• In The Trenches

    We’ll Take Every Opportunity to Push for Real Health Equity

    A few weeks ago, following up President Joe Biden’s initial clutch of executive orders in late January — including several that delivered wins to family medicine — the Office of Management and Budget called for information to help the federal government advance equity through policy.

    health equity written in sky

    The Academy answered with a lot of information.

    In fact, last month brought a few opportunities for us to remind regulators and lawmakers that current health inequities and their consequences are clear — and that they await a basic corrective: stronger primary care.

    “Investing in primary care is an essential strategy to achieving health equity,” the AAFP said in its 15-page June 23 letter to OMB Acting Director Shalanda Young. “Evidence confirms primary care mitigates health disparities and improves patients’ access to and utilization of low-cost, high-value care that ultimately results in better patient outcomes and population health.”

    We backed up that “evidence confirms” part with four studies. Numerous others point to the same conclusion. Our position here isn’t just well supported. It’s heavily fortified.

    In offering our detailed recommendations to the administration, we urged an approach to policymaking that integrates primary care with public health and called for investment in equitable, affordable access to comprehensive primary care. And we indicated that policymakers and physicians alike must scale up their attentiveness to the social determinants of health and other factors that affect patients’ health, including systemic racism. (This is why the Academy developed its EveryONE Project.)

    Our advocacy in the letter included calls for

    • swift FDA rulemaking and implementation of its ban on the manufacture and sale of menthol cigarettes and flavored cigars;
    • improved Medicaid payment rates and a reduction of the significant administrative burdens associated with Medicaid billing, which create barriers to health care access for enrollees in that program;
    • the reversal of recent regulatory changes weakening network adequacy requirements for Medicaid and Children’s Health Insurance Program managed care programs;
    • expansion of graduate medical education training opportunities in underserved and low-income areas to diversify the physician workforce;
    • improved accountability for federal GME payments to correct the historic maldistribution of federal GME financing;
    • permanent authorization and expansion of the Teaching Health Center Graduate Medical Education program; and
    • removal of the National Health Service Corps’ funding cap for individuals and reinstatement of the goal of zero disparities in health care due to race, class, income, geography, language or immigration status.

    With the same health equity imperative in mind, the Academy also wrote June 23 to Reps. Barbara Lee, D-Calif.; and Ayanna Pressley, D-Mass.; and Sen. Elizabeth Warren, D-Mass., in support of the Anti-Racism in Public Health Act of 2021 (S. 162/H.R. 666).

    As the Academy has sought, the legislation would direct the CDC to declare racism a public health crisis. This bill would also direct the CDC to establish a Center on Antiracism and Health and a law enforcement violence prevention program.

    “The compound intergenerational effects of structural racism, discrimination and discriminatory policing affect health outcomes, including fetal health, and into childhood and adulthood, making early interventions and resources critically important,” said the Academy and its co-signatories, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians and the American Psychiatric Association.

    The Academy also shared its health equity insights with the House Committee on Energy and Commerce’s Subcommittee on Health ahead of a June 23 hearing titled “Empowered by Data: Legislation to Advance Equity and Public Health.” In a letter to Reps. Anna Eshoo, D-Calif.; and Brett Guthrie, R-Ky., the subcommittee’s chair and ranking member, respectively, we noted that family physicians “can mitigate health inequity, including systemic racism, by collaborating with community stakeholders to affect positive change for the populations they serve.”

    To maximize that impact, the AAFP said, Congress should pass several important bills, including the Anti-Racism in Public Health Act and

    • the Improving Social Determinants of Health Act of 2021 (H.R. 379), which would create a new SDOH program at the CDC;
    • the Data to Save Moms Act (H.R. 925) and the Social Determinants for Moms Act (H.R. 943) (components of the Black Maternal Health Momnibus package, which the AAFP backs);
    • the Ensuring Transparent Honest Information on COVID-19 Act (H.R. 976), mandating transparency in COVID-19 data reporting;
    • the Social Determinants Accelerator Act of 2021 (H.R. 2503), which would give states new tools to develop and implement strategies to improve health outcomes for Medicaid beneficiaries; and
    • the Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants of Health Act of 2021 (H.R. 3894), which would direct HHS to issue guidance to states clarifying SDOH strategies under the Medicaid and CHIP programs.

    We also aired these priorities in a June 3 letter welcoming new CMS Administrator Chiquita Brooks-LaSure to her role. “We look forward to partnering with you to strengthen Medicare, Medicaid and marketplace coverage; build a robust primary care workforce; expand primary care alternative payment models; and reduce physicians’ administrative burdens,” the Academy wrote.

    We do indeed look forward to that partnership and others. We also mean to lead the way.

    Stephanie Quinn is senior vice president of advocacy, practice advancement and policy.


    The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.