Health Equity and Accountability Act Introduced

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Sen. Mazie K. Hirono (D-Hawai‘i) introduced S. 3660, the Health Equity and Accountability Act (HEAA) of 2018 on Wednesday, Nov. 28, 2018.

HEAA lays out a comprehensive roadmap to address health disparities among racial and ethnic minorities, the LGBTQ community, rural populations and socioeconomically disadvantaged communities.

“Minority communities and other traditionally underserved populations have faced healthcare disparities for decades, and we have a long way to go to ensure that these communities have equal, affordable access to culturally competent healthcare services,” Sen. Hirono said. “HEAA lays out a bold blueprint to deliver on the idea that quality, affordable healthcare is truly a right for all and not a privilege reserved for some. I thank my Senate and House colleagues, and the hundreds of advocacy groups who support HEAA for their work to ensure that all Americans can access and afford the care that may save their lives.”

The Health Equity and Accountability Act is cosponsored by Sens. Tammy Duckworth (D-Illinois), Ben Cardin (D-Maryland), Kamala Harris (D-California), Cory Booker (D-New Jersey), Jeff Merkley (D-Oregon), Tim Kaine (D-Virginia), Richard Blumenthal (D-Connecticut), Kirsten Gillibrand (D-New York), and Sherrod Brown (D-Ohio). Rep. Barbara Lee (D-California) introduced the bill’s House counterpart, H.R.5942, in May 2018 and HEAA is supported by over 300 advocacy groups.

“We commend Sen. Hirono, Congresswoman Lee and the Congressional Tri-Caucus for their leadership and commitment to putting us on a path toward health equity,” Kathy Ko Chin, president and CEO of the Asian & Pacific Islander American Health Forum said. “Now more than ever, HEAA is needed to both build upon the historic reforms achieved by the Affordable Care Act and to look beyond them to truly create a more equitable health system for our nation.”

HEAA has been introduced in every Congress since 2007. The bill’s many policies are organized under ten titles aimed at effectively addressing health disparities and barriers to access that disproportionately affect minority communities:


Title I: Data Collection and Reporting

Currently, standard methods for collecting data do not fully capture the experiences of communities of color and other vulnerable populations. Without accurate data, healthcare policy decisions unintentionally exclude several communities, including Asian Americans and Pacific Islanders, sexual and gender minorities, and rural communities. To address this fundamental problem, Title I requires data to be reported in a way that can be used to address health disparities and participation in health programs, housing, and nutrition. More specifically, Title I also includes a provision to develop and implement a national strategy for identifying and evaluating the health status and needs of Native Hawaiians and Pacific Islanders.

Title II: Culturally and Linguistically Appropriate Health and Healthcare

Access to quality healthcare and providers are essential to addressing health disparities. Communities of color, people with limited English proficiency, and other minorities often experience challenges seeking care with providers that do not share their backgrounds, do not speak their language, or may lack appropriate cultural sensitivity to the experiences of minority patients. Title II outlines concrete steps to ensure patient access to high quality care by enhancing language access services and providing better information and training on cultural competency to providers. More culturally and linguistically appropriate care will empower patients to access high quality care.

Title III: Health Workforce Diversity


Title III focuses on improving the diversity of the health workforce through grants for training underrepresented minorities and providers that treat under-served populations. Title III establishes several scholarship and fellowship programs, including the Patsy Mink Health and Gender Research Fellowship program, which awards research fellowships to post-baccalaureate students to conduct research examining gender and health disparities. This title also provides additional supports for workforce development through loan forgiveness and other training programs.

Title IV: Improving Healthcare Access and Quality

Despite progress made through the Affordable Care Act, healthcare access for minority communities remains a problem in the U.S. Immigrant communities are particularly disadvantaged because under current law they are excluded from public healthcare and other social programs. Title IV will expand healthcare access by allowing immigrant communities to qualify for the Affordable Care Act’s premium tax credits and cost-sharing reduction payments, as well as allowing lawfully present individuals to qualify for Medicare. It also provides support for the improvement of rural hospitals and health services, for example, through the expansion of telehealth services in Medicare including across state lines. HEAA would also incorporate health equity into quality payment programs in Medicare and Medicaid to ensure that progress being made to improve health quality improves care for everyone. Finally, Title IV would restore access to Medicaid for Compact of Free Association (COFA) communities.

Title V: Improving Health Outcomes for Women, Children and Families

Title V addresses barriers that disproportionately prevent access to healthcare and nutrition services for minority women, children, and other marginalized communities. This title includes several provisions to improve maternal mortality and maternity health outcomes and increase diversity in the maternity healthcare profession. Title V also calls for the development of medically accurate, age appropriate sex education, as well as emergency contraception education and information programs.


Title VI: Mental Health

Mental health services and treatments are still heavily stigmatized in communities of color. To help expand the understanding and participation of mental health services, Title VI seeks to address social barriers by investing in proper provider training, research on mental health disparities, promotion of mental health among minority populations, and by providing mental health services in schools.

Title VII: Addressing High Impact Minority Diseases

Racial and ethnic minority populations experience higher rates of many chronic illnesses, including cancer, viral hepatitis and liver cancer, bone marrow disease, cardiovascular disease, HIV/AIDS, diabetes, lung disease, osteoarthritis and musculoskeletal diseases, sleep disorders, and sickle cell. Title VII outlines steps to ensure programs take into consideration patients of color and diseases that disproportionately affect minorities, such as sickle cell and Hepatitis B. Additionally, this title calls for an increase in federal resources for research, prevention, and treatment of those diseases.

Title VIII: Health Information Technology

As health information (IT) technology becomes more ingrained in our healthcare system, it provides an opportunity to reduce health disparities through improved data collection. Title VIII extends funding for health IT in communities with racial and ethnic minorities so that health IT helps to identify and ultimately eliminate health disparities.

Title IX: Accountability and Evaluation

This title focuses on oversight of federal agencies and programs to ensure the progress and accuracy of work to address health disparities continues and that civil rights in healthcare are protected.

Title X: Addressing Social Determinants and Improving Environmental Justice

The environment, housing, school, and nutrition all have a significant influence on a person’s health. Efforts to address health disparities must also address these “social determinants of health.” Title X establishes grants and provides coordination with non-health agencies including the Department of Housing and Urban Development, Department of Transportation, Department of Agriculture, and Environmental Protection Agency to study and address these social determinants of health.

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