Medicare and Health Equity
Key Takeaways
- Medicare has contributed to making access to healthcare more equitable since the program’s founding in 1965.
- Hospitals that accepted Medicare were not allowed to discriminate against patients for their race, religion, gender, or national origin.
- Today, Medicare continues to address inequities in the healthcare system.
Every individual has their own challenges when it comes to managing their health and finding the right insurance coverage. However, there are also widespread, systemic issues in healthcare systems that make it harder for entire groups of people to receive high-quality care.
To address those problems, health organizations at the local, national, and international levels strive for health equity, which the U.S. Centers for Disease Control and Prevention (CDC) defines as “the state in which everyone has a fair and just opportunity to attain their highest level of health.”
Since its 1965 founding as a public health insurance program that provides hospital and medical coverage for older adults, Medicare has played a major role in efforts to make U.S. healthcare fairer. In this article, we’ll learn about Medicare’s past achievements in helping underserved groups, the unequal treatment that persists today, and the policies that are being implemented to build a better future for beneficiaries of all identities and backgrounds.
Medicare and Civil Rights
Up until the 1960s, racial segregation was commonly and openly practiced in American hospitals. Black patients could find themselves turned away for treatment, and Black doctors were often not allowed practice medicine at white-dominated facilities. In many cases, these forms of discrimination continued even after the passage of the 1964 Civil Rights Act made them illegal.
When the federal government established Medicare, it was clear that hospitals would rely on payments through the new public insurance program to provide care for older adults. As a result, the administration of President Lyndon B. Johnson could pressure healthcare facilities across the country to comply with the Civil Rights Act. Any hospital that violated the law by refusing to serve patients because of their race, religion, gender, or national origin would not be able to receive federal payments through Medicare.
Since then, Medicare has made healthcare more accessible for generations of older Americans across all races, ethnicities, and socioeconomic backgrounds. The program also expanded to cover people under 65 with certain disabilities. According to figures from the Centers for Medicare and Medicaid Services, about 61.2 million people were either on Original Medicare, administered by the federal government, or a Medicare Advantage plan from a private insurer in 2024.
Addressing Inequities Today
Despite the strides taken since the civil rights movement, the U.S. healthcare system still has work to do in providing equitable access and treatment. For example, a study published in the Journal of the American Medical Association found that maternal mortality rates more than doubled between 1999 and 2019, with Black and American Indian women more likely to die because of complications during pregnancy when compared to white women. Even for mothers of similar socioeconomic status, studies show that the children of Black women are more likely to experience problems like low birth weight.
One obstacle in the ongoing struggle to achieve equity is the fact that smaller percentages of American Indian, Black, and Hispanic people have health insurance than white people, according to an analysis by the health policy nonprofit KFF. However, once U.S. citizens and permanent residents turn 65, nearly everyone qualifies for coverage through Medicare.
Among this older population, Medicare Advantage plans — which match Original Medicare’s coverage and usually include a variety of supplemental benefits such as Medicare Part D prescription coverage, dental, hearing, and vision — have become an increasingly popular choice. These plans from private insurers served 54% of people on Medicare as of 2024.
Based on data from 2022, KFF found that 13% of those on Medicare Advantage plans were Black, compared to 7% of Original Medicare beneficiaries, and 12% were Hispanic, as opposed to 6% on Original Medicare. These groups are able to access healthcare with lower out-of-pocket costs and premiums than they would on Original Medicare; an analysis commissioned by the Better Medicare Alliance found that Black and Hispanic beneficiaries save more than $1,000 per year on average by enrolling in Medicare Advantage plans.
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Ongoing Medicare Initiatives to Promote Equity
The Centers for Medicare and Medicaid Services (CMS) make rule changes each year intended to improve beneficiaries’ experiences and outcomes. Some recent shifts in policy that could advance healthcare equity include:
- Limiting the situations where patients on Medicare Advantage plans can be required to get prior authorization from their insurer before receiving care.
- Expanding access to behavioral health services in rural areas and underserved communities
- Factoring equity into the Star Ratings used to evaluate Medicare Advantage plans and help enrollees find the best ones.
CMS is also exploring long-term strategies for using its resources as the nation’s largest health insurer to do more to help historically underserved groups. In 2022, the agency issued a health equity framework for the next 10 years that features priorities like:
- Improving data collection to gain a better understanding of the needs of people with diverse identities and backgrounds.
- Addressing disparities that affect healthcare access, quality, or outcomes both within CMS programs like Medicare and in the healthcare organizations they support.
- Making services available in more languages and ensuring that patients and their families understand important healthcare information.
- Enforcing accessibility requirements and making it easier for people with disabilities to receive care.
Medicare has a long history of making quality healthcare available to more people of all backgrounds and identities, but achieving true equity is an ongoing challenge. Fortunately, consumers have a range of options for accessing the coverage, benefits, and assistance they need to have healthier lives.
Sources
Medicare Advantage in 2024: Enrollment Update and Key Trends. KFF.
About Health Equity. CDC
Desegregation: The Hidden Legacy of Medicare. U.S. News & World Report.
Desegregating Hospitals. Stanford Medicine Magazine.
A Snapshot of Sources of Coverage Among Medicare Beneficiaries. KFF.
Medicare Advantage Outperforms Fee-For-Service Medicare on Cost Protections for Low-Income and Diverse Populations. Better Medicare Alliance.