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Health equity is when every member of a society is empowered to achieve their full potential for a healthy life. Access to care is a critical health equity issue. According to the Agency for Healthcare Research and Quality (AHRQ), access to care means having "the timely use of personal health services to achieve the best health outcomes" and is comprised of four key components: affordability, services provided, timely availability, and a culturally competent provider workforce. Studies found that even though the percentage of uninsured U.S. residents is declining, different races are experiencing disparate outcomes: non-Hispanic white people saw a decrease in uninsured rates from 10.5% in 2019 to 7.4% in 2022, while no other racial groups experienced significant improvements. Furthermore, 70% of Health Professional Shortage Areas are in rural or partially rural areas. To help, some states are investing in Medicaid expansion, telehealth, graduate medical education, and the Interstate Medical Licensure Compact. Access to care is a health equity issue. A study from the National Center for Health Statistics found that in 2022, 8.4% of U.S. residents did not have insurance; a decrease from 10.3% in 2019. While this overall trend is something to celebrate, these improvements were not felt by all communities equally. Among working-age adults, non-Hispanic white people saw a statistically significant decrease in uninsured rates from 10.5% in 2019 to 7.4% in 2022 whilst no other racial groups experienced significant improvements. For rural Americans, accessing primary care can be a serious barrier to a healthier life. Primary care providers (PCPs) offer a consistent source of care, preventive care, early detection and treatment for disease. Currently, an estimated 100 million people live in Health Professional Shortage Areas (HPSAs) where over 17,000 additional primary care practitioners are needed. Of the nation’s 8,267 HPSAs, 70% are in rural or partially rural areas. According to a study from the Association of American Medical Colleges, the U.S. is on a path to see the shortage of primary care physicians grow up to 48,000 by 2034. With the end of the federal public health emergency and the unwinding of the Medicaid continuous enrollment provision, states are seeing a renewed push for Medicaid expansion. As of June 2023, 41 states (including, DC) adopted Medicaid expansion, with North Carolina most recently joining the group. In the 10 non-expansion states, nearly two million people fall in the coverage gap, with income too high for Medicaid but too low for ACA marketplace subsidies. According to the Kaiser Family Foundation, presently, at least 1,652,000 Medicaid enrollees were disenrolled across 28 states currently reporting redetermination data; Florida leads with over 300,000 disenrolled, followed by Arizona with 149,000 disenrolled. What’s being done? Below are examples of initiatives taken to improve access to care:

• Expanding telehealth access. During the COVID-19 pandemic, virtual care through telehealth boomed in popularity, helping to address many access concerns. Since the pandemic, states’ legislatures have passed thousands of bills pertaining to telehealth. Federally, the Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities through December 2024, including geographic and originating site restrictions for Medicare patients and rural health care providers. Now Congress and state legislatures are struggling with what flexibilities to make permanent and what guardrails to adopt.
• Increasing access to high-speed internet. In conjunction with telehealth access, in June, the Biden Administration outlined their plan to invest $42 billion from the 2021 bipartisan infrastructure law to increase broadband internet access and close the digital divide.
• Addressing physician shortages. Congress introduced The Resident Physician Shortage Reduction Act of 2023 to increase the number of graduate medical education slots to increase the physician shortage.
• Expanding the Interstate Medical Licensure Compact. Beginning in 2017 with the goal to increase access to care in underserved or rural areas, the IMLC offers a streamlined pathway for eligible physicians to practice medicine across state lines through new medical technologies such as telemedicine. Currently, the IMLC includes 37 states, DC, and the U.S. territory of Guam. Since the start of the COVID-19 pandemic in 2020, 9 state legislatures and DC voted to join the IMLC and 5 have introduced legislation to join.
• Weaving health equity in every policy. Almost every rule released by the Biden Administration has included one policy focused on health equity (e.g., requiring providers to screen for social determinants of health). The U.S. Department of Health’s Healthy People 2030 initiative to bridge health equity and access to care includes addressing barriers to care such as language, cultural, transportation, geographic, and disability-related barriers.