Pervasive Inequality in the Health Care System Sustains Discrimination and Poor Health Outcomes
Our lawyers and policy analysts stand up for the civil rights of the millions of people who struggle to access affordable, quality health care. The National Health Law Program integrates civil rights into all of our substantive work—advocacy, litigation, and research—and all of our program areas. We work to ensure that people of color, people with disabilities, those with limited English proficiency, women, and LGBTQ people can achieve their fullest health potential. As stated in our Equity Stance, NHeLP works towards a society where everyone can achieve an optimal state of well-being and where everyone has a fundamental right to their highest attainable standard of health.
Over our 50-year history, our civil rights work includes:
- Filing litigation challenging implementation of Medicaid managed care programs that were discriminating on the basis of race, and in more recent cases, on the basis of disability
- Filing litigation that resulted in revisions of racial classifications for data collection purposes. Before the case, the classifications consisted of only “white, black, other.” Our advocacy has helped to debunk the longstanding myth that federal law prohibits race, ethnicity and language data collection, which led to a greater recognition of the need for data and standards for collecting data.
- Publishing extensive analysis of federal revisions to laws affecting immigrants’ eligibility for Medicaid, including taking a leading national voice on immigrants’ access to Medicaid coverage for emergency medical conditions;
- Assisting in crafting the Affordable Care Act’s landmark nondiscrimination and data collection provisions.
- Filing a first-in-time complaint to enforce the ACA nondiscrimination provision that stopped insurers from using drug pricing practices that discouraged people with HIV/AIDS from enrolling.
See our webpage on Disability Rights for more information on our civil rights work on behalf of individuals with disabilities.
Health equity is the presence of opportunity for each person to be as healthy as possible regardless of their identity or circumstances. Health equity is achieved when a person’s characteristics and circumstances — including race and ethnicity, sex, gender identity, sexual orientation, age, income, class, disability, health, immigration status, nationality, religious beliefs, language proficiency, or geographic location — do not predict their health outcomes. Health disparities are gaps in health outcomes driven by differences in race, gender, income, socioeconomic status, sexual orientation, ability, English proficiency, immigration status, and geographic location, among other issues. Put another way, health equity is the absence of health disparities.
The National Health Law Program believes that health equity is a moral imperative and basic human right. As an organization, National Health Law Program strives to achieve health equity by building systems that eliminate discriminatory barriers to health, disrupt harmful stereotypes, promote health equity, support people who may be experiencing difficult circumstances, and by advocating for national and state health care systems to remedy the harms caused by health disparities.
For example, racism and racial bias in health care have contributed to a national crisis of maternal mortality for women of color. The rates of maternal morbidity and mortality for Black women and Indigenous women are particularly high. Notably, these racial disparities in maternal mortality rates exist regardless of income, age, and education. In response, National Health Law Program is:
- Helping lead work in California on legislation providing Medicaid coverage for doula care, which can reduce the impacts of racism on pregnant women of color by helping them seek and advocate for culturally appropriate, patient-centered care;
- Assisting advocates and legislators seeking ways to curb the rising maternal mortality rates through legislation at both the state and national levels;
- Creating and disseminating publications on Using the Affordable Care Act and Other Opportunities to Address Maternal Mortality and Maternal Mortality Review Committees: Step-by-Step Analysis and Action.
Communities of color, low-income individuals, women, immigrant communities and other underserved populations experience health and health care disparities caused by factors such as high health care and insurance costs, difficulties accessing linguistically and culturally competent care, and implicit and explicit bias. In addition, low-income and minority communities systematically have higher exposure to health threats and worse health outcomes. The U.S. also has the second-largest reported disparity for people deciding not to seek medical treatment because of cost. Disparities like these hit especially hard on minority populations.
- Submitted an amicus brief in NFIB v. Sebelius, and cited by Justice Ruth Bader Ginsburg, to help protect the Affordable Care Act’s Medicaid expansion, a key coverage provision that supports communities of color and has reduced disparities in health coverage. In its first year after implementation, the ACA reduced the uninsurance rate for non-Hispanic white individuals by 21.6%, but had even more dramatic results for black individuals, reducing their uninsurance rate by 25.8%. Since the NFIB decision, NHeLP has also worked to support efforts to promote Medicaid expansion in states and improve application and enrollment systems for Medicaid expansion and other insurances that help communities of color.
- Successfully advocated to include enhanced funding for states paying for language services in Medicaid and CHIP, enabling more states to provide funding and more beneficiaries to have access to effective communication with their healthcare providers.
- Wrote and co-sponsored successful contraceptive equity legislation in California to close the gaps and disparities in access to services. Legislation has been replicated in Maryland and Vermont, with other states following suit.
- Submitted at amicus brief in United States v. California (2018) to highlight the positive public health impacts of California’s sanctuary state laws on immigrant communities in the state.
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