I 
116TH CONGRESS 
2D SESSION 
H. R. 8436 
To prohibit discrimination in health care and require the provision of equitable 
health care, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 29, 2020 
Mr. SCHIFF (for himself, Ms. BASS, Mr. GRIJALVA, Mr. COOPER, Mrs. 
HAYES, Mr. KHANNA, Ms. SCANLON, Ms. NORTON, and Ms. LEE of Cali-
fornia) introduced the following bill; which was referred to the Committee 
on Energy and Commerce, and in addition to the Committee on Ways 
and Means, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
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 Representa-
tives 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: 
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(1) In 1966, 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) Inequality in health care remains a per-
sistent and devastating reality for many commu-
nities, but, in particular, communities of color. 
(3) Unequal health care has complex causes, 
many stemming from systemic inequality in access 
to health care, housing, nutrition, economic oppor-
tunity, education, and other factors. 
(4) Health care outcomes for African-American 
communities in particular lag far behind those of the 
population as a whole. 
(5) Dr. Anthony Fauci, director of the National 
Institute of Allergy and Infectious Diseases, said on 
April 7, 2020, the coronavirus outbreak is ‘‘shining 
a bright light’’ on ‘‘unacceptable’’ health disparities 
in the African-American community. 
(6) 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 race or ethnicity. 
(7) The Institute of Medicine issued a report in 
2002 titled ‘‘Unequal Treatment’’, finding that ra-
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cial and ethnic minorities receive lower-quality 
health care than Whites do, even when insurance 
status, income, age, and severity of condition is com-
parable. 
(8) Just as Congress has sought to eliminate 
bias, both explicit and implicit, in employment, hous-
ing, 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 consultation with Director of the 
National Institutes of Health, the Director of the 
Centers for Medicare & Medicaid Services, the Di-
rector of the Agency for Healthcare Research and 
Quality, the Deputy Assistant Secretary for Minority 
Health, and the Director of the National Center for 
Health Statistics, shall by regulation require all 
health care providers and facilities that are required 
under other provisions of law to report data on 
health outcomes to the Department of Health and 
Human Services to disaggregate such data by demo-
graphic characteristics, including by race, ethnicity, 
sex, sexual orientation, disability status, gender 
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identity, age, and any other factor that the Sec-
retary determines would be useful for determining a 
pattern of inequitable health care. 
(2) PROPOSED REGULATIONS.—Not later than 
90 days after the date of enactment of this Act, the 
Secretary of Health and Human Services shall issue 
proposed regulations to carry out paragraph (1). 
(b) REPOSITORY.—The Secretary of Health and 
Human Services shall— 
(1) not later than 1 year after the date of en-
actment of this Act, establish a repository of the 
disaggregated data reported pursuant to subsection 
(a); 
(2) subject to paragraph (3), make the data in 
such repository publicly available; and 
(3) ensure that such repository does not contain 
any data that is individually identifiable. 
SEC. 4. REQUIRING EQUITABLE HEALTH CARE IN THE HOS-
PITAL 
VALUE-BASED 
PURCHASING 
PRO-
GRAM. 
(a) EQUITABLE HEALTH CARE AS VALUE MEASURE-
MENT.—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: 
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‘‘(XIII)(aa) Effective for pay-
ments beginning with fiscal year 
2022, in expanding the number of 
measures under subclause (III), the 
Secretary shall adopt measures that 
relate to equitable health care fur-
nished by hospitals in inpatient set-
tings. 
‘‘(bb) In carrying out this sub-
clause, the Secretary shall solicit 
input and recommendations from indi-
viduals and groups representing com-
munities of color and ensure measures 
adopted pursuant to this subclause ac-
count for social determinants of 
health care outcomes. 
‘‘(cc) For purposes of this sub-
clause, the term ‘equitable health 
care’ refers to the principle that qual-
ity of care provided to an individual 
shall not vary on account of the real 
or perceived race, ethnicity, sex, sex-
ual orientation, disability status, gen-
der identity, or age of such indi-
vidual.’’. 
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(b) INCLUSION OF EQUITABLE HEALTH CARE MEAS-
URES.—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 2021, measures selected under 
subparagraph (A) shall include the equi-
table health care measures described under 
subsection (b)(3)(B)(viii)(XIII).’’. 
SEC. 5. PROVISION OF INEQUITABLE HEALTH CARE AS A 
BASIS FOR PERMISSIVE EXCLUSION FROM 
MEDICARE AND STATE HEALTH CARE PRO-
GRAMS. 
Section 1128(b) of the Social Security Act (42 U.S.C. 
1320a–7(b)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(18) PROVISION
OF
INEQUITABLE
HEALTH 
CARE.—Any individual or entity that the Secretary 
determines has engaged in a pattern of providing in-
equitable health care (as defined in section 7 of the 
Equality in Health Care for All Act) on the basis of 
race, ethnicity, sex, sexual orientation, disability sta-
tus, gender identity, age, or any other protected 
class.’’. 
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SEC. 6. OFFICE OF CIVIL RIGHTS AND HEALTH EQUITY OF 
THE DEPARTMENT OF HEALTH AND HUMAN 
SERVICES. 
(a) NAME OF OFFICE.—The Office for Civil Rights 
of the Department of Health and Human Services shall, 
beginning on the date of enactment of this Act, be known 
as the Office of Civil Rights and Health Equity. Any ref-
erence to the Office for Civil Rights in any law, regulation, 
map, document, record, or other paper of the United 
States shall be deemed to be a reference to the Office of 
Civil Rights and Health Equity. 
(b) HEAD OF OFFICE.—The head of the Office of 
Civil Rights and Health Equity shall be the Assistant Sec-
retary for Civil Rights and Health Equity, to be appointed 
by the President with advice and consent of the Senate. 
Any reference to the head 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 Assistant Secretary for Civil Rights and Health Eq-
uity. 
SEC. 7. PROHIBITING DISCRIMINATION IN HEALTH CARE. 
(a) IN GENERAL.—No health care provider or entity 
providing health care may, on the basis of race, ethnicity, 
sex, sexual orientation, disability status, gender identity, 
age, subject another to inequitable health care. 
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(b) DEFINITION.—In this section, the term ‘‘inequi-
table health care’’ means any service provided by a health 
care provider or entity providing health care that— 
(1) is discriminatory in intent or effect; and 
(2) results in a disparate outcome for an indi-
vidual based at least in part on their membership in 
a protected class. 
SEC. 8. ADMINISTRATIVE COMPLAINT AND CONCILIATION 
PROCESS. 
(a) COMPLAINTS AND ANSWERS.— 
(1) IN GENERAL.—An aggrieved person may, 
not later than one year after an alleged violation of 
section 7 has occurred or terminated, file a com-
plaint with the Assistant Secretary alleging discrimi-
natory health care by a health care provider. 
(2) COMPLAINT.—A complaint submitted pur-
suant to paragraph (1) shall be in writing and shall 
contain such information and be in such form as the 
Assistant Secretary requires. 
(3) PROCEDURE.—Upon the filing of such a 
complaint— 
(A) the Assistant Secretary shall serve no-
tice upon the aggrieved person acknowledging 
receipt of such filing and advising the aggrieved 
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person of the time limits and procedures pro-
vided under this section and sections 9 and 10; 
(B) the Assistant Secretary shall, not later 
than 10 days after receipt of such filing serve 
on the respondent alleged to have provided dis-
criminatory care a notice of the complaint and 
advise the provider of the procedural rights and 
obligations of respondents under this section 
and sections 9 and 10, together with a copy of 
the original complaint; 
(C) a respondent may file, not later than 
30 days after receipt of notice from the Assist-
ant Secretary, an answer to such complaint; 
(D) the Assistant Secretary shall make an 
investigation of the alleged discriminatory 
health care practice and complete such inves-
tigation within 100 days after the filing of the 
complaint, unless it is impracticable to do so; 
and 
(E) the Assistant Secretary shall notify 
State licensing authorities with authority over 
the respondent of the complaint and provide a 
copy of the complaint and the final disposition 
of the complaint. 
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(4) INVESTIGATION.—If the Assistant Secretary 
is unable to complete the investigation within 100 
days after the filing of the complaint (or, when the 
Secretary takes further action under subsection 
(f)(2) with respect to a complaint, within 100 days 
after the commencement of such further action), the 
Assistant Secretary shall notify the complainant and 
respondent in writing of the reasons for not doing 
so. 
(5) OATH OR AFFIRMATION.—Complaints and 
answers shall be under oath or affirmation, and may 
be reasonably and fairly modified at any time. 
(6) PATTERN OF CARE.—In the course of inves-
tigating a complaint, the Assistant Secretary may 
seek records of care provided to patients other than 
the complainant if necessary to demonstrate or dis-
prove an allegation of inequitable health care. 
(7) ACCOUNTING FOR SOCIAL DETERMINANTS 
OF
HEALTH.—In investigating a complaint and 
reaching a determination, the Assistant Secretary 
shall account for social determinants of health and 
their effect on health care outcomes. 
(b) INVESTIGATIVE REPORT AND CONCILIATION.— 
(1) CONCILIATION.—During the period begin-
ning with the filing of such complaint and ending 
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under section 1886(r) of the Social Security Act (42 
U.S.C. 1395ww) or section 1925 of such Act (42 U.S.C. 
1396r–6) with respect to fiscal year 2020. 
(e) SUPPLEMENT, NOT SUPPLANT.—Grants awarded 
under this section shall be used to supplement, not sup-
plant, any other Federal funds provided to a recipient. 
(f) EQUITABLE HEALTH CARE DEFINED.—The term 
‘‘equitable health care’’ has the meaning given the term 
in section 1886(b)(3)(B)(viii)(XIII)(cc) of the Social Secu-
rity Act (42 U.S.C. 1395ww(b)(3)(B)(viii)(XIII)(cc)), as 
amended by this Act. 
(g) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal years 2021 
through 2026. 
Æ 
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