Equal Access for All? The Impact of Reducing Disparities in Insurance Generosity Among Medicare Beneficiaries

Policymakers are concerned about whether low-income beneficiaries covered by public health insurance programs have adequate access to medical care. This paper analyzes the effect of a large, federally-mandated provider reimbursement rate increase for selected primary care services provided to dual-eligible beneficiaries, which effectively closed the gap between reimbursements paid for services provided to dual-eligible beneficiaries and standard Medicare beneficiaries. Leveraging across-state, across-provider, and across service variation in the policy-induced reimbursement rate, we find that provider reimbursement rate increases led to an economically significant and persistent increase in the utilization of targeted primary care services. Overall, the evidence indicates that reducing the disparity in primary care reimbursement rates among Medicare beneficiaries led to significant increases in primary care utilization among the relatively low-income, high disease-burden population dually-eligible for both Medicaid and Medicare.