of no HI were lower among older individuals, women, and those with more chronic medical conditions and greater among non-Hispanic Blacks (AOR=1.18, 95% CI=1.05-1.33), Hispanics (AOR=2.34, 95% CI=2.09-2.93), and other racial/ethnic groups (AOR=2.18, 95% CI=1.75-2.71) compared to non-Hispanic Whites, those who were not married, lacked a college degree, and had income <200% of poverty (compared to 400+% of poverty), and those with any functional limitation. These near-older Americans without HI were 7 to 14 times more likely to have postponed or foregone needed healthcare due to costs. In the preceding 12 months, only 45.5% had seen a general practitioner, 33.2% a dentist, 20.4% an eye doctor, and 12.7% a medical specialist. Their odds of any ED visit were lower than those with any public HI but no different from those with private HI. Their odds of any overnight hospital stay were lower than those with private or public HI.

Conclusions and Implications: The study illuminates the needs of near-older adults without HI. Their uninsured rate is likely to continue to rise now that the ACA’s individual mandate penalty has been rescinded (and given skyrocketing unemployment due to COVID-19). Expanding HI to near-older adults would increase healthcare access, aid in reducing health disparities, especially among those with low incomes and racial/ethnic minorities, and improve life quality. Adequate preventive health care for near-older adults will also help reduce overall healthcare expenditures as it is likely to prevent catastrophic illnesses.