The appearance of COVID-19 in the United States has had a major impact on the nation’s health care delivery system. Lockdowns in many states are viewed as being successful in slowing down the rate at which new cases of the disease occur. Now that such restrictions have been loosened, in many jurisdictions there is a resurgence in the number of new cases as businesses reopen and some individuals choose to refrain from wearing masks when in public settings. The number of hospital admissions continues to grow in certain states, heightening a concern that the ability to treat newly infected patients may be compromised if hospital facilities become sufficiently overwhelmed.

Older Americans are disproportionately affected by this disease. Data released by the Centers for Medicare & Medicaid Services (CMS) on June 22, 2020 show that that more than 325,000 Medicare beneficiaries had a diagnosis of COVID-19 between January 1 and May 16 of this year, which translates to 518 COVID-19 cases per 100,000 beneficiaries. The data also indicate that nearly 110,000 beneficiaries were hospitalized for COVID-19-related treatment, which equals 175 COVID-19 hospitalizations per 100,000 beneficiaries. Blacks were hospitalized with COVID-19 at a rate nearly four times higher than whites. Disparities go beyond race/ethnicity and suggest the impact of social determinants of health, particularly socio-economic status. End-stage renal disease (ESRD) patients (individuals with chronic kidney disease undergoing dialysis) had the highest rate of hospitalization among all Medicare beneficiaries, with 1,341 hospitalizations per 100,000 beneficiaries. These patients also are more likely to have chronic comorbidities associated with increased COVID-19 complications and hospitalization, such as diabetes and heart failure.

Medicare And The Health Care Delivery System

The Medicare Payment Advisory Commission’s June 2020 Report to the Congress: Medicare and the Health Care Delivery System was issued on June 15, 2020. The Commission believes that unless substantial changes are made to the way Medicare pays for services and to how beneficiary care is organized and delivered, the cost of the Medicare program will remain on an unsustainable trajectory. The Part A trust fund is projected to exhaust its reserves in 2026, which will force Medicare to reduce payment rates sharply for hospitals and other Part A providers unless policymakers take some other action. The Commission asserts that the use of fee-for-service payment for Medicare services should be replaced, over time and to the degree feasible, by payment to accountable systems of care that have incentives to: provide preventive services and early disease detection, improve the quality and beneficiary experience of care; avoid delivering unnecessary or inappropriate services; control the costs of providing necessary services in the most appropriate care setting; deliver chronic care services through care coordination among providers; coordinate both the medical and nonmedical needs of beneficiaries; and enhance the use of technologies that improve quality and reduce program costs. Moreover, serious attention must be given to new innovations, for example, changing how hospitals are paid and giving providers incentives to manage the cost of medications.

Report To Congress On Medicaid And CHIP

The Medicaid program was instrumental in providing coverage to the uninsured when the Patient Protection and Affordable Care Act became law in 2010. Medicaid is playing this same role during the COVID-19 pandemic. Unemployment that results in loss of health insurance coverage through one’s job has helped to fuel a surge in the rolls of Medicaid beneficiaries. The Medicaid and CHIP Payment and Access Commission (MACPAC) on June 15, 2020 submitted its June 2020 Report to Congress on Medicaid and CHIP. This document contains six chapters addressing three fundamental challenges facing Medicaid: (1) improving integration of care for low-income seniors and individuals with disabilities who are dually eligible for Medicaid and Medicare; (2) ensuring that Medicaid is the payer of last resort when beneficiaries also have coverage from another insurance program; and (3) addressing concerns about high rates of maternal morbidity and mortality. A focus is on integrating Medicaid and Medicare, two separate programs that were not designed to work together, for beneficiaries who are eligible for both entities. Dually eligible beneficiaries account for a disproportionate share of Medicaid and Medicare service use and spending. Integrating the delivery and financing of their care is viewed as having a potential to address better the totality of their needs and reduce spending.

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