For all the harm that COVID-19 has wrought on our world and our lives, a thin, faint silver lining in this dark cloud that still hangs over our health care system has emerged.
The pandemic’s disproportionate impact on communities of color and ongoing racist acts of brutality against innocent Black lives, brought out into the light of day in the social media age, forced a reluctant populace to finally reckon with uncomfortable truths about the deep, systemic disparities experienced by their Black and brown neighbors.
Cities ranging from Denver, Colorado to Indianapolis, Indiana and New York, New York formally named racism for the public health crisis that it is.
The once scant media attention paid to communities of color’s cries for social justice became front page news.
A Gallup poll released last year showed roughly two thirds of Americans – still too few but a record high – acknowledging the truth of “widespread” racial prejudice.
And a new, historic administration ascended to the White House with health equity as a pillar of its agenda.
These emerging signs of progress inspire hope that this month, National Minority Health Month, can be a catalyst for continued strides in the long march to health equity. Meaningful change, however, requires us to go beyond hashtag activism to critically evaluate what is working, what is not, and where we can apply lessons learned.
For the 1 in 4 seniors who are people of color, Medicare Advantage – the public private partnership in Medicare where some 29.5 million Americans will choose to receive health coverage this year – is demonstrating particular value. Don’t take our word for it: research shows that minority enrollment in Medicare Advantage jumped 111% from 2013 to 2019 alone.
One likely cause: dollars and cents. A new study commissioned by the Better Medicare Alliance found that Black Medicare Advantage beneficiaries spend $1,104 less annually on health expenditures than those who choose Original Medicare. Likewise, Latino Medicare Advantage beneficiaries see savings of over $1,400 each year.
The result is that Black Medicare Advantage beneficiaries have a 27% lower rate of cost burden – defined as spending 20% or more of one’s income on health expenses – than Black enrollees in Original Medicare. Latino beneficiaries see a 45% lower rate of cost burden.
Lower premiums and out-of-pocket costs are attractive to just about anyone, but for Black and brown seniors on fixed incomes who know all too well of racism’s ugly impact on generational wealth building and opportunity, that cost savings can be transformational.
Of course, affordable health coverage means little if it sacrifices quality but data tells us this is not the case: a December 2021 Morning Consult poll gives Medicare Advantage a 94% beneficiary satisfaction rate, and research from Avalere Health finds a 43% lower rate of avoidable hospitalizations compared to original Medicare.
Further, with the coronavirus pandemic continuing to inflict its heaviest toll on people of color, separate findings show that Medicare Advantage saw lower COVID-19-related hospitalization and mortality rates than Original Medicare.
Most recently, a December 2021 report released by the Biden administration’s Center for Medicare & Medicaid Services noted Medicare Advantage’s “substantial improvement for Black and Hispanic beneficiaries in the area of clinical care,” resulting in what the agency billed as a “substantial reduction” in inequities on “almost all clinical care measures analyzed.”
Add to this Medicare Advantage’s uptake of supplemental benefits – vision, hearing, wellness, and dental benefits are now nearly universal while benefits aimed at social determinants of health such as meal delivery, transportation benefits, and even structural home modifications are on the rise – and you have a health care program suited to play a meaningful role in the task of eliminating the stains of racial injustice that still pervade our health care system.
There is much work ahead to reimagine health care in ways that protect the wellbeing and dignity of people of color and ensure every individual can achieve their full health potential. Medicare Advantage is not a cure-all to this complex problem, but its glimpses of success offer us a worthy place to start.
During National Minority Health Month, it is incumbent upon policymakers to look closely at these equity-enhancing lessons found in Medicare Advantage and consider ways to carry that innovation forward across the health care system.
Daniel E. Dawes, JD, is Director of the Satcher Health Leadership Institute at Morehouse School of Medicine and author of “The Political Determinants of Health.”
Martha A. Dawson, DNP, RN, CNS, FACHE, is President and CEO of the National Black Nurses Association and Associate Professor of Nursing at the University of Alabama at Birmingham School of Nursing.
Mary Beth Donahue, MPP, is President and CEO of the Better Medicare Alliance and is the former Chief of Staff at the U.S. Department of Health and Human Services during the Bill Clinton administration.