Historically, Medicare has done significant work in reducing racial and ethnic disparities in health status and access to health care, including driving the desegregation of America’s hospital systems in the 1960s. However, as a new report from the Kaiser Family Foundation demonstrates, that work remains incomplete. Not only do racial and ethnic disparities persist, the COVID-19 pandemic has exacerbated them.
Several issues combine to create these disparities. Average income and savings for Black or Hispanic beneficiaries are lower than for white beneficiaries. In addition, Black or Hispanic beneficiaries are less likely to have access to private wraparound coverage—like Medigap plans or retiree plans—to supplement their Medicare coverage. They are more likely, however, to have Medicaid coverage and low-income subsidies for Part D, demonstrating the important role Medicaid and other programs play in eliminating disparities in access to care. Still, more Black or Hispanic beneficiaries report struggles in finding care, including delays in getting appointments and problems finding a specialist, and far too many find affording care impossible, resulting in delayed care and rising debt.
The report also shows that Medicare beneficiaries who are Black or Hispanic report higher prevalence of poor health and many chronic conditions such as high blood pressure and diabetes compared to white beneficiaries. Black beneficiaries are more likely to need emergency care, hospitalization, and readmission, and are more likely to be hospitalized at low-quality facilities.
During the pandemic, outcome disparities have been even worse. Rates of infection are higher, and the death rates from COVID-19 are nearly twice as high for Hispanic, Indigenous, and Black beneficiaries as for white beneficiaries. Nursing facilities with relatively high percentages of Black or Hispanic residents were more likely to see at least one death from the virus.
As all of these data show, disparities in care and outcomes continue. Medicare has made great strides in ending discrimination in health care, but more improvements are both necessary and possible. Such changes must come both within health care and the larger social and economic systems where inequities flourish.
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