[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2347 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 2347
To prohibit discrimination in health care and require the provision of
equitable health care, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 17, 2025
Mr. Padilla (for himself, Mr. Booker, Mr. Schiff, and Mr. Gallego)
introduced the following bill; which was read twice and referred to the
Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To prohibit discrimination in health care and require the provision of
equitable health care, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Equal Health Care for All Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) In 1966, Dr. Martin Luther King, Jr. said ``Of all the
forms of inequality, injustice in health care is the most
shocking and inhuman because it often results in physical
death.''.
(2) Inequity in health care remains a persistent and
devastating reality for many communities, and, in particular,
communities of color.
(3) The inequitable provision of health care has complex
causes, many stemming from systemic inequality in access to
health care, housing, nutrition, economic opportunity,
education, and other factors.
(4) Health care outcomes for Black communities in
particular lag far behind those of the population as a whole.
(5) A contributing factor in health disparities is explicit
and implicit bias in the delivery of health care, resulting in
inferior care and poorer outcomes for some patients on the
basis of factors that include race, national origin, sex
(including sexual orientation or gender identity), disability,
age, and religion.
(6) The National Academy of Medicine (formerly known as the
``Institute of Medicine'') issued a report in 2002 titled
``Unequal Treatment'', finding that racial and ethnic
minorities receive lower-quality health care than White
individuals do, even when insurance status, income, age, and
severity of condition is comparable.
(7) Just as Congress has sought to eliminate bias, both
explicit and implicit, in employment, housing, and other parts
of our society, the elimination of bias and the legacy of
structural racism in health care is of paramount importance.
SEC. 3. DATA COLLECTION AND REPORTING.
(a) Required Reporting.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary''), in
consultation with the Director for Civil Rights and Health
Equity, the Director of the National Institutes of Health, the
Administrator of the Centers for Medicare & Medicaid Services,
the Director of the Agency for Healthcare Research and Quality,
the Deputy Assistant Secretary for Minority Health, and the
Director of the Centers for Disease Control and Prevention,
shall by regulation require all health care providers and
facilities that are required under other provisions of law to
report data on specific health outcomes to the Department of
Health and Human Services in aggregate form, to disaggregate
such data by demographic characteristics, including by race,
national origin, sex (including sexual orientation and gender
identity), disability, and age, as well as any other factor
that the Secretary determines would be useful for determining a
pattern of inequitable provision of health care.
(2) Proposed regulations.--Not later than 90 days after the
date of enactment of this Act, the Secretary shall issue
proposed regulations to carry out paragraph (1).
(b) Repository.--The Secretary shall--
(1) not later than 1 year after the date of enactment of
this Act, establish a repository of the disaggregated data
reported pursuant to subsection (a); and
(2) ensure that such repository does not contain any data
that is individually identifiable.
SEC. 4. REQUIRING EQUITABLE HEALTH CARE IN THE HOSPITAL VALUE-BASED
PURCHASING PROGRAM.
(a) Equitable Health Care as Value Measurement.--Section
1886(b)(3)(B)(viii) of the Social Security Act (42 U.S.C.
1395ww(b)(3)(B)(viii)) is amended by adding at the end the following
new subclause:
``(XIII)(aa) Effective for payments beginning with fiscal year
2026, in expanding the number of measures under subclause (III), the
Secretary shall adopt measures that relate to equitable health care
furnished by hospitals in inpatient settings.
``(bb) In carrying out this subclause, the Secretary shall solicit
input and recommendations from individuals and groups representing
communities of color and other protected classes and ensure measures
adopted pursuant to this subclause account for social determinants of
health, as defined in section 7(e)(10) of the Equal Health Care for All
Act, such that the social determinants of health do not adversely
affect hospitals if any inequitable outcomes are not caused by that
hospital's provision of care.
``(cc) For purposes of this subclause, the term `equitable health
care' refers to the principle that high-quality care should be provided
to all individuals and health care treatment and services should not
vary on account of the real or perceived race, national origin, sex
(including sexual orientation and gender identity), disability, or age
of an individual, as well as any other factor that the Secretary
determines would be useful for determining a pattern of inequitable
provision of health care.''.
(b) Inclusion of Equitable Health Care Measures.--Section
1886(o)(2)(B) of the Social Security Act (42 U.S.C. 1395ww(o)(2)(B)) is
amended by adding at the end the following new clause:
``(iv) Inclusion of equitable health care
measures.--Beginning in fiscal year 2026,
measures selected under subparagraph (A) shall
include the equitable health care measures
described in subsection
(b)(3)(B)(viii)(XIII).''.
SEC. 5. INEQUITABLE PROVISION OF HEALTH CARE AS A BASIS FOR PERMISSIVE
EXCLUSION FROM MEDICARE AND OTHER FEDERAL HEALTH CARE
PROGRAMS.
Section 1128(b) of the Social Security Act (42 U.S.C. 1320a-7(b))
is amended by adding at the end the following new paragraph:
``(18) Inequitable provision of health care.--
``(A) In general.--Subject to subparagraph (B), any
health care provider that the Secretary determines,
under section 7(b)(2) of the Equal Health Care for All
Act, has engaged in a pattern of inequitable provision
of health care (as defined in subsection (e)(7) of such
Act) on the basis of race, national origin, sex
(including sexual orientation and gender identity),
disability, or age of an individual.
``(B) Exception.--For purposes of carrying out
subparagraph (A), the Secretary shall not exclude any
health care provider from participation in the Medicare
program under title XVIII or the Medicaid program under
title XIX if the exclusion of such health care provider
would result in increased difficulty in access to
health care services for underserved or low-income
communities.''.
SEC. 6. OFFICE FOR CIVIL RIGHTS AND HEALTH EQUITY OF THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES.
(a) Name of Office.--Beginning on the date of enactment of this
Act, the Office for Civil Rights of the Department of Health and Human
Services shall be known as the ``Office for Civil Rights and Health
Equity'' of the Department of Health and Human Services. Any reference
to the Office for Civil Rights of the Department of Health and Human
Services in any law, regulation, map, document, record, or other paper
of the United States shall be deemed to be a reference to the Office
for Civil Rights and Health Equity.
(b) Head of Office.--The head of the Office for Civil Rights and
Health Equity shall be the Director for Civil Rights and Health Equity,
to be appointed by the President. Any reference to the Director of the
Office for Civil Rights of the Department of Health and Human Services
in any law, regulation, map, document, record, or other paper of the
United States shall be deemed to be a reference to the Director for
Civil Rights and Health Equity.
SEC. 7. PROHIBITING DISCRIMINATION IN HEALTH CARE.
(a) Prohibiting Discrimination.--
(1) In general.--No health care provider may, on the basis,
in whole or in part, of race, sex (including sexual orientation
and gender identity), disability, age, or religion, subject an
individual to the inequitable provision of health care.
(2) Notice of patient rights.--The Secretary shall provide
to each patient a notice of a patient's rights under this
section.
(b) Administrative Complaint and Conciliation Process.--
(1) Complaints and answers.--
(A) In general.--An aggrieved person may, not later
than 1 year after an alleged violation of subsection
(a) has occurred or concluded, file a complaint with
the Director alleging inequitable provision of health
care by a provider described in subsection (a).
(B) Complaint.--A complaint submitted pursuant to
subparagraph (A) shall be in writing and shall contain
such information and be in such form as the Director
requires.
(C) Oath or affirmation.--The complaint and any
answer made under this subsection shall be made under
oath or affirmation, and may be reasonably and fairly
modified at any time.
(2) Response to complaints.--
(A) In general.--Upon the filing of a complaint
under this subsection, the following procedures shall
apply:
(i) Complainant notice.--The Director shall
serve notice upon the complainant acknowledging
receipt of such filing and advising the
complainant of the time limits and procedures
provided under this section.
(ii) Respondent notice.--The Director
shall, not later than 30 days after receipt of
such filing--
(I) serve on the respondent a
notice of the complaint, together with
a copy of the original complaint; and
(II) advise the respondent of the
procedural rights and obligations of
respondents under this section.
(iii) Answer.--The respondent may file, not
later than 60 days after receipt of the notice
from the Director, an answer to such complaint.
(iv) Investigative duties.--The Director
shall--
(I) make an investigation of the
alleged inequitable provision of health
care; and
(II) complete such investigation
within 180 days (unless it is
impracticable to complete such
investigation within 180 days) after
the filing of the complaint.
(B) Investigations.--
(i) Pattern or practice.--In the course of
investigating the complaint, the Director may
seek records of care provided to patients other
than the complainant if necessary to
demonstrate or disprove an allegation of
inequitable provision of health care or to
determine whether there is a pattern or
practice of such care.
(ii) Accounting for social determinants of
health.--In investigating the complaint and
reaching a determination on the validity of the
complaint, the Director shall account for
social determinants of health and the effect of
such social determinants on health care
outcomes, so that the health care provider
named in the complaint is not held accountable
for a factor outside of the control of the
provider's provision of health care.
(iii) Inability to complete
investigation.--If the Director is unable to
complete (or finds it is impracticable to
complete) the investigation within 180 days
after the filing of the complaint (or, if the
Secretary takes further action under paragraph
(6)(B) with respect to a complaint, within 180
days after the commencement of such further
action), the Director shall notify the
complainant and respondent in writing of the
reasons involved.
(iv) Report to state licensing
authorities.--On concluding each investigation
under this subparagraph, the Director shall
provide to each State licensing authority that
is responsible for the licensing of the health
care provider under investigation, information
specifying the results of the investigation.
(C) Report.--
(i) Final report.--On completing each
investigation under this paragraph, the
Director shall prepare a final investigative
report.
(ii) Modification of report.--A final
report under this subparagraph may be modified
if additional evidence is later discovered.
(3) Conciliation.--
(A) In general.--During the period beginning on the
date on which a complaint is filed under this
subsection and ending on the date of final disposition
of such complaint (including during an investigation
under paragraph (2)(B)), the Director shall, to the
extent feasible, engage in conciliation with respect to
such complaint.
(B) Conciliation agreement.--A conciliation
agreement arising out of such conciliation shall be an
agreement between the respondent and the complainant,
and shall be subject to approval by the Director.
(C) Rights protected.--The Director shall approve a
conciliation agreement only if the agreement protects
the rights of the complainant and other persons
similarly situated.
(D) Reporting of agreement.--
(i) In general.--Subject to clause (ii),
the Secretary shall make available to the State
licensing authority described in paragraph
(2)(B)(iv) a copy of a conciliation agreement
entered into pursuant to this subsection unless
the complainant and respondent otherwise agree,
and the Secretary determines, that disclosure
is not required to further the purposes of this
subsection.
(ii) Limitation.--A conciliation agreement
that is made available to the State licensing
authority pursuant to clause (i) may not
disclose individually identifiable health
information.
(4) Failure to comply with conciliation agreement.--
Whenever the Director has reasonable cause to believe that a
respondent has breached a conciliation agreement, the Director
shall refer the matter to the Attorney General to consider
filing a civil action to enforce such agreement.
(5) Written consent for disclosure of information.--Nothing
said or done in the course of conciliation under this
subsection may be made public, or used as evidence in a
subsequent proceeding under this subsection, without the
written consent of the parties to the conciliation.
(6) Prompt judicial action.--
(A) In general.--If the Director determines at any
time following the filing of a complaint under this
subsection that prompt judicial action is necessary to
carry out the purposes of this subsection, the Director
may recommend that the Attorney General promptly
commence a civil action under subsection (d).
(B) Immediate suit.--If the Director determines at
any time following the filing of a complaint under this
subsection that the public interest would be served by
allowing the complainant to bring a civil action under
subsection (c) in a State or Federal court immediately,
the Director shall certify that the administrative
process has concluded and that the complainant may file
such a suit immediately.
(7) Annual report.--Not later than 1 year after the date of
enactment of this Act, and annually thereafter, the Director
shall make publicly available a report detailing the activities
of the Office for Civil Rights and Health Equity under this
subsection, including--
(A) the number of complaints filed and the basis on
which the complaints were filed;