Racial and Ethnic Health Inequities and Medicare
Medicare is a national health insurance program that provides coverage to more than 60 million people ages 65 years and older and younger adults with long-term disabilities, including 15 million beneficiaries who are people of color. Medicare covers a broad range of health services, including hospital and physician services, preventive services, skilled nursing facility and home health care, hospice, and prescription drugs. While Medicare has been instrumental in providing adults access to medical care, racial disparities in diagnoses, treatment, and outcomes among beneficiaries persist and have been exacerbated by the coronavirus pandemic.
Medicare has helped to mitigate racial and ethnic inequities in health care in its role as both a regulator and the largest single purchaser of personal health care in the U.S. Prior to the establishment of Medicare, half of older adults lacked health insurance. Soon after its enactment in 1965, Medicare facilitated the integration of hospitals by enforcing Title VI of the Civil Rights Act, which prohibits the distribution of federal funds to institutions that practice discrimination.1 Before then, many hospitals were segregated, and in many parts of the country, Black physicians were unable to practice in hospitals in their community.2 As Dorothy Height, an American civil and women’s rights activist, observed, “the combination of Medicare, Medicaid and the civil rights legislation changed the health care landscape forever for Black Americans and minorities of all ages. Everyone benefited from these policies.”
However, as the coronavirus pandemic has laid bare, racial and ethnic inequities in health and health care persist, including among people with Medicare. Among adults ages 65 and over, COVID-19 related mortality rates for Black and Hispanic adults are nearly double the rate for White adults. In the Medicare population, which includes both older adults and younger adults with long-term disabilities, Black, Hispanic, and American Indian and Alaska Native beneficiaries have borne a disproportionate burden of COVID-19 cases and hospitalizations.
Long before the COVID-19 pandemic, numerous studies documented health inequities among Medicare beneficiaries by race and ethnicity, even after controlling for multiple factors, such as age, sex, and comorbidities. For example, Black Medicare beneficiaries have higher hospital readmission rates than White beneficiaries even after controlling for multiple patient-level factors,3, 4, 5 and in some studies, these disparities persist even within the same hospital or skilled nursing facility,6,7 suggesting that systemic-level factors are driving forces behind these disparities. Moreover, studies have documented racial/ethnic disparities in cancer survival rates and receipt of optimal treatments.8, 9, 10, 11,12
Health inequities among Medicare beneficiaries are attributed to broader structural, socioeconomic, political, and environmental factors that are rooted in years of systemic racism. Socioeconomic disadvantages associated with structural racism shape health outcomes among people of color long before the age of Medicare eligibility is reached and have a cumulative effect over the course of a lifetime, contributing to ongoing or greater inequities in older ages.13,14
This chart collection draws on primary and secondary data analyses by KFF and other sources to examine the characteristics, experiences, and outcomes of the Medicare population by race and ethnicity (see Methods for details on data and analysis). It includes data from a variety of sources to describe demographics, health status and disease prevalence, health coverage, access to care and service utilization, and health outcomes, including the most current data available pertaining to disparities related to COVID-19 within the Medicare population. It also documents disparities in income and wealth among people on Medicare.
While the collection of race and ethnicity data in administrative and survey data has improved over time, sample size and data collection limitations, including limitations related to completion, accuracy, and classifications of race/ethnicity data, preclude analysis of certain racial and ethnic groups consistently across data sources. Further, gaps in data reporting and collection standards, such as the reporting of COVID-19 cases and deaths in nursing homes by race and ethnicity, impede the complete identification of racial and ethnic disparities. These data limitations affect our ability to display results for a consistent set of racial and ethnic groups in this chart collection, especially for Asian, American Indian and Alaska Native, and Native Hawaiian and Other Pacific Islander beneficiaries, and beneficiaries who identify as two more races in some of our analyses. Moreover, due to these data limitations, we are unable to present more nuanced and disaggregated data that reflect the heterogeneity within different racial and ethnic groups. For example, researchers have documented differences in health outcomes within Hispanic subgroups, such as those identifying as Mexican, Cuban, Puerto Rican, Dominican, and Central/South American, that would otherwise be masked.15,16 Throughout this brief, individuals of Hispanic origin may be of any race, but are classified as Hispanic for the analysis; all other groups are non-Hispanic.