By Allyson Y. Schwartz and Martha A. Dawson
News about the novel coronavirus, which has now claimed over 90,000 American lives, is all around us. A subtext told in this reporting is the painful story of the pandemic’s devastating effect on people of color.
While coronavirus does not know boundaries of race, income, or ethnicity, its disproportionate impact on minority communities is unmistakable and points to a deeper crisis of racial disparities in health care that have persisted long before the onset of this disease.
A Centers for Disease Control and Prevention (CDC) study in Atlanta found that, in a cohort of 305 adults hospitalized with coronavirus, 83 percent were black. Similarly, in Washington, D.C., 80 percent of lives lost to coronavirus are black. Public health officials report that Latinx populations are overrepresented in coronavirus deaths, too.
There will be lessons gained from this pandemic, giving us the insights and motivation to build on new ways to deliver care. A renewed call to confront racial inequality in health care should be at the top of the list both for policymakers, the educational system, and health care itself.
As a former member of Congress who represented Philadelphia, the nation’s sixth-largest city with a minority population of over 60 percent (Schwartz), and the President of the National Black Nurses Association, a health system administrator and educator of more than 40 years (Dawson), this is a subject close to our hearts.
Last year, we participated in a convening on racial disparities in health care hosted by Better Medicare Alliance that brought together representatives from the National Minority Quality Forum, NAACP, National Medical Association, members of the Congressional Black Caucus, and other health equity leaders.
While we could not have predicted the havoc that coronavirus would wreak on our health care system the following year, we find ourselves reflecting on the solutions discussed that can be brought to bear today.
This convening crystalized what we have already known: racial inequities elsewhere in our culture manifest today in the form of unconscious and conscious bias by health providers, lack of representation of minorities in high-level health professions, and lagging outcomes for minorities across the health care system.
Our institutions in health care are not powerless to take on these inequities – many already are. The Accreditation Council for Graduate Medical Education (ACGME) explained at the convening the steps being taken to ensure greater diversity in the physician workforce, while providers like ChenMed and Oak Street Health are directly engaging minority communities and leveraging supplemental benefits to address health disparities.
We believe that Medicare Advantage – the managed care option in Medicare where more than 24 million seniors and Americans with disabilities receive coverage – highlights successful remedies for the inequities in health care that are deeply felt amid the coronavirus pandemic.
Increasing numbers of racial minorities are choosing Medicare Advantage for their health care needs. 57 percent of Latinx Medicare beneficiaries are enrolled in Medicare Advantage and black seniors represent a higher proportion of beneficiaries in Medicare Advantage than in Traditional Medicare.
Black and Latinx seniors are more likely to be affected by health conditions that can heighten the risk of coronavirus-related complications. Black adults are 20 percent more likely to have asthma, 72 percent more likely to be diabetic, and eight times as likely to be diagnosed with HIV than white adults. Tackling these chronic conditions and slowing disease progression is essential to protecting these individuals, future generations, and their communities from future health crises.
Medicare Advantage offers promising signs – with a 29 percent lower rate of avoidable hospitalizations among beneficiaries with multiple chronic conditions, and a 73 percent lower rate of serious complications among the most clinically at-risk diabetics.
We also know that most seniors live on fixed incomes, including racial minorities who are more likely to experience poverty than white older adults. Medicare Advantage can help these vulnerable beneficiaries stay more financially secure, saving them nearly $1,600 a year in annual health expenditures compared to Traditional Medicare.
Consider, too, the impact of hunger and food insecurity that is exacerbated amid the coronavirus pandemic. Even before this crisis took its toll, over 21 percent of black households struggled with food insecurity.
Medicare Advantage’s flexible benefit design offers tools to help. Nearly half of Medicare Advantage plans provide supplemental coverage for meal benefits and have stepped up in this moment of crisis to help get food in the hands of seniors in need.
These achievements do not happen by chance. They are made possible by the unique incentives built into the framework of Medicare Advantage that reward the value of health services provided, rather than the volume. This allows for a greater focus on primary care, earlier clinical interventions, supplemental benefits tailored to address social determinants of health, and lower costs to the patient and the health care system.
Medicare Advantage is not a panacea for the racial inequities that persist across our culture today, and there is more work to be done. A report that followed our convening outlines sensible recommendations for reform — from required unconscious bias and cultural sensitivity training, to more accurate and actionable data to pinpoint where and how disparities occur.
Still, these successes offer us great hope that, even in this season of crisis, innovations are taking hold that can lead to a more just future in health care.
Allyson Y. Schwartz is president and CEO of the Better Medicare Alliance. She represented Pennsylvania in the U.S. House of Representatives from 2005 to 2015.
Martha A. Dawson, DNP, RN, CNS, FACHE, is President of the National Black Nurses Association and Associate Professor of Nursing at the University of Alabama at Birmingham School of Nursing.
