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Legislative Summary: Addressing Disparities in Access to Health Care

People with low incomes, people of color, LGBTQ+ communities and people living in rural or under-resourced areas often experience differences in health outcomes.

By Erika Parkinson and Tammy Hill  |  July 27, 2023

Access to health care services varies greatly across populations in the United States and continues to be one of the system’s greatest disparities.

People with low-incomes, people of color, LGBTQ+ communities and people living in rural or under-resourced areas often experience differences in outcomes related to health, well-being and economic stability. According to researchers, these disparities are typically driven by social factors—sometimes called social drivers of health—such as availability of and access to health care services, including preventative care, healthy food and education.

Health disparities can amount to about $93 billion in excess medical care costs and up to $42 billion in lost of productivity due to premature death.

In addition to differing rates of preventable factors such as injury, violence and disease, health disparities can affect the nation’s overall health and economic prosperity. Reports have estimated that disparities can amount to about $93 billion in excess medical care costs, up to $42 billion in lost of productivity due to premature death, and $2 billion to $15 billion in unnecessary spending for chronic conditions like diabetes and asthma.

State lawmakers continue to work to better understand and address health disparities in their states. Common actions within the last year include creating advisory committees and boards, increasing access to health care services and addressing workforce shortages.

Legislative Trends, 2022-23

Advisory Committees and Boards

Louisiana (HCR 44) created a task force as a subcommittee of the statewide health equity consortium to identify key drivers of health disparities in rural areas, to consider social determinants of health while developing recommendations for delivering high-quality care, and to draft a training proposal for the rural health workforce on promoting diversity in health professions.

Illinois (HB 5186) similarly established a working group including the University of Illinois at Chicago School of Public Health and the state health department to develop health regulations and policies and provide implementation recommendations to improve overall health outcomes and reduce health inequalities. The group will assess the effects of access to safe and affordable housing, educational attainment, economic stability and public safety, among other topics, as they impact the health of residents.

Accessing Health Care Service

Disparate access to health care services can lead to worse health outcomes in some communities. Access problems can result from a lack of service providers in a given area or physical barriers, such as living in a rural area remote from brick-and-mortar facilities.

New York (SB 7885) required health equity assessments when constructing new hospitals and a consideration of whether a project will improve access to hospital services or reduce health disparities for underserved groups in the construction area.

Utah (SB 38) created an office to address American Indian-Alaska Native health and family services within the state Department of Health and Human Services. Among other things, the office will appoint a health liaison to promote and coordinate efforts between the department and Utah’s American Indian-Alaska Native population to improve availability and accessibility to health care, and improve health disparities. The office will also facilitate education, training and technical assistance for tribal health programs, local health departments, state agencies, and officials and providers of health care in the private sector.


State legislatures addressed challenges related to diversity and representation in the workforce by adding or increasing positions for qualified providers, offering scholarships and providing loan repayment opportunities. Washington, D.C., (R 798) addressed the need for workers in high-demand health care positions, including dentists, mental health professionals and physicians. It also expanded the DC Health Professional Loan Repayment Program to lessen economic barriers experienced by people entering health care careers.

Arkansas (HB 1178) eased education requirements for community paramedics and added areas of clinical experience pertaining to social determinants of health to its training programs.

To follow state actions related to health disparities, go to NCSL’s public health database.

Tammy Hill is a project manager in NCSL’s Health Program; Erika Parkinson was an intern in the program.

This resource is funded through the support of Amgen.

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