Advancing Health Equity: Lessons from National and State-Level Strategies

The 2011 National Stakeholder Strategy for Achieving Health Equity engaged federal, state, and local partners to work toward reducing racial and ethnic health disparities (Beadle & Graham, 2011). Key components of the National Stakeholder Strategy included developing strategic partnerships, mobilizing networks, and improving awareness and communications about health disparities through various media outlets. Based on key findings in my study, the existing infrastructure facilitated educational messaging specifically to men about ways to engage with the healthcare delivery system in terms of insurance status and having a usual source of care.

More recently, the Biden-Harris Administration signed Executive Order (EO) 13985, which called for a comprehensive approach to advancing equity for all by embedding fairness into executive agency decision-making processes (Biden-Harris, 2021). The executive order specifically called for a study to identify the best methods, consistent with applicable law, to assist agencies in assessing equity with respect to race, ethnicity, religion, income, geography, gender identity, sexual orientation, and disability. This executive order also presented an opportunity to dismantle structural racism throughout and across various government-funded research infrastructures. As noted earlier, because Black principal investigators were less likely to be awarded funding grants that could help the Black community, barriers persisted in terms of funding interventions to improve access to care for Black men (Lauer, 2021). In response, the Department of Health and Human Services Health Equity Action Plan put forward a plan to advance equity as a fundamental component of the decision-making framework at the executive agency level (Beard et al., 2022).

Regarding health insurance coverage specifically, the HHS Health Equity Action Plan noted that the Centers for Medicare and Medicaid Services examined ways to address inequities by providing guidance on streamlining Medicaid and CHIP enrollment and renewal processes across states (HHS, 2022). Each state had unique policy and political contexts, and the initial adoption of state-level approaches to expanding insurance coverage fell under four broad categories: 1) a standard legislative process, 2) section 1115 waivers, 3) gubernatorial executive action, and 4) ballot initiatives (Antonisse, 2019). At the state level, Kingdon’s Multiple Streams approach referenced earlier could still be operationalized to help expand health insurance coverage, access to care, and having a usual source of care for men. Moreover, the key findings in my study could be used as additional evidence to support civic engagement with elected officials and their staff. However, decisions about expansion adoption in many states were predicated upon financing for the state share of expansion costs (Antonisse, 2019).