Health Equity blog

In early May, the Department of Justice (DOJ) sent letters to the schools of medicine at both Yale University and the University of California, Los Angeles (UCLA), notifying them that it has found, in the course of its compliance review, that the schools’ admissions decisions “intentionally discriminate against applicants based on their race.” The DOJ’s letters follow the U.S. Supreme Court’s decision in Students for Fair Admissions Inc. v. President & Fellows of Harvard College, 600 U.S. 181 (2023), holding that certain race-conscious admissions programs in higher education are unconstitutional and in violation of Title VI of the Civil Rights Act of 1964. The DOJ’s actions could jeopardize medical schools’ ongoing efforts to diversify the physician workforce. Such diversification is often viewed as one means by which to effectively improve health outcomes for minority and other underserved populations.

Numerous nursing associations have joined a federal lawsuit launched by several Democrat-led states in response to the Department of Education’s final rule that removes advanced nursing degrees from the definition of “professional degree” for federal student loan purposes. Absent such inclusion, nurses seeking post-baccalaureate nursing degrees will be subject to the $100K aggregate cap on federal loans for graduate education. This move could force many graduate nursing students to rely upon high-interest loans or forego furthering their education altogether. In turn, fewer advanced practice nurses (APNs) may enter the workforce in coming years, threatening an already severe shortage of primary care practitioners. The Department of Education claims the rule will incentivize institutions to control increasing tuition costs. The rule goes into effect July 1.

Early in his second term, President Trump issued a flurry of Executive Orders and directives targeting the elimination of diversity, equity, and inclusion (DEI) initiatives and programs within the federal government. KFF reports that these policies – despite the myriad of court orders and other legal challenges following in their wake – are having widespread implications, including reductions in research and interventions previously aimed at addressing disparities in health outcomes. Moreover, the report indicates the Administration’s actions to suspend certain national surveys and omit DEI-related data elements have also compromised the integrity and accessibility of public health information, the effects of which could jeopardize the validity and accuracy of future health care-related research.

The Centers for Medicare & Medicaid Services (CMS) issued an interim final rule on June 3 that attempts to narrow the definition of “medical frailty” for purposes of determining work requirement (or community engagement) exemptions for Medicaid beneficiaries in most states. Such states must comply with the work requirement rules by January 1, 2027, including developing lists of health conditions that constitute medical frailty. However, the rule prohibits states from categorically exempting beneficiaries with those health conditions and requires them to instead evaluate an individual’s ability to satisfy the work requirement based upon their overall health. Nonetheless, through 2027, the rule permits states to accept self-declaration of work or exemption status when reliable data are not otherwise available. Key provisions of the rule can be found in CMS’s Fact Sheet.

Faced with higher premium payments without enhanced tax credits beyond 2025, plan sign-ups during the Affordable Care Act’s (ACA) Marketplace 2026 open enrollment period dropped by over a million. And the rates of effectuated enrollment, i.e., how many individuals will actually pay their premiums following enrollment, may be even lower. That number could plummet to a monthly average that is 6 million fewer than in 2025. KFF reports that enrollee premium costs increased by an average of 58%, from $113 to $178 per month in 2026, while deductibles increased by 37% ($1,027 per person) to a record high of $3,786.

The most recent annual report by the Commonwealth Fund, which analyzes health disparities nationwide, found that American Indian/Alaska Native, Black, and Hispanic communities generally experienced worse access to, and affordability of, health care services in most states during 2023–24. The report anticipates that these disparities will only worsen due to major federal funding cuts and changes to Medicaid and the Affordable Care Act (ACA) marketplace, while also highlighting the potential for artificial intelligence to help close gaps in care. Notably, the report assigns each racial and ethnic group in every state an overall health system score based on the state’s combined performance in health outcomes, access to care, quality of care, and individuals’ use of health services.

A UnidosUS report claims that the progress made in Latino health care during the past decade is threatened by Medicaid funding cuts in 2025 and the expiration in January 2026 of the enhanced tax credits under the Affordable Care Act (ACA). The report estimates that more than 28% of the 14 million individuals projected to lose health insurance coverage during the next 10 years will be Hispanic. States with large Latino populations, such as California and Florida, will be most impacted.

On May 4, the Department of Health and Human Services (HHS), as part of Secretary Kennedy’s Make America Healthy Again (MAHA) campaign, announced its action plan to curb overprescribing of psychiatric medications, particularly to children. HHS seeks to avoid the unnecessary initiation of psychiatric medications and supports their tapering and discontinuation when patients do not realize any clinical benefit. Various HHS agencies are aligning to evaluate prescription patterns for psychiatric medications, assess their benefits and potential harms, and emphasize the role of nonmedication treatment alternatives.

The Boston Globe sponsored the Health Equity Summit, held on May 13 at Harvard University. The summit gathered health and life sciences ecosystem leaders, medical experts, community advocates, and journalists to engage in crucial conversations focused on resolving health disparities and fostering more inclusive health care. Replays of the day’s events are available for viewing here.

Although climate change negatively impacts all Californians, data show that Hispanic communities face disproportionately more serious outcomes regarding their health. A recent analysis published in Health Affairs highlights that current data systems fail to integrate health outcomes, climate exposure, and neighborhood-level vulnerability, which limits policymakers’ ability to address the health care needs of California Latinos. The Analysis emphasizes the need to draw upon data from the publicly available Latino Climate and Health Dashboard to better understand the disparities between California’s Latino and White non-Latino neighborhoods.