December 5, 2019

South Bend, Indiana, Mayor Pete Buttigieg (D), who is seeking the 2020 Democratic nomination for president, on Tuesday released a plan intended to combat inequality in the U.S. health care system.

Where the 2020 Democratic candidates stand on health care

Plan details

The plan, called "Health Equity and Justice in America," aims to address inequalities in the country's health care system by ensuring equity in health care even before an individual reaches a hospital or clinic. The plan notes, "Most of our health outcomes are determined by what happens outside a clinic or hospital: by where we can live, what we can eat, and what jobs we have access to."

To address those issues, Buttigieg under the plan would direct the federal government to launch a National Health Equity Strategy Task Force within his first 100 days in office if he is elected president. According to the plan, part of that initiative's focus would be to create "equity plans" for Medicaid and Buttigieg's proposed public option health plan, "setting aggressive goals for closing access outcomes gaps."

Buttigieg under the plan also would designate areas with "significant health disparities" as "Health Equity Zones" where officials could place a particular focus and investments toward combating those inequities. According to the plan, those zones would "receive federal funding to end their most pressing health disparities, with a programatic budget of $5 billion over 10 years."

The plan also calls for creating a Public Health Infrastructure Fund that would have "a mandatory funding stream … starting at a $500 million governmental contribution and ramping up annually until the gap of $4 billion a year between current spending and existing needs is met." According to the Associated Press, the federal government would contribute the initial $500 million to the fund and increase its funding each year, and individual states would be required to contribute funding on a sliding scale based on the median income within each state. The plan states that the funding would be used to help "support state and local health departments." It calls on local public health departments to focus on "identify[ing] the root causes of local health inequities across sectors, including housing, transportation, and criminal justice."

The plan also commits to increasing investments in efforts to discover cures for diseases that disproportionately affect minorities and in behavioral and social science research. In addition, Buttigieg under the plan would require all federally funded health programs to collect and monitor data related to cost and quality of care, as well as outcomes for specific ethnic, sexual orientation, and gender identity demographics. Buttigieg's administration would use the data to disperse financial incentives based on equitable outcomes.

Further, the plan calls for installing Offices of Health Equity and Justice within a number of federal agencies, including the Departments of Education, Housing and Urban Development, and Justice, as well as the Environmental Protection Agency. The plan also notes that Buttigieg would appoint an HHS secretary who is "committed to achieving health equity," and "[r]evitalize" HHS' Office of Civil Rights "to ensure that legal frameworks exist to challenge health inequities, protect communities' health and human rights, and ensure agencies explicitly consider the racial and demographic impact of their decisions."

The plan states that it also aims to address "systemic discrimination" that occurs among health care providers, which can take "the form of a doctor who takes a black person's pain symptoms less seriously … [or] a hospital system that breaks ground only in a predominantly white neighborhood." Under the plan, Buttigieg's administration would "both invest in training our health workforce to combat racism and bias when treating patients, and support more underrepresented groups entering the sector to achieve equitable representation." The plan also calls for encouraging health systems to dedicate resources to address social determinants of health in their areas.

Comments

Buttigieg said he is "determined to usher in a new era for health in America. One that recognizes that our policies must target systemic disparities in our health system. One that understands what happens in our lives outside the clinic is equally as important to our health and well-being than what happens in a hospital or doctor's office. And one that makes achieving health equity—where everyone has a fair opportunity to be as healthy as they can be—a national imperative" (Cunningham, "PowerPost," Washington Post, 12/3; Thompson, "Meet the Press," NBC News, 12/3; Axelrod, The Hill, 12/3; Sherfinski, Washington Times, 12/3; Buttigieg campaign website, accessed 12/4).

Health Equity 101

Health care delivery is incomplete without addressing the social determinants of health that contribute to health disparities. However, providers often find it difficult to pinpoint the areas of health inequity that need the most attention in their communities.

Download the slide deck from our recent webinar to learn how to focus your identification efforts on a community and patient level to inform strategic priorities and improve outcomes of at-risk patients.

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