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Thursday, August 4, 2016

Federal Health Equity Bill Offers a Model for States

Ben D'Avanzo

Special Projects Manager

A new bill offers a vision for what Congress could achieve if it were truly committed to ending health disparities. In the current political environment, we don’t anticipate Congress will act any time soon on the Health Equity and Accountability Act of 2016 (HEAA), sponsored by Rep. Robin Kelly of Illinois.  

But in the meantime, health equity advocates can look to the HEAA for ideas about concrete policy solutions they could potentially pursue through other avenues, including state legislative or regulatory action.  

HEAA addresses health disparities holistically

There is no magic bullet for addressing racial and ethnic health disparities comprehensively. For example, despite the enormous progress achieved through the Affordable Care Act, blacks and Hispanics continue to be more likely to be uninsured than whites, are less likely to have a regular doctor, and had lower confidence in their ability to afford their medical costs.

And health care is just the tip of the disparities iceberg.  The root causes of why communities of color are sicker than whites in the first place are multiple, complex, and reach deep into communities.   Because health outcomes are influenced by many determinants, improving them requires advancing a variety of strategies and working on multiple fronts.

Here is where the HEAA helps. Taken together, the 10 titles of the HEAA offer a snapshot of the primary areas where we need improvements:

  1. Improving data collection so that health disparities can be better identified and targeted
  2. Ensuring that patients receive culturally and linguistically appropriate care
  3. Improving the diversity of the health care workforce
  4. Expanding access to health insurance and providers
  5. Addressing disparities faced by women and children
  6. Improving the quality of and access to mental health services
  7. Advancing research into diseases that disproportionately impact minorities, such as HIV/AIDs, diabetes, and cancer   
  8. Strengthening Health Information Technology that benefits minority communities
  9. Ensuring the government invests in research evaluation and accountability around disparities
  10. Addressing environmental and other social determinants of health

To learn about specific policy solutions that would lead to progress in these areas, we encourage advocates to delve into the individual sections of the bill. Many of HEAA’s provisions could serve as models for policies that states or localities could implement.

HEAA contains ideas for tackling health disparities in health coverage   

For example, some of the provisions below could inspire similar measures that would apply to state’s insurance markets. The following list represents the new ideas for addressing disparities in access and coverage that Families USA, working with the HEAA community working group, contributed to the bill:

  • Require qualified health plans (QHPs) in the marketplaces to provide information on the languages that their providers speak. States could require this in their ACA marketplace, or even better, for all health plans regulated by the state’s insurance department.
  • Require QHPs to contract with at least 90 percent of Federally Qualified Health Centers and at least 75 percent of all other essential community providers in their service area. This could be applied to all health plans in the state.
  • Require network adequacy standards for QHPs and Medicaid plans. These standards would cover appointment wait times, travel times, hours of operation, and other standards to ensure diverse communities can access providers. If a plan cannot meet these standards, it must allow consumers to go out of network at no extra cost.
  • Address oral health disparities by adding oral health coverage in QHPs (or all health plans) and Medicaid for people of all ages, requiring studies on utilizing dental therapist programs to address dental shortage areas, expanding tribal access to dental therapists, and other ideas proposed in the Comprehensive Dental Reform Act.

What advocates can do about the HEAA

Besides asking members of Congress to cosponsor the Health Equity and Accountability Act of 2016, advocates can advance the goals of HEAA in two ways:

First, use HEAA as a toolbox for ideas in your own state. Are there pieces of the legislation that you can bring to your state legislators as a model for your state? Go through the bill’s titles for inspiration.

Second, let us know if there are successful programs combatting health inequities in your state. The text of the HEAA is improved every Congress, so we’d love to know what new ideas we should be suggesting for inclusion. Contact us at and tell us about the successful programs or policy changes that are making a difference in health disparities in your community.