Why It Matters
For roughly 3.7 million Medicare beneficiaries, the mailbox is the pharmacy. A Brookings Institution commentary submitted into the congressional record by Rep. Kweisi Mfume (D-MD) during a House Oversight subcommittee hearing on June 4 argues that ongoing U.S. Postal Service operational reforms are quietly becoming a public health problem, one that Congress has yet to fully price. USPS is restructuring to survive financially, but the communities bearing the cost of slower postal service prescription delivery are the same ones with the fewest alternatives.
The Big Picture
The Delivering for America (DFA) plan, launched in 2021 under Postmaster General Louis DeJoy, extended delivery standards for some first-class mail, consolidated processing into regional hubs, and reduced mail pickup frequency. The goal was financial stabilization after years of declining mail volumes and mounting costs.
The Brookings commentary, authored by Elena Patel with co-authors Josh Feng and Matthew Higgins, finds the tradeoffs are uneven. About 6 percent of all asthma and diabetes prescriptions nationwide are filled by mail. Medicare beneficiaries living 10 miles away from a pharmacy are approximately 20 percent more likely to rely on mail-order pharmacy services. Mail-order programs are also associated with 30 to 40 percent higher medication adherence rates compared to retail pharmacy use.
When USPS delivery slows or becomes unreliable, those adherence gains erode. The research links delivery disruptions to higher rates of emergency department visits and hospitalizations, costs that don’t appear on USPS’s balance sheet but land squarely on Medicare and Medicaid.
The report identifies what it calls “triple-burdened” communities, which are areas with limited pharmacy access, high mail-order reliance, and direct exposure to postal network changes under the DFA plan. Those communities are concentrated in Appalachia, the rural South, the Upper Midwest, and parts of the Mountain West. Approximately 3.7 million Medicare beneficiaries live in these zones.
The subcommittee hearing, chaired by Rep. Pete Sessions (R-TX) with Mfume serving as ranking member, was titled “The Route Forward for the U.S. Postal Service: A View from Stakeholders” and included testimony from Postal Regulatory Commission commissioners.
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