CMS to Rate Health Plans on Racial ‘Health Equity’ Measures

The Centers for Medicare and Medicaid Services (CMS) is making changes to its rating systems for Obamacare and seniors’ health plans that require insurers to collect and report race and ethnicity data to promote “health equity.”

The CMS will require Medicare Advantage plans and insurance sold on the federal or state health insurance exchanges to report “stratified race and ethnicity” data beginning in 2023. Information will be collected on five measures: colorectal cancer screening, controlling high blood pressure, hemoglobin A1c (HBA1c) control for patients with diabetes, prenatal and postpartum care, and child and adolescent well-care visits.

Additional procedures and treatment outcomes could be added in future years—stratified by income, gender, and geography—states a CMS letter published as part of its annual rule-making process.

Collecting more data will benefit coverage providers, or Qualified Health Plans (QHP), and eventually figure into the “starred” quality rating system enrollees rely on and government reimbursements to the plans, says the CMS.

“Reporting of stratified data would provide insight and awareness for QHP insurers into the quality of care among members of different demographics enrolled in each health plan and thereby allow insurers to advance health equity,” states the letter.

‘Focus on Race’

The CMS proposal will contribute nothing to public health, Jeff Stier, senior fellow at the Consumer Choice Center, told Health Care News.

“The proposed changes are deceptively pernicious because they will force the health care sector to consider care through the lens of race,” said Stier. “CMS claims that increasing the focus on race will somehow increase health equity.”

This is the opposite of removing barriers to care, says Stier.

“Equity is defined as ‘something that is just and fair,’ said Stier. “Any common-sense interpretation of the meaning of equity would require a de-emphasis on race, not a focus on race. Unless of course, ‘equity’ is just code language for something completely unjust and unfair, such as using race as a factor in how health care is provided.”

The direction of CMS policy is misguided if the aim is to improve the well-being of disadvantaged individuals, says Stier.

“There’s no doubt that there are disparities in health outcomes that cut across a wide range of socio-economic factors,” said Stier. “But we should focus on advancements in science, not racial division, to achieve improved outcomes for all.”

‘Tsunami of Progressivism’

It is important for the public to pay attention to changes like the new rating system, says Chad Savage, M.D., president of DPC Action, health care policy fellow at Docs 4 Patient Care Foundation, and policy advisor to The Heartland Institute, which co-publishes Health Care News.

“Our societal march toward progressivism has mostly occurred unnoticed in dribs and drabs,” said Savage. “However, each small drop of change in the aggregate turns into a tsunami of progressivism. CMS continues this descent with this rule.”

The CMS proposal is another step in a decades-long trend, says Savage.

“Years ago, they started by broadly tracking what doctors do,” said Savage. “Through gradualism they have become more and more specific, replacing the doctor’s decision making, and instead subjecting them to glorified data entry clerks.”

‘Why The Obsession?’

Initially, health plans will be allowed to use telephone survey data, but eventually, health care providers will collect the data directly from patients, says the CMS letter.

“If CMS wants to track trends, they could perform a much more cost-effective and less intrusive survey,” said Savage. “Which makes one wonder why the obsession with forcing each doctor to collect this data, what are the unintended (or intended) consequences of this collection and what do they intend to do with the results.”

In addition to the racial factors in ratings, CMS describes several initiatives on its website to “eliminate disparities in health care quality and access.”

Bonner R. Cohen, Ph.D. (bcohen@nationalcenter.org) is a senior fellow at the National Center for Public Policy Research.

Internet info:

“Draft 2022 Call Letter for the Quality Rating System and the Qualified Health Plan Enrollee Experience Survey,” Centers for Medicare and Medicaid Services, February 2022: https://www.cms.gov/files/document/2022-call-letter-qrs-qhp-enrollee-survey.pdf

“Equity Initiatives,” Office of Minority Health, CMS: https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives

Bonner R. Cohen, Ph.D. (bcohen@nationalcenter.org) is a senior fellow at the National Center for Public Policy Research.