How We Are Shaping Federal Policy to Drive Health Equity

Through the public comment process, we are working to ensure that our laws and policies give everyone—regardless of race, ethnicity, gender, class, or disability—a fair and just opportunity to reach their best health and wellbeing.

We can all agree that our families, our communities, our economy, and our country are stronger when everyone can access quality healthcare without barriers. The laws Congress passes can expand this access, but how well these laws work depends on the rules and regulations that federal agencies create to implement them. Through the federal rule making process, the public has an opportunity to comment on proposed rules before they become final to make sure they fit the needs of the people they will affect.

These comments can make a serious difference. The perspectives of communities can help policymakers better understand how to write and implement the law. Comments can also be protective—research shows that when federal rules are responsive to public comments, courts are less likely to overturn them. Following a recent Supreme Court decision that made federal rules more vulnerable to legal challenges, it’s more critical than ever for the public to weigh in and share how policies will impact their health and their lives. 

To advance our mission of dismantling structural barriers to health that deny too many the care they need, RWJF has offered comments on five proposed rules that have been finalized in recent months. Each time we provided detailed analysis with one purpose: to make our healthcare system work better for everyone.

We shaped our comments to fully support people eligible for Medicaid and the Children’s Health Insurance Program (CHIP), immigrants, people with disabilities, those seeking reproductive healthcare, lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) people, and others. These five rules, which the U.S. Department of Health and Human Services (HHS) finalized this year bring the country closer to a future where health is not a privilege for some, but a right for all.

1.   Streamlining Medicaid and CHIP Enrollment and Eligibility

Navigating the Medicaid and CHIP enrollment process can be overwhelming for those who have faced systemic racism. Historically, Medicaid eligibility rules in many states reflect racist concepts of “deservingness,” making it harder for people to get or keep the coverage that they are eligible for. While the Affordable Care Act (ACA) eased some of these burdens in the Medicaid program, many states have not simplified their enrollment processes, perpetuating racial inequities.

The Centers for Medicare and Medicaid Services (CMS) finalized a federal rule in April 2024 to change this. Without this rule many have had to overcome barriers like in-person interviews. This limits access for people who cannot take time off work or away from caregiving responsibilities, have mobility challenges, or lack reliable access to transportation. Waiting periods and coverage limits on children enrolled in separate CHIP programs have also hampered access.

This new federal rule is changing that. As of June, it eliminates waiting periods for CHIP. By June 2025, it will phase out annual and lifetime dollar limits for CHIP plans, removing limits on services like dental care. By June 2027, it will prevent states from requiring in-person interviews as part of the renewal process. These changes will make it easier for the more than 80 million Medicaid and CHIP enrollees to get care.

2.   Restoring Civil Rights Protections in Healthcare

Discrimination has no place in healthcare, and everyone deserves care without fear of racism and bias. However, several years ago lawmakers rolled back many protections against discrimination in healthcare—particularly for LGBTQIA+ people—leaving them and others in other historically marginalized groups at risk of facing discrimination and barriers when seeking care.

In April 2024, HHS finalized a landmark regulation that updates the ACA and reinstates those nondiscrimination protections for LGBTQIA+ people, while also strengthening protections for women, people with disabilities, and people who don’t speak English as their primary language. It reduces language access barriers, expands physical and digital accessibility, tackles bias in health technology, and more, giving people a clear way to challenge discrimination they face at the doctor or with their health plan.

Specifically, the new rule aims to help trans people access the care they need to live their lives authentically and help same-sex couples access fertility services. This rule is a critical step toward health equity. 

3.   Strengthening Protections Against Disability Discrimination

A new rule helps reverse some of the barriers that have long made it difficult or even impossible for people with disabilities to access basic healthcare and services. Before HHS finalized this rule in May 2024, officials had not updated the regulations implementing Section 504—one of the most important statutory provisions prohibiting discrimination based on disability in healthcare—since 1977.

These outdated regulations allowed often-insurmountable barriers to care to remain in place. For example, when making decisions on who should receive medical treatments like organ transplants or life-extension services, people with disabilities have faced biases that have unjustly placed a lower value on their lives.

The new rule clarifies and modernizes anti-discrimination regulations so people with disabilities can access treatment, community-based services, and accessible technology without facing discrimination. It establishes robust civil rights protections so programs and activities that receive HHS funds do not subject people with disabilities to discrimination. 

4.   Protecting Privacy in Reproductive Healthcare

Privacy is vital in healthcare, especially for reproductive care. In several states with abortion bans, private reproductive health information is at risk as abortion opponents target people who are traveling out of state for reproductive healthcare. For example, Alabama’s attorney general publicly threatened to sue an organization that provides financial assistance to people seeking healthcare in states where abortion is legal. And in Texas, several counties passed laws allowing private citizens to sue those traveling on local roads to seek abortions where it is legal.

The finalized rule makes it illegal for physicians to share the private health information of patients who are seeking legal reproductive healthcare services—whether in their home state or elsewhere—when that information is intended to investigate or impose liability.

This rule can help build and protect trust between patients and healthcare providers. Privacy is crucial for providing people with safe and effective care, particularly now, when access to abortion and other reproductive health services is under attack.

5.   Expanding DACA Recipients’ Access to Healthcare

Every person deserves the opportunity to lead a healthy life, no matter where they were born.

A recent HHS rule extends access to health insurance for approximately 100,000 previously uninsured Deferred Action for Childhood Arrivals (DACA) recipients, allowing them to enroll in Marketplace coverage with financial assistance beginning November 1, 2024. DACA recipients can enroll during the 60 days following November 1, with Marketplace coverage beginning as early as December 1.

Before this rule, people who immigrated to the United States as children and are protected under the DACA program were excluded from Marketplace coverage and Medicaid, unfairly blocking them from accessing the health coverage that we all need.

Thanks to these five rules, more people in historically marginalized groups will have secure access to healthcare regardless of the political climate in their state. This is life changing and life saving for many—the ability to see a doctor or get medical treatment should be available to all of us.

Since we know it will take time and continued work to tear down longstanding barriers designed to discriminate, RWJF will continue using the comment process—and every other tool at our disposal—to influence federal rules and advance health equity. Everyone in our country, no matter their race, ethnicity, gender, or class, deserves a fair and just opportunity to reach their best health and wellbeing.

About the Author

Avenel Joseph, interim executive vice president for Policy, brings a wealth of government, management, and political expertise to leading the Foundation’s Policy office and heading its Washington presence; serves as a key member of the Foundation’s senior leadership team; and guides, motivates, and inspires RWJF’s commitment to its policy and government engagement work.