Prepared for the Study Panel on Sharpening Medicare’s Tools to Reduce Racial and Ethnic Disparities National Academy of Social Insurance By

Medicare has substantially narrowed racial and ethnic disparities in health care, most dramatically in its first year when Medicare was responsible for desegregating the nation’s hospitals—virtually ending this most visible form of health care discrimination in a year’s time. Over nearly four decades, racial and ethnic gaps in utilization of health care services and quality of care provided to Medicare beneficiaries have been reduced, not eliminated. This paper provides an inventory of programs and initiatives implemented by the Centers for Medicare and Medicaid Services to reduce remaining disparities in the Medicare program. These include efforts to: (1) develop culturally appropriate education and outreach; (2) measure and reduce clinical health care disparities through beneficiary and provider-focused interventions; and (3) enhance providers ’ cultural competency. The paper describes the initiatives, the disparities they seek to reduce, efforts to evaluate them, and their actual and potential impact to reduce disparities both locally and nationally. The central finding is that, despite successes in some areas, ongoing efforts have had limited reach and limited impact on racia