"Old age is a territory populated largely by women," a commentator wrote in a 1996 issue of the New England Journal of Medicine.1 Women live about six years longer than men, on average. This In Brief summarizes the findings of the AARP Public Policy Institute Issue Paper, Older Women's Access to Health Care: Potential Impact of Medicare Reform,2 which identifies and discusses key issues related to older women (age 65 and older) and proposed changes in the Medicare program. This analysis can inform the development of options that have the greatest prospect of fulfilling policy intentions, while avoiding disproportionately negative impacts on the most vulnerable beneficiaries.
Older women outnumber older men in Medicare and are disproportionately represented among poor and low-income beneficiaries age 65 and older.
Older women are more subject than men to chronic illness and health conditions that severely limit their activities of daily living (ADLs) and that may require treatment with prescription medications.
Older women are more likely than men to use care in post-acute or non-acute-care settings such as nursing facilities or to receive care from home health agencies.
Women tend to outnumber men in the ranks of the uninsured in the 10 years preceding Medicare eligibility.
Medicaid figures more prominently as a source of health care coverage for older women than older men, while older men are more likely to lack any supplemental coverage.
However, among beneficiaries with private sources of supplemental coverage (i.e., Medigap or employer-sponsored), Medigap figures more prominently for older women than for older men.
Analysis of out-of-pocket spending for health care reveals certain disparities between older women and older men:
- Women, on average, spend a higher percentage of their incomes on health care than do men. This disparity widens with age.
- Women, on average, spend substantially more than men on short-term nursing home care, but substantially less on inpatient hospital care.
- Women tend to be more burdened by prescription drug costs than men.
Older women, even if they have adequate insurance coverage, may encounter barriers to health care due to factors such as caregiving responsibilities, living arrangements, or provider attitudes.
Implications for Medicare Reform
Given the financial vulnerabilities facing older women, the most important Medicare reforms are the ones that address the availability, adequacy, and affordability of health insurance coverage. Notable in this respect are proposals for a Medicare prescription drug benefit, and cost-sharing reform that assures access to post-acute care. There are serious questions as to whether a Medicare premium support system would be affordable for many beneficiaries in the long run. Concerns about access to affordable health insurance arise in the context of proposals to raise the age of Medicare eligibility. Some form of a Medicare buy-in option would help to offset this potential problem. However, it appears that policymakers will be challenged to design a buy-in program that would be affordable to those who need it most.
For the most complete assessment of how Medicare reform might affect older women, further analysis is required, and careful consideration must be given to the role of Medicaid in the lives of older persons. A focus on Medicaid as part of the Medicare reform debate could provide a needed opportunity to confront the challenges of better protecting low-income beneficiaries from high out-of-pocket costs, as well as developing policies for long-term care of older persons. For older women who are living with chronic conditions and often without the support of a life partner, access to long-term care is a critical concern, especially as health and functional status decline.
Finally, it is reasonable to question whether or how Medicare policy affects access to health care in ways not strictly limited to coverage. For example, less educated and poorer women need targeted health promotion and disease prevention messages so that they are aware of the importance of seeking timely health care services. Since Medicare covers certain preventive and screening services such as mammograms and Pap smears, there is a clear rationale for developing policies to increase the effective delivery of these services. Other barriers to access may be more difficult to address in the context of Medicare reform.
The enduring policy challenge is to maximize Medicare's value to its more vulnerable beneficiaries. These include many women who are poor, who live in ethnic or minority communities, or who live alone and lack informal support. Insurance coverage may increase, but does not necessarily guarantee, their access to health care services.
- Butler, Robert N., "On Behalf of Older Women: Another Reason to Protect Medicare and Medicaid," New England Journal of Medicine, March 21, 1996.
- AARP Public Policy Institute Issue Paper #2000-08 (July 2000).
Written by Lisa A. Foley and Mary Jo Gibson, AARP Public Policy Institute
May be copied only for noncommercial purposes and with attribution; permission required for all other purposes.
Public Policy Institute, AARP, 601 E Street, NW, Washington, DC 20049