In letters to NASEM, HHS, ACP makes recommendations for addressing federal policies that contribute to health inequities, comments on proposed rule regarding nondiscrimination in federal health programs
Nov. 4, 2022 (ACP) — The American College of Physicians is championing nondiscrimination through input provided on several key diversity, equity and inclusion efforts currently underway by the National Academies of Sciences, Engineering and Medicine and the U.S. Department of Health and Human Services (HHS).
“Diversity, equity and inclusion is a key priority of the College, and centering health equity is a central tenant of our policy and advocacy work,” said Josh Serchen, ACP associate for health policy. “As an organization representing frontline physicians who observe the social and health inequities our marginalized patients experience on a daily basis, the College believes efforts to address these inequities must be a priority and applauds federal agencies and other organizations for undertaking efforts to begin to systematically understand and address this evergreen issue.”
Marginalized populations have experienced persistent, preventable and unjust differences in health outcomes and health status for decades, and the National Academies of Science, Engineering and Medicine established a committee to investigate federal policies that contribute to racial and ethnic health disparities and inequities and issue recommendations to address these policies and improve racial and ethnic health equity.
To that end, ACP provided the National Academies with detailed comments highlighting the federal policies contributing to racial and ethnic health disparities as identified in several policy papers in recent years, Serchen said. In a letter to the National Academies about these policies, ACP called for Medicaid eligibility expansion in all states plus action to address disparities in upstream social drivers of health that perpetuate health inequities. In addition, ACP supports universal health coverage, either through a single-payer or public choice model, to address the underlying racial and ethnic disparities in comorbidities that increase the risk for negative health outcomes.
They also write that federal policy should support the maintenance, reinstatement and expansion of programs that provide outreach to encourage racial and ethnic-minority enrollment in medical and other health professional schools, including diversity/minority affairs offices, scholarships and other financial aid programs.
Section 1557 of the Affordable Care Act prohibits discrimination based on race, color, national origin, age, disability or sex in covered health programs or activities that receive federal funding, explained Serchen.
“It is illegal for these covered entities who receive federal funds to exclude participation by, deny benefits to, or otherwise discriminate against individuals based on these protected personal characteristics,” he said.
Now, a new proposed rule from the HHS seeks to expand the regulations implementing Section 1557 by restoring the definition of discrimination based on sex to encompass sex stereotypes; sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; and gender identity.
“This proposed rule would align federal health care anti-discrimination policy with the recent Supreme Court ruling in Bostock v. Clayton County, which found that discrimination based on sexual orientation and gender identity constitutes sex discrimination under Title VII of the Civil Rights Act of 1964,” Serchen said. “It also requires covered entities to take reasonable steps to provide meaningful access to each limited English proficient individual eligible to be served or likely to be directly affected by the program or facility.”
In a letter to HHS, ACP stressed that this is an important step to ensure that marginalized populations have equitable access to the health care system and urged HHS to finalize it.
Serchen said everyone can do something to help prevent discrimination based on race, color, national origin, age, disability or sex. “ACP encourages members to become educated on the sources of these inequities, screen patients for social drivers of health that may contribute to health disparities and familiarize themselves with community supports and resources available to address patients' health-related social needs,” he added.