Two Years of Much-Needed Progress on Health Equity

It’s been a banner two years for acronyms—and legislative and regulatory progress. From the ARP (American Rescue Plan) to the CHIPS and Science Act and IIJA (Infrastructure Investment and Jobs Act), there have been significant advances in economic recovery, infrastructure, and climate change. Under these marquee headlines, however, there has been significant progress on improving equity in health care. As we move into the new year and new Congress, let’s take stock of some of the major moves Washington made across health care.

Lowering Health Care Costs

In 2020, Democrats campaigned on lowering costs because there was an overwhelming belief among Americans that health care costs too much. As we have written, the high cost of health care is one of the leading reasons why people don’t seek out medical care. For Hispanic and Black people, costs are an even bigger barrier.

The first two years of the Biden Administration delivered on reducing costs. In the American Rescue Plan, and then again in the Inflation Reduction Act, Democrats expanded cost caps for Americans getting their health insurance through the Affordable Care Act (ACA) exchanges. A record 14.5 million people signed up for health insurance through the ACA in 2022, and 90% could find plans that cost less than $10 a month, with low-income families being the main beneficiaries. The Biden Administration also fixed the family glitch in the ACA, where middle- and low-income families with employment-based coverage had been exposed to high insurance premiums. This will reduce health care costs by $4,152 for a family of four with employment-based coverage and an income of $53,000.

Lowering prescription drug costs has long been a priority for Americans. The Inflation Reduction Act allowed Medicare to negotiate better prescription drug prices and capped insulin co-payments at $35 a month. This particularly helps those with chronic health conditions who often rely on medication to live a good and healthy life.

The American Rescue Plan provided a 100% COBRA subsidy for people who lost their health insurance because of involuntary job loss during the pandemic, increasing cost protections and access to medical care during a vital public health crisis.

Improving Maternal Health Care 

The United States is currently facing a maternal mortality crisis, with a maternal death rate more than three times the rate in most other high-income countries. Many members of Congress, led by trailblazing Black Congresswomen like Rep. Lauren Underwood (D-IL) and Rep. Alma Adams (D-NC), have made this issue a top priority—launching the Black Maternal Health Caucus in 2019 and pushing a Momnibus package of bills. While Congress wasn’t able to pass the Momnibus, they still made significant investments in maternal health care.

The maternal mortality crisis has hit Black women and women of all races/ethnicities in rural areas especially hard as rural hospitals continue to close their maternity wards or close all together. Many women find themselves choosing between going to work or driving a few hours to the closest obstetric provider, often depriving them of vital medical care. To address this, Congress passed Sen. Tina Smith’s (D-MN) Rural Maternal and Obstetric Modernization of Services (MOMS) Act in the 2022 omnibus bill. The Rural MOMS Act took a number of steps to improve rural maternal health with improved data collection, increased funding for rural care grants, expanded maternal telehealth resources, and broadened training opportunities for healthcare professionals in maternal health. The omnibus included the Maternal Health Quality Improvement Act, which established grant programs to improve maternal health outcomes and bias training. The bill also included Sen. Kirsten Gillibrand (D-NY) and Rep. Katherine Clark’s (D-MA) Into the Light for Maternal Mental Health and Substance Use Disorders Act, which reauthorized a grant program to improve maternal mental health care, including a permanent hotline that provides voice and text support from licensed professionals for patients and their families.

In the American Rescue Plan, Congress allowed states to extend Medicaid and CHIP postpartum coverage to up to one year after pregnancy; 27 states did just that, with seven more states planning to follow suit. Congress made the extended postpartum coverage option permanent in the 2022 omnibus bill. Originally, Medicaid was only required to provide coverage through 60 days after birth, contributing to high maternal mortality rates, especially among Black women and women of color. Making postpartum care more accessible will mean better maternal and infant health outcomes.

The Department of Health and Human Services (HHS) also awarded over $20 million in grants to improve maternal and infant health. Funding was allocated to programs that support community-based doulas, rural obstetric care, new state task forces to tackle maternal health disparities, and investments in infant health equity. 

Expanding Health Care in Rural and Underserved Areas

Health care access in many rural and urban areas has been lacking for decades, resulting in hour-long commutes or skipped doctor’s visits. Access only continues to decline as rural hospitals and medical practices close their doors. In light of that, we saw important investments in the past two years to expand access in rural and other underserved areas.

Congress passed the Maximizing Outcomes through Better Investments in Lifesaving Equipment (MOBILE) for Health Care Act, which allowed community centers to use federal funds to establish mobile health care delivery sites. This will greatly improve access in rural and underserved areas as doctors will be able to meet patients where they are, making it less burdensome and time-consuming to get care.

Millions of dollars were also allocated to rural health care grant programs. Nearly $46 million from the American Rescue Plan was awarded to expand health care capacity in rural and tribal communities through health care job development, training, and placement. Another $10 million will help establish new medical residency programs in rural communities to increase the number of physicians training. Another big issue in rural areas is the lack of primary care doctors, compared to specialized ones. HHS announced over $155 million to expand training programs specifically for primary care residents in rural and underserved communities.

Investing in Equity

Congress and the Administration also took action on a number of other barriers to health equity, from improving language services to data collection. For example:

• Congress passed the John Lewis NIMHD Research Endowment Revitalization Act, which provides grants for schools conducting research into minority health disparities.
• The American Rescue Plan awarded $90 million to community health centers to improve data collection and reporting, often a big barrier to health equity.
• Congress allocated $4 million in grants for organizations to develop and test methods to increase uptake of language access services in health care, making it more accessible to non-English speakers.
• Congress allotted $5 million to improve access to cancer screenings for underserved populations, who often see lower rates of screenings and catching cancer early.
• Congress also appropriated $256.6 million to expand and restore access to Title X family planning services after cuts made during the Trump Administration. Title X provides affordable reproductive and preventive care, including cancer screenings, contraceptive counseling, and STI testing, to low-income and uninsured individuals. This is more important than ever now due to the overturn of Roe v. Wade.
• HHS instituted a rule that prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in health programs receiving federal funding.
• And the Department of Homeland Security (DHS) reversed the public charge rule from the Trump Administration. This means noncitizens can access government programs like Medicaid and SNAP without fear of jeopardizing their immigration status.

Congress and the Administration have made significant progress on health equity over the past two years. Let’s continue that momentum into this new Congress and beyond.