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Schiff Introduces Legislation Addressing Systemic Racism and Inequality in Health Care by Treating It as a Civil Rights Issue

09.29.20

Legislation Would Increase Funding and Data for Equitable Care, and Provide New Legal Rights

Washington DC – Today, Rep. Adam Schiff (D-CA) introduced the Equal Heath Care for All Act, to begin to address the systemic racism and inequality endemic to our health care system by – for the first time – treating equitable care as a civil rights issue.

This legislation would establish a legal definition of “inequitable health care,” and create a formal structure to enforce the standard. It would establish a regulatory process to investigate complaints from patients, create a private right of action for patients, and authorize the Department of Justice to conduct pattern or practice investigations based on the failure to meet the standard of equitable care. It would also establish a grant program to assist hospitals and other providers in implementing reforms to ensure equitable care, establish a permanent Federal Health Equity Commission, to study and make recommendations on health equity issues, and greatly increase the collection and reporting of greater demographic data by health providers.

The legislation is co-sponsored by Reps. Karen Bass (D-CA), Raul Grijalva (D-AZ), Barbara Lee (D-CA), Jim Cooper (D-TN), Jahana Hayes (D-CT), Ro Khanna (D-CA), Eleanor Holmes Norton (D-DC), and Mary Gay Scanlon (D-PA).  It is also supported by the National Association for the Advancement of Colored People (NAACP), the National Urban League, Families USA, and the National Hispanic Medical Association.

“As America confronts its legacy of racism and discrimination, we must recognize that in the field of healthcare, discrimination can be among the most pernicious because it is a matter of life and death. Just as Congress passed landmark legislation to prohibit discrimination on the basis of race or other protected classes in housing, employment and more, it is time to address discrimination in health care head on,” said Rep. Schiff. “We must apply a civil rights framework to healthcare, by ensuring that every patient receives equal care, regardless of the color of their skin, their ethnicity, or any other characteristic. Every life is worth saving and every American deserves equitable health care, and the introduction of the Equal Health Care for All Act is an important step towards making that a reality.”

As Dr. Martin Luther King, Jr. said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane because it often results in physical death.” Unfortunately, injustice and inequity in our healthcare system remain rampant. A 2002 review of scientific literature by the Institute of Medicine, undertaken at Congress’s request, found that, “minorities are less likely than whites to receive needed services, including clinically necessary procedures.” These effects persisted even when controlling for socioeconomic and other factors.

One need only look at the toll of the COVID-19 pandemic, and how it has been disproportionately borne by Black and Latino communities, with Black Americans approximately twice as likely to die of the disease. This systemic inequality and disparate treatment has existed long before COVID-19. The death rate for Black Americans is higher for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and homicide. Black infants have 2.3 times the infant mortality rate than white infants, and Black women are 3 times more likely to die of pregnancy-related causes. And according to the American Medical Association, white Americans spent an average of 80 minutes waiting for or receiving care, while Black Americans spent 99 minutes and Latinos 105 minutes waiting for that same care.

The Equal Health Care for All Act will:

  • Establish an Office of Civil Rights and Health Equity within the Department of Health and Human Services, strengthening the existing Office of Civil Rights;
  • Establish a legal definition of “inequitable health care;”
  • Create a complaint process where patients who believe they have suffered inequitable care by a health care provider can make a complaint to HHS, triggering an investigation;
  • Establish a private right of action for patients to bring suit in state or federal court for failure to provide equitable care;
  • Authorize the Department of Justice to investigate and bring civil actions against health care providers with a pattern or practice of inequitable care;
  • Require the Secretary of HHS to issue regulations mandating the collection and reporting of greater demographic data by providers;
  • Mandate that the failure to provide equitable care would be included as a potential cause for exclusion from payment by federal health programs;
  • Include equitable care metrics as a factor in “pay for quality” programs for hospitals;
  • Create a grant program to assist hospitals and other providers with implementing reforms intended to ensure equitable care, with priority given to disproportionate share hospitals; and
  • Establish a permanent, bipartisan Federal Health Equity Commission, to study and make recommendations on health equity issues.

“There is a growing awareness in our nation that racial health gaps are driven by inequities in systems of healthcare delivery, not just a few bad apples in the system. The National Urban League has been documenting and advocating for policies to help close these disparities for decades. Congressman Schiff’s legislation, the Equal Health Care for All, helps to identify and roll-back these systemic barriers to healthcare, while imposing much-needed accountability measures to ensure people of color have access to the care they deserve,” said Marc H. Morial, President and CEO of the National Urban League. “Modeled on the historic Civil Rights Act, this legislation gives patients a right to be treated fairly and incentives for hospitals and other providers to make necessary reforms. With the uncertain future of the Affordable Care Act before the Supreme Court and a coronavirus pandemic that has claimed the lives of more than 200,000 people, Congressman Schiff’s legislation is just what the doctor ordered.”

“NHMA applauds Congressman Schiff for introducing Equal Health Care for All Act that will support Black and Latino and other vulnerable people with grievance options to hold health systems and physicians accountable if they are found to be providing substandard quality care management based on racism or discrimination,” said Elena Rios, President and CEO of the National Hispanic Medical Association.

Click here to read the full text of the legislation.

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