Medicare bills point to poverty-covid tie

High likelihood follows low income

Income is a potent force along with race in determining who among the nation’s vulnerable, older population has been infected with the novel coronavirus, according to a federal analysis that lays bare stark disparities in the pandemic’s toll.

The findings released Monday are based on billing records for people on Medicare who have contracted the virus. They echo the commonly understood pattern that black Americans are more likely to test positive for and to be hospitalized for covid-19, the disease caused by the coronavirus, than other racial and ethnic groups. But they also point to the role of poverty as the pandemic has sped through U.S. communities in the winter and spring.

Individuals covered by Medicare, the vast federal insurance program for older Americans, who are poor enough to also qualify for Medicaid, the public insurance safety net, were four times more likely to have been infected or hospitalized with the coronavirus than those on Medicare alone, according to billing records from more than 325,000 cases from January through mid-May.

For men, women and every racial, ethnic and age group of Medicare beneficiaries, the rate of coronavirus cases among those with incomes low enough to be on Medicaid is far higher than for everyone else in the analysis. Among those 65 and older, known in health-policy parlance as “dual eligibles,” 1,732 out of 100,000 people were infected, compared with 320 on Medicare alone, the data shows.

Such rates are “drastically higher,” said Seema Verma, administrator of the federal Centers for Medicare and Medicaid Services, which performed the analysis. The differences are a “clarion call,” Verma said, for changes that would focus on the health problems that come with poverty, including inadequate housing and access to nutritious food.

“At the end of the day,” Verma said on a conference call with journalists, the data analysis “reconfirms longstanding issues around disparities and vulnerable populations” — an issue that has traditionally been more of a priority for Democrats than for the Trump administration and other Republicans. She said the administration will press harder to pay doctors and other providers of care in ways that hold them responsible for making patients healthier, rather than the traditional “fee-for-service” method that simply rewards a high volume of patient visits.

Unlike previous government data about the pandemic — based on reports of tests, hospitalizations or deaths — the new analysis is based on the bills sent to Medicare, the federal insurance program that covers 62 million people who are 65 and older or have a disability.

The analysis looks in particular at the subset of people eligible for Medicaid, the public insurance for low-income Americans, as well as Medicare. Sometimes, people qualify for both because they always were poor, and sometimes they qualify because they have spent their savings — for instance, on expensive nursing-home care.

Verma did not address whether part of the high rates of infection and hospitalization among people in both programs is tied to living in nursing homes, which have been hit hard by the virus. Another Centers for Medicare official said the analysis does not allow officials to determine the relative weight of poverty vs. living in long-term care settings.

Officials called the analysis, the government’s first attempt to examine the way the virus has penetrated the nation’s older population, a snapshot. They noted that the data is incomplete because doctors, hospitals and others are allowed up to a year to submit bills, known as claims, to the Medicare program, so the government is still awaiting an unknown number of claims for coronavirus treatment.