Health Equity’s Role in Public Policy

Public policymakers and state agencies across the nation are becoming increasingly intentional about bringing health equity into their policymaking decisions, looking to address the issues of health equity and maternal mortality through legislation and rulemaking. As equity discussions occur in these spaces, a trend is emerging where the line between health equity and general economic equity can be blurred.

The conventional approach to public policy is to integrate social determinants of health into plans designed to ensure everyone can be healthy regardless of who they are or where they live. However, the interest in health equity is evident in the broader discussions about medical professional liability insurance coverage and tort reforms and can converge with the undercurrents of social inflation and equity in general.

Eliminating health disparities can involve developing a health equity ecosystem that not only addresses healthcare access and quality of care, but also broader social determinants of health such as economic stability, discrimination, housing, transportation, access to technology, education, and environmental considerations such as air and water quality.¹

As a first step, policymakers often implement healthcare system strategies that are aimed at addressing biases, targeted toward populations that are known to be disadvantaged. On December 17, 2024, the University of Minnesota’s School of Public Health released a study on health disparity that was published in the Annals of Internal Medicine. Although the study focused on patient-targeted healthcare strategies related to chronic conditions through a racial and ethnic disparities lens, the authors noted that the strategies “may not fully address the structural root causes of inequities” and that systematic changes are necessary to address the broader “social and structural determinants of health and disparities.”²

New York is in its first year of implementing its Department of Health’s “Health Equity Plan.” The first year of the plan is geared toward building a foundation for health equity that considers the full spectrum of social determinants of health. The state’s public health law states that health equity efforts are to be focused on “equalizing conditions for health for those that have experienced injustices, socioeconomic disadvantages, and systemic disadvantages.”³

Knowing that social determinants of health reach beyond the delivery of healthcare, state legislators are advancing proposals that invest in housing, transportation, and education, and are regulating insurance with health equity as one of the objectives.

We see this in a variety of initiatives. For example, in 2024, the Michigan Legislature considered its “Momnibus” initiative designed to drive equity in the state’s prenatal and maternal healthcare. The legislation required reporting on biased and unjust perinatal care, health insurance coverages, programs supporting midwives and doulas, and, interestingly, mandated data collection from medical malpractice insurers’ policies related to perinatal care.

Equity is central to the heated wrongful death legislative efforts in New York. Over the past three years, proponents of the thrice-vetoed Grieving Families Act have argued that the state’s existing system is inequitable, as damages awards are biased against and lower for disadvantaged populations. At the same time, opponents to the bill have argued that the proposal will have a significant negative impact on the state’s healthcare system and, in particular, jeopardize safety-net hospitals, thereby further reducing access to and equity in healthcare.

Public policy debates about noneconomic damages caps in the medical professional liability space are surrounded by equity concerns. Financial desensitization among policymakers is similar to what is being witnessed in the courtroom as juries deliver increasingly large, disproportionate awards. Repealing noneconomic damages limitations comes with the rallying cry that economic damages can inequitably limit compensation and future access to care for less advantaged parties, and that lifting the noneconomic damages cap will allow parties to be more equitably compensated. However, limits on noneconomic damages are essential to protect patients’ access to healthcare.

The equity debate is happening at the appellate court level, too, where plaintiffs’ lawyers seek to have the courts rule that noneconomic damages caps are unconstitutional, violate the right to equal protection, and allow for disproportionate impact for individuals with lower incomes. Proponents for noneconomic damages caps strenuously argue that they serve a legitimate interest by preserving availability to healthcare.

TDC Group works to protect medical liability reforms that boost access to healthcare and the efforts made by public policymakers to enhance social determinants of health. We have an advocacy presence in all 50 states, the District of Columbia, and the federal government that is focused on advancing the practice of good medicine and preventing the erosion of the reforms necessary to support equity.

Our amicus program gives a voice before the courts to help inform on the importance of noneconomic damages caps and other statutes that are meaningful to preserving access. Importantly, The Doctors Company is committed to building healthy communities and addressing the social determinants of health through our three community investment programs. These programs, combined with our legislative, judicial, and regulatory advocacy, serve to address important issues for our members and their patients and to advance and protect the practice of outstanding healthcare.

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References

1. U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion. Healthy People 2030: Social Determinants of Health. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health. Accessed January 10, 2025.
2. Lamina, T. et al. Annals of Internal Medicine. Strategies to Address Racial and Ethnic Disparities in Health and Health Care for Chronic Conditions: An Evidence Map of Research From 2017 to 2024. https://doi.org/10.7326/ANNALS-24-01262. Accessed January 10, 2025.
3. NY Public Health Statute, Chapter 45, Article 2, Title 2-F, § 240*2.

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The Doctor’s Advocate is published by The Doctors Company to advise and inform its members about loss prevention and insurance issues.

The guidelines suggested in this newsletter are not rules, do not constitute legal advice, and do not ensure a successful outcome. They attempt to define principles of practice for providing appropriate care. The principles are not inclusive of all proper methods of care nor exclusive of other methods reasonably directed at obtaining the same results.

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