The article discusses the need for clarity on concepts of health disparities and health equity. The authors provide plain language definitions along with background information. This article can be used to help community members, stakeholders, decision makers and staff understand the differences between health equity and health disparities. It is written in a non-academic voice and the concepts are easily understandable for multiple audiences.
The administration and Congress have taken a range of actions to expand access to and enrollment in health coverage. As noted, beginning in , health coverage gains stalled and began reversing. The COVID pandemic has likely further increased coverage losses as people have experienced job loss and decreases in income. In January , President Biden issued an Executive Order on Strengthening Medicaid and the Affordable Care Act , which established a Special Open Enrollment Period for the Health Insurance Marketplaces and directed federal agencies to review policies and practices to ensure they support access to health coverage.
The American Rescue Plan Act also contains provisions designed to increase access to health coverage and make health coverage more affordable. These include increases and expansions in eligibility for subsidies to buy health insurance through the Marketplaces as well as Medicaid provisions that offer incentives to encourage states that have not yet adopted the ACA Medicaid expansion to do so and provide a new option for states to extend the length of Medicaid coverage for postpartum women.
The administration also restored funding for navigators to help eligible people enroll in health coverage and increased outreach activities. These actions will particularly benefit people of color and low-income people who are more likely to be uninsured. Six in ten uninsured adults who would become eligible if all remaining states expanded Medicaid are people of color, and over seven in ten are adults living below poverty.
The administration has reversed policies implemented under the Trump administration that contributed to reduced access to health care and other programs for immigrant families. In February , President Biden issued an Executive Order on Restoring Faith in Our Legal Immigration Systems and Strengthening Integration and Inclusion Efforts for New Americans , which declared that the federal government should develop welcoming strategies that promote integration, inclusion, and citizenship.
The order directed federal agencies to review existing actions to ensure they are consistent with this policy, reduce barriers that impede access to immigration benefits, and review changes to public charge policies made under the Trump Administration, which contributed to reduced access to health care and other programs for immigrant families.
The administration subsequently took action to reverse these public charge policy changes. The Department of Homeland Security also issued a statement to clarify that all individuals, regardless of immigration status, should receive the COVID vaccines, and that it will not carry out enforcement operations at or near health care facilities, except in the most extraordinary circumstances.
The administration has launched several initiatives focused on addressing inequities in maternal health. In April , President Biden issued a proclamation to recognize the importance of addressing the high rates of Black maternal mortality and morbidity. In addition, the Centers for Medicare and Medicaid Services CMS has approved several state waivers to extend the Medicaid postpartum coverage period, a policy which will become available as a state option beginning in , under the American Rescue Plan Act.
In sum, disparities in health and health care for people of color and underserved groups are longstanding challenges. The COVID pandemic has exacerbated these disparities and heightened the importance of addressing them. Health disparities are driven by underlying social and economic inequities that are rooted in racism.
The federal government has identified equity as a priority and launched a range of initiatives to address disparities both in response to COVID and more broadly. States, local communities, private organizations, and providers also are engaged in efforts to reduce health disparities.
A broad range of efforts both within and beyond the health care system will be instrumental in advancing equity, including: prioritizing equity across sectors; providing resources to support efforts to advance equity; increasing availability of data; supporting and building on existing community strengths and resources; establishing incentives, accountability, and oversight for equity; and recognizing and addressing racism as a root cause of disparities.
Introduction The disparate impacts of the COVID pandemic, ongoing incidents of police brutality, and recent rise in Asian hate crimes have brought health and health care disparities into sharper focus among the media and public. What are health and health care disparities? Census Bureau, American FactFinder. American Community Survey. ACS demographic and housing estimates: [cited November 7]. Selected social characteristics in the United States: [cited November 7]. Total population — universe: Total population [cited November 8].
Sexual and gender minority health: What we know and what needs to be done. Am J Public Health. Chapter 1: Introduction. Department of Health and Human Services.
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