Bill Overview
Title: Preventing Racism in Medicare Act of 2022
Description: This bill prohibits the Centers for Medicare & Medicaid Services from including the development of anti-racism plans (i.e., plans to address systemic racism in health care) as a qualifying clinical practice improvement activity under the Merit-based Incentive Payment System (MIPS), as described in a November 2021 rule. (MIPS is an incentive program under Medicare that allows health care professionals to receive payment adjustments based on certain performance measures.)
Sponsors: Rep. Palmer, Gary J. [R-AL-6]
Target Audience
Population: People affected by Medicare policy changes
Estimated Size: 65000000
- Medicare is a US federal program that primarily covers individuals aged 65 and older, as well as younger individuals with disabilities and certain diseases.
- Since the bill specifically addresses the implementation of anti-racism plans within Medicare, it will primarily affect those reliant on Medicare services, including healthcare providers under the MIPS.
- Systemic racism in healthcare can lead to disparities in the quality of care received by different racial groups, indicating the potential for broader impacts on all beneficiaries if such disparities are not addressed.
- While the bill is specific to Medicare in the United States, the principles it touches upon regarding systemic racism and healthcare disparities are relevant to global discussions on healthcare equity.
Reasoning
- The primary population affected by this policy are Medicare beneficiaries, particularly those who may be subject to systemic racism in healthcare settings. This includes not only the direct patients but also the healthcare providers who participate in MIPS and might have influenced incentives due to the policy changes.
- Given the budget constraints mentioned (zero dollars), the policy is likely more symbolic or procedural rather than leading to new direct interventions or funding changes. Updates to MIPS criteria without extra funding might impact how providers structure their services, potentially affecting service delivery indirectly.
- Considering the focus on anti-racism plans and systemic racism, the impact is likely to be more significant on racialized communities who have historically experienced disparities in healthcare.
- Even though there will be people significantly impacted, a large portion of the Medicare population who do not face racial or direct healthcare disparities may not notice any significant change due to this policy. The distribution of interviewees will try to reflect this broad population spread.
Simulated Interviews
retired factory worker (Detroit, MI)
Age: 70 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- I've faced unequal treatment in hospitals before, and it worries me. Not working towards making healthcare better for everyone feels wrong.
- It's crucial that hospitals and clinics actively work to be fair and just, without that, nothing changes.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 6 |
| Year 2 | 5 | 6 |
| Year 3 | 5 | 6 |
| Year 5 | 5 | 6 |
| Year 10 | 6 | 7 |
| Year 20 | 6 | 7 |
retired school teacher (Albuquerque, NM)
Age: 85 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 18/20
Statement of Opinion:
- I don't think this change will affect me directly as I haven't faced issues with my Medicare.
- Changing incentives seems bureaucratic; I care more about the quality and accessibility of my health care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
retired nurse (Atlanta, GA)
Age: 68 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- I've worked in healthcare; systemic bias is real, and stepping back from tackling it isn't progress.
- Providers need to be rewarded for making inclusive, equitable care part of their daily practice.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 7 |
| Year 2 | 6 | 7 |
| Year 3 | 6 | 7 |
| Year 5 | 5 | 8 |
| Year 10 | 5 | 8 |
| Year 20 | 6 | 8 |
retired engineer (Houston, TX)
Age: 72 | Gender: male
Wellbeing Before Policy: 9
Duration of Impact: 1.0 years
Commonness: 16/20
Statement of Opinion:
- Honestly, these policy intricacies don't affect my day-to-day life. My care has been consistent.
- I do think ensuring a fair system is important, but I haven't seen issues personally.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 9 | 9 |
| Year 2 | 9 | 9 |
| Year 3 | 9 | 9 |
| Year 5 | 9 | 9 |
| Year 10 | 9 | 9 |
| Year 20 | 9 | 9 |
retired social worker (Chicago, IL)
Age: 65 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 7.0 years
Commonness: 6/20
Statement of Opinion:
- This kind of policy seems to avoid dealing with real issues. We need commitment to tackling systemic racism, not silence.
- It could discourage those providers pushing for better, fairer care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 7 |
| Year 2 | 5 | 7 |
| Year 3 | 5 | 8 |
| Year 5 | 5 | 8 |
| Year 10 | 5 | 9 |
| Year 20 | 6 | 9 |
retired accountant (Miami, FL)
Age: 80 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 2.0 years
Commonness: 10/20
Statement of Opinion:
- Healthcare's been okay for me, so I don't think I'll notice much change.
- It's important, however, that all people get equal treatment.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 7 | 8 |
| Year 5 | 7 | 8 |
| Year 10 | 7 | 8 |
| Year 20 | 7 | 8 |
retired librarian (Seattle, WA)
Age: 66 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 3.0 years
Commonness: 9/20
Statement of Opinion:
- I'm a big believer in fair healthcare. Policies like this can make things harder for groups already struggling.
- Would like to see more focus on inclusion and fairness.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 8 |
| Year 2 | 7 | 8 |
| Year 3 | 7 | 8 |
| Year 5 | 7 | 8 |
| Year 10 | 8 | 9 |
| Year 20 | 8 | 9 |
retired marketing executive (New York, NY)
Age: 69 | Gender: male
Wellbeing Before Policy: 9
Duration of Impact: 0.0 years
Commonness: 15/20
Statement of Opinion:
- Medicare has been a seamless process for me. Any policy that might lead to unease in management needs careful handling.
- I care about efficiency and predictability in healthcare.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 9 | 9 |
| Year 2 | 9 | 9 |
| Year 3 | 9 | 9 |
| Year 5 | 9 | 9 |
| Year 10 | 9 | 9 |
| Year 20 | 9 | 9 |
retired homemaker (Philadelphia, PA)
Age: 75 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- Systemic racism is a big issue; ignoring it makes me concerned for future care quality.
- I hope that people keep pushing for better treatment standards for all.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 6 |
| Year 2 | 5 | 7 |
| Year 3 | 5 | 7 |
| Year 5 | 5 | 7 |
| Year 10 | 5 | 8 |
| Year 20 | 6 | 9 |
retired IT consultant (San Francisco, CA)
Age: 77 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- I have concerns about changes to incentives that make system bias less of a focus.
- Policies like this should aim to actively reduce racism, not ignore it.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 7 |
| Year 2 | 6 | 7 |
| Year 3 | 6 | 8 |
| Year 5 | 6 | 8 |
| Year 10 | 7 | 8 |
| Year 20 | 7 | 9 |
Cost Estimates
Year 1: $0 (Low: $0, High: $1000000)
Year 2: $0 (Low: $0, High: $1000000)
Year 3: $0 (Low: $0, High: $1000000)
Year 5: $0 (Low: $0, High: $1000000)
Year 10: $0 (Low: $0, High: $1000000)
Year 100: $0 (Low: $0, High: $1000000)
Key Considerations
- The policy primarily influences the administrative aspect of Medicare's MIPS program.
- Potential long-term impacts on health outcomes and disparities are challenging to estimate but are critical to assess.
- The exclusion of anti-racism plans may have indirect effects on the quality of care and health disparities among racial groups within Medicare.