Agencies need to discuss health effects caused by the climate crisis

The Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC) are independent agencies, created in 1997 and 2009, respectively. Both are given broad authority to recommend improvements to the nation’s two health insurance programs. For example, MACPAC is charged with creating an “early-warning system” to identify factors that adversely affect beneficiary health status. 

Considering their mandate, it is remarkable neither has ever discussed, much less mentioned, the increasingly dire population health effects caused by the climate crisis.

This neglect is particularly perverse since the climate crisis disproportionately affects Medicare and Medicaid beneficiaries, or poor children and the frail elderly since federal policymakers continue to ignore the climate crisis, and since Medicare and Medicaid providers exacerbate health harm caused by the climate crisis via their own carbon or greenhouse gas emissions.

Two weeks before MedPAC and MACPAC held their December meetings, The Lancet published its 2019 “Countdown on Health and Climate Change,” appropriately subtitled, “Ensuring That the Health of a Child Born Today is Not Defined by a Changing Climate.”

The 2019 report again documented in detail, as the report states, “a world struggling to cope with the warming that is occurring faster than governments are able, or willing, to respond.”

Concerning our carbon footprint, the carbon intensity of the world’s energy system remains unchanged over the past 30 years — disproportionately the result of U.S. greenhouse gas emissions, historically the most significant and today second only to China. 

This is particularly troubling when you realize more than half of all industrial greenhouse gas emissions have been released over this same period.

The Countdown report also found fossil fuel subsidies increased, not decreased, to $427 billion in 2018, an increase of 50 percent in the past three years, and carbon pricing in 2018 covered only 13 percent of global greenhouse emissions with U.S. carbon pricing averaging a trivial $1 per ton. 

Concerning health, the Countdown report concludes, “the emerging health impacts and the lack of a coordinated global response portray a bleak picture.” Bleak, in part, because ambient air pollution, principally driven by burning fossil fuels, is presently the cause of 65,000 U.S. and seven million global deaths annually. (More than 90 percent of children worldwide breath air that does not meet World Health Organization standards).

Hundreds of millions more are adversely affected by climate crisis-related heart, kidney and lung disease, numerous water- and vector-borne diseases, mental health sequelae, and declines in both the quantity and nutritional value of significant foodstuffs. 

The most harmed are again Medicaid and Medicare beneficiaries. “The life of every child born today,” the report concluded, “will be profoundly affected by climate change.” As for the Medicare population, which will double to 88 million by 2050 (over 20 percent of whom will be 85 or older), the report notes they are particularly vulnerable to heat extremes and resultant degraded air quality.

Philip Alston, the UN Special Rapporteur on Extreme Poverty and Human Rights, best summed up this reality when he concluded in his June “Climate Change and Poverty” report, “Climate change is, among other things, an unconscionable assault on the poor.” 

The “lack of a coordinated global response” was most recently made evident by the recently concluded United Nation’s Paris climate accord-related meeting held in Madrid, termed COP 25. The meeting ended in abject failure.

Substantially due to U.S. recalcitrance, COP 25 did not reach agreement on, for example, rules for international carbon trading and a mechanism to compensate developing countries for climate crisis-related events caused by industrialized countries. 

This conclusion was likely predictable since the U.S. intends to withdraw from the Paris accord in 2020. The Trump administration has also reversed several federal regulations, including power plant and tailpipe emissions designed to limit greenhouse emissions. These actions can be understood when you realize that in 2017 the administration admitted that global temperatures would rise by 4°C absent drastic measures.

Or when you read the Department of Justice’s opening brief in Juliana v. the U.S., a case filed in 2015 by 21 children and young adults claiming a constitutional right to a survivable climate.

The Justice Department argued this past February that the plaintiffs have no fundamental right to “a climate system capable of sustaining human life,” because, “the state of the climate . . . is a public and generalized issue having no connection to personal liberty or personal privacy.” 

As for the Congress, the House had heard committee testimony this year that carbon concentrations were last this high three million years ago when the planet was 2°C to 3°C warmer, sea levels were 75 feet higher, and beech trees grew in Antarctica.

Nevertheless, House Speaker Pelosi (D-Calif.), whom mockingly termed the Green New Deal the Green Dream, refuses to bring a carbon bill, for example, HR 763 that proposes a carbon tax with revenues paid out to the taxpayer, to the House floor if for no other reason than to put Republicans on record for voting against maintaining life on earth. 

As for the health-care industry, the Countdown report found it was responsible in 2016 for 4.6 percent of total global carbon emissions with U.S. health care accountable for one-third.

U.S. health-care industry emissions that have increased by 30 percent over the past 10 years are now responsible for approximately 10 percent of total U.S. emissions, or second only to the food industry.

Researchers in 2016 estimated the indirect health burden caused by the industry’s emissions is commensurate with upwards of 98,000 U.S. deaths annually. Worth considering is how many additional deaths are caused globally by U.S. health care industry emissions and what number of deaths could be avoided if the one-third of industry activities considered wasteful were eliminated.

To add insult to injury, researchers more recently have found the U.S. health-care industry “lags far behind” other industries in publicly reporting their greenhouse emissions. This, too, is unsurprising when you consider a recent America’s Essential Hospital’s survey.

Though these hospitals disproportionally serve Medicare and Medicaid beneficiaries, over three-quarters of survey respondents reported having made no formal commitment to climate resilience, defined as merely responding to crisis impacts. 

The earth is rapidly warming to 2°C and to a threshold where feedback loops, for example, the albedo effect, will cause temperatures to increase unabated or despite reductions in greenhouse emissions. This will create millions of premature deaths in the U.S., a disproportionate number of whom will again be Medicaid and Medicare beneficiaries.

Though MedPAC and MACPAC should have begun addressing the climate crisis decades ago, at the minimum, they should immediately recommend providers rapidly reduce their carbon footprint under regulations governing Medicare and Medicaid conditions of participation. 

David Introcaso, Ph.D., is the vice president of regulatory policy at Strategic Health Care. He spent several years working in the U.S. Department of Health and Human Services as the evaluation officer for the Agency for Healthcare Research and Quality (AHRQ) and as a public health analyst at DHHS in the Office of Assistant Secretary for Planning and Evaluation (ASPE).