Photo credit: Rosa Palacios
The Centers for Medicare and Medicaid Services (CMS) has released new data detailing the impact of COVID-19 on Medicare beneficiaries. As many consumers and advocates are acutely aware, the pandemic has had a disproportionate impact on older adults and people with complex needs. The new data highlights the continued impact COVID-19 is having on Black consumers, who are weathering the dual pandemics of systemic racism and COVID-19 at the same time.
According to the recent data, Black beneficiaries continue to be hospitalized at higher rates than other racial and ethnic groups. Black older adults also have the highest rate of COVID-19 cases in general, with more than double the rate of white older adults. American Indian/Alaska Native and Hispanic Medicare enrollees also suffered a significantly higher rate of cases per capita. Those dually eligible for both Medicaid and Medicare were hospitalized at a rate more than five times higher than beneficiaries with Medicare only. This evidence shows that the racial gap of the COVID-19 pandemic is still felt most acutely by those most at risk for infection and severe complications.
A concerning element of this data release is the CMS explanation for these dramatic racial and ethnic disparities. The corresponding press release attributes “the higher rates of chronic health conditions in these populations and issues related to the social determinants of health” as the cause of these disparities, but fails to connect these outcomes to the pandemic of systemic racism that leads to disproportionate rates of chronic illness in the first place.
As we process this data, the fact that racial and ethnic minorities experience higher rates of chronic illness should not be a conclusion, but the beginning of a policy response. We know that the effects of racial discrimination are linked to common chronic conditions like hypertension, the most common chronic condition among hospitalized Black beneficiaries. It is important not to individualize the poor health outcomes Medicare beneficiaries experience that are a result of systemic racism and fit clearly demonstrable patterns. While CMS acknowledges the “social risks” that have led to these disparate outcomes, it must go further and name the impact of systemic racism on Black Medicare consumers.
The CMS Office of Minority Health has responded to these concerning numbers through listening sessions with stakeholders representing Medicare consumers of color. This engagement can be helpful, but also falls short of full engagement with consumers using Medicare. CMS should be directly engaging with consumers at all steps of the process, not just in a retrospective way. Barriers to health care for consumers with complex needs existed before the pandemic. Consistent pathways for consumer engagement are a critical priority at all times, and can serve as valuable sources of information in a health care crisis such as our nation’s current one.
The rates of COVID-19 cases and hospitalizations show our failure to protect populations who are most at risk for contracting the virus and suffering complications. The devastating effects of COVID-19 on older adults of color, especially those who have complex medical needs, should push policymakers to go further with community-wide interventions to stop the spread of the virus. While many of our recent conversations about COVID-19 are centered around general community spread, we need to forcefully re-focus our discourse and policy decisions on those populations that are most impacted. We also must invest in policy levers that help address racial health disparities, such as Medicaid. Now more than ever, it is apparent that engagement with consumers and advocates has tangible impact on health outcomes for people with complex needs.