Doctor Holding Cell Phone. Cell phones and other kinds of mobile devices and communications technologies are of increasing importance in the delivery of health care. Photographer Daniel Sone.

Toward a Broader Telehealth Licensing Scheme

By Fazal Khan

Evidence generated during the first year the COVID-19 pandemic has called into question the need for many of the telehealth restrictions that were in effect prior to the pandemic.

The question many policymakers are asking now is: which of the telehealth regulatory waivers enacted during the pandemic should become permanent?

My forthcoming article proposes that the federal government use its spending power to incentivize states to adopt a de facto national telehealth licensing scheme through state-based mutual recognition of licensing and scope of practice reforms through a Medicaid program funding “bonus.”

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Group of Diverse Kids Playing in a Field Together.

Health Justice is Within Our Reach

By Dayna Bowen Matthew

Health justice is the outcome when law protects against the unequal distribution of the basic needs that all humanity requires to be healthy. Angela Harris and Aysha Pamukcu define health justice in terms of ending the subordination and discrimination that produce health disparities.

I first saw and experienced the need for the work to achieve health justice as a child. I grew up in the South Bronx, insulated from the absence of health justice until the fourth grade, when I began attending private school. Before then, I had no idea that the racially, ethnically, and economically segregated society in which I lived, played, and attended school and church was any different than the society that existed unbeknownst to me outside of my zip code.

I crossed interstate highway exchanges daily as I walked to P.S. 93, oblivious to the fact that other kids did not breathe the exhaust fumes and toxins from nearby waste transfer stations that tainted the air where my mostly Black, Dominican, and Puerto Rican neighbors lived. I had no idea that clean, breathable air was inequitably distributed in this country by race.

It was not until I left the South Bronx to attend school in Riverdale that I realized other families had an array of housing options to choose from that were different than mine. In fourth grade, when my family began voluntarily bussing me to private school, I learned that the housing available to families extended beyond the racially segregated shotgun row house I lived in, the stinky, dimly lit apartment buildings on my corner or “the projects” where my grandparents lived in Harlem. Who knew there were sprawling homes atop manicured lawns and opulent apartments overlooking Central Park available throughout other parts of the city? Who knew that even modestly priced apartments could be located near green spaces, well-stocked grocery markets, and schools that prepared kids well for college? Not me. I had no idea until I began to see that decent, clean, affordable housing, and resource-rich neighborhoods are inequitably distributed by race and ethnicity in America.

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WASHINGTON, DC - OCT. 8, 2019: Rally for LGBTQ rights outside Supreme Court as Justices hear oral arguments in three cases dealing with discrimination in the workplace because of sexual orientation.

LGBTQ Health Equity and Health Justice

By Heather Walter-McCabe

LGBTQ communities experience health inequities compared to heterosexual and cisgender peers. The health justice framework allows advocates to move the work upstream to the root causes of the problems, rather than placing a band-aid on the resultant consequences once the harm is caused.

It is not enough to provide individual treatment for the harm caused by stigma and bias. Health justice is a crucial means of ensuring that health care is equitable and that impacted communities are involved in policy and system advocacy.

The health justice framework, with its emphasis on community involvement in structural and governmental responses to systems-level transformation, must guide work in the area of LGBTQ health equity.

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U.S. Capitol Building.

Congress Should Act to Fund Medical-Legal Partnerships

By Emily Rock and James Bhandary-Alexander

On August 9, legislators introduced a new bill in Congress that allocates funding to the development of Medical-Legal Partnerships (MLPs), in recognition of the important role MLPs can play in the lives of older Americans.

As attorneys with the Medical-Legal Partnership program at the Solomon Center for Health Law and Policy at Yale Law School, we strongly encourage Congress to act quickly to pass this legislation.

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Brown Gavel With Medical Stethoscope Near Book At Wooden Desk In Courtroom.

Health Justice, Structural Change, and Medical-Legal Partnerships

By Liz Tobin-Tyler and Joel Teitelbaum

To us, health justice means change.

Changes to norms and attitudes, to systems and environments, to law and policy, to resource and opportunity distribution. Not cosmetic or peripheral change, but wide-scale, systemic change. For health justice to be realized — for all people to reach their full health potential — laws and policies must be geared toward restructuring the systems, practices, and norms that have heretofore advantaged some groups over others, and thus given them greater opportunity for good health, economic and social prosperity, and greater longevity.

We recognize that this kind of change is profoundly challenging, both biologically and structurally. Biologically, because humans are programmed to do what’s comfortable, and what’s comfortable is what’s already known. Structurally, because of the nation’s unique political, social, and cultural attributes. Some of these attributes include a strong sense of individualism, and thus an entrenched unwillingness to prioritize community benefit over individual choice; limited governmental power; capitalism; unprecedented wealth with massive inequality; resistance to growing racial and ethnic diversity; over-spending on the downstream consequences of the failure to invest in upstream wellness; and a willingness to enact and maintain policies and practices that privilege some lives over others.

For these reasons, we are not naïve about the prospects for major change in a relatively short period of time, but neither are we cowed by the challenge. We embrace the opportunity to get uncomfortable, to challenge the racist, gender-based, and ableist norms and attitudes in all forms that harm health and well-being, to raise awareness of the inert systems that perpetuate health injustice, and to promote innovative and progressive law and policy change.

One of the ways that we apply our approach to health justice is our work to develop and advance medical-legal partnerships (MLPs), as both an expert consultant (Liz) to and Co-Director (Joel) of the National Center for Medical-Legal Partnership.

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Symbol of law and justice, banknote of one dollar and United States Flag.

Saving Lives and Decreasing Costs: The Economic Case for Health Justice

By Wendy Netter Epstein

Most proponents of health justice will tell you that health is a fundamental human right. They will say that there is a moral imperative to eliminate health inequities and to give all people equal opportunity to lead a healthy life. And they will be correct. Health justice as a framework is driven by this narrative — the laudable goals of health equity and social justice.

What you aren’t as likely to hear from health justice advocates, however, is that health justice is economically efficient. To the contrary, most health justice advocates see its framework as an alternative to the markets, efficiency, autonomy, and individual responsibility that are the hallmarks of conservative ideology.

Yet, there is no question that health inequities are costly to the individuals that bear them, in higher health care expenses, missed days of work, and fewer years lived. There are also significant costs to society — both direct and indirect. According to one analysis, disparities lead to $93 billion in excess medical care costs and $42 billion in lost productivity per year.

Making the economic case for health justice, and noting how it is inextricably linked to the moral case, is crucial. Because not only is the framework bolstered by notions of both fairness and efficiency, but also, as a practical matter, getting legislative and regulatory buy-in to fund initiatives to address health inequities requires making the economic case.

If health inequities could be ameliorated, government health spending and other safety net spending would be drastically reduced, workforce productivity would increase, and even healthy and wealthy Americans — who are the most likely to oppose the health justice framework — would benefit.

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Blue stethoscope with gavel on white background

Equipping the Next Generation of Health Justice Leaders

By Yael Cannon

Health justice begins with exploring and understanding health disparities and the role of law in facilitating the social, political, and economic determinants at their roots. It requires naming structural racism — and the many forms of subordination that flow from it — as a public health crisis and recognizing that health justice is racial justice. Most importantly, health justice requires us to partner with affected communities to leverage law and policy to address and eliminate the root causes of disparities.

Those of us at schools of law and medicine, and other academic institutions who are training the next generation of lawyers, policy advocates and policymakers, doctors, nurses, and other health professionals have a special responsibility to equip our students with the knowledge, skills, and values they need to ensure that everyone has an equal chance at health and well-being.

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Envelope from U.S. Citizenship and Immigration Services with the American flag on top/U.S. immigration concept.

Health Justice for Immigrants, Revisited

By Medha D. Makhlouf

A major contribution of health justice is that it provides a framework for understanding how universal access to health care protects collective, as well as individual, interests. The pandemic has underscored the collective nature of the health and wellbeing of every person living in the United States, regardless of immigration status.

In a 2019 article, Health Justice for Immigrants, I adopted and adapted the health justice framework to the problem of disparities in immigrant access to subsidized health coverage. I argued that, in future health care reforms, health justice requires that immigrants be included in the “universe” of universal access to health care. In this blog post, I revisit this argument in light of the COVID-19 pandemic.

This blog post applies the health justice lens to inequities in immigrant health and access to health care, drawing out lessons for the pandemic and post-pandemic eras. It describes three examples illustrating the utility of health justice for catalyzing cross-sector initiatives to improve health, reducing the role of bias in the design of interventions to address health disparities, and ensuring that such efforts are serving the needs of historically subordinated communities.

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Picture of north star in starry night sky.

Health Justice as the Lodestar of Incremental Health Reform

By Elizabeth McCuskey

Health justice is the lodestar we need for the next generation of health reform. It centers justice as the destination for health care regulation and supplies the conceptual framework for assessing our progress toward it. It does so by judging health reforms on their equitable distribution of the burdens and benefits of investments in the health care system, and their abilities to improve public health and to empower subordinated individuals and communities. Refocusing health reform on a health justice gestalt has greater urgency than ever, given the scale of injustice in our health care system and its tragic, unignorable consequences during the coronavirus pandemic.

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illustration of person tracking his health condition with smart bracelet, mobile application and cloud services.

Expanded Reimbursement Codes for Remote Therapeutic Monitoring: What This Means for Digital Health

By Adriana Krasniansky

New reimbursement codes for virtual patient monitoring may soon be incorporated into Medicare’s fee schedule, signaling the continued expansion and reach of digital health technologies catalyzed by the COVID-19 pandemic.

In July 2021, the Centers for Medicare & Medicaid Services (CMS) proposed adding a new class of current procedural terminology (CPT) codes under the category of “remote therapeutic monitoring” in its Medicare Physician Fee Schedule for 2022 — with a window for public comments until September 13, 2021. While this announcement may seem like a niche piece of health care news, it signals a next-phase evolution for virtual care in the U.S. health system, increasing access possibilities for patients nationwide.

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