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Health Equity

Nicole Ortiz

Healthcare Brew delivers the latest news and trends in healthcare.

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Loneliness epidemic. Mental health crisis. These terms are often used to describe the state of mental health in the US, all while the country is also experiencing a behavioral health 

These mental health professionals provide counseling without going through the traditional state licensure process. One group, the 

 (LCA), is helping train groups like social workers, legal aid staff, and community health workers to become lay counselors.

Co-founder Alli Moreno brings her own expertise as a defense investigator and lay counselor to provide guidance for others interested in a “nonconventional pathway.”

After leaving the legal field when she started a family, she told us she was looking “for something that would be intervening or making a meaningful difference in people’s lives.” She joined up with co-founder Elizabeth Morrison in 2021 to see how Morrison’s psychology background and Moreno’s experience could help shape the field.

Healthcare Brew spoke with Moreno about her career and what people might not know about lay counseling.

This interview has been edited for length and clarity.

What do you think are some of the biggest misconceptions about lay counselors?

One that comes to mind is this misconception that mental health counseling is only being provided by licensed professionals. The reality is that, as we all know, the mental health crisis is acute, and the 

 is severe, so there’s that ongoing barrier to access.

There’s tons of different ways to approach this issue, but one of them is to acknowledge that mental health counseling is happening. Really pour in rigorous professional development like workshops, training, practice opportunities, adding weekly clinical supervision and support, all of that to make structural adjustments so that counseling that’s already happening is more effective and the people providing it are more confident in doing so.

[Another] misconception is the idea of a triage, or the idea [lay counseling] is a cheaper way to provide care. Our hope is that it is equivalent in terms of value.

What are the biggest challenges you’re trying to address through the LCA?

It’s really access to quality mental health support. The need is so severe, and it’s only increasing as more marginalized, vulnerable communities are targeted in government policies and 

. It’s already affecting young people and immigrants and LGBTQ+ community members; it’s already affecting people in 

There are so many competent, skillful people who are nowhere in this conventional licensure pipeline. But they have skill, and they have community connection, and they have the desire to be helpful. So, bridging that gap of helping folks, who are already in connection with people who need the help, to help them be able to do that even better and more competently and confidently and feel acknowledged is the biggest challenge.

What are the ways health equity plays into how you’re approaching this?

When you think about people who have lower resources, have lower social power, they’re less likely to be able to get care that they need. When we’re supporting people who are already in those communities—who already have relationships to meaningfully respond to those needs and to do so in a way that’s supported and there’s continual learning and growth—we’re responding to people who have the least access. That’s where we’re gravitating toward first.

What’s your biggest achievement in your career so far?

These [cohorts] are hearing these mental health struggles from people, which means that they’re doing something to indicate to the people that they’re safe. And that means that they have some sort of skill. And then not only is that person telling them, but they keep coming back.

I always feel so proud and happy to be able to elevate and amplify and acknowledge that skill in other people who come through our course and who are on our team, too.

A portrait of Alli Moreno, co-Creator of the Lay Counselor Academy & Counselor.

Lay Counselor Academy's Alli Moreno discusses lay counseling and reaching underserved patients

Through the Lay Counselor Academy, Moreno is addressing a provider shortage in behavioral health.

Alli Moreno discusses lay counseling and reaching underserved patients

Maia Anderson

When you think of healthcare innovation, you may think of 

artificial intelligence (AI)-powered medical devices

 that can diagnose diseases quicker than a doctor or devices that can 

But if you ask Kyu Rhee, president and CEO of the National Association of Community Health Centers (NACHC), the “most innovative part” of the healthcare system is one that’s already been around for 60 years: 

Established in 1965 as part of President Lyndon B. Johnson’s War on Poverty, CHCs provide primary healthcare services including chronic disease management, cancer screening, dentistry, behavioral health, and more to patients regardless of whether they can pay or are insured.

Today, CHCs treat nearly 1 in 10 people across the US. As head of NACHC, which represents the roughly 1,500 CHCs across the US, Rhee has big plans to expand that number to 1 in 3.

“I do believe when you look at the broader system, there’s no better model of primary care,” Rhee said. “Our model is very focused on those communities that need us the most, and in many ways, it’s defined by people who are low income or poor.”

Rhee took the helm of NACHC in July 2023 after a healthcare career spanning both public and private roles, including chief medical officer of CVS Health’s Aetna division and chief public health officer at the Health Resources and Services Administration, a division of the Department of Health and Human Services that focuses on providing care to vulnerable populations.

Rhee told Healthcare Brew he took the role as president and CEO of the nonprofit organization because he thinks, in addition to being the most innovative, CHCs are the best and “most resilient” part of the healthcare system.

Part of what makes them so is the fact that they “save lives and save money,” he said.

Though CHCs treat about 10% of the US population—that’s nearly 34.7 million people—they only cost about $55 billion, or 1% of all healthcare spend, according to NACHC. That’s because they’re efficient, affordable, and local, according to Rhee.

Plus, CHCs are required by law to be nonprofits and serve their communities, so they can’t be scooped up by giant for-profit corporations like Optum or CVS Health.

Another factor that keeps costs low, Rhee said, is that CHC boards are required to be made up of at least 51% patients, meaning the people they treat get a say in how the clinics are run.

However, it’s not easy to treat so many people while keeping costs down.

The two biggest challenges on Rhee’s mind at the moment are 

The NACHC says half the patients treated at CHCs are on Medicaid, which Rhee calls the “lifeblood” of the clinics. CHCs get roughly 42% of their revenue from the public payer, “so we need Medicaid to be protected in order to do the work that we do in saving lives and saving money in communities across this nation,” he said.

The Trump administration’s One Big Beautiful Bill, which was signed into law on July 4, reduces federal Medicaid spending by an estimated $990 billion over 10 years, according to 

Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County—which represents the more than 450 CHCs serving about 2 million people across the region—told Healthcare Brew the organization is bracing for “seismic shifts in the healthcare landscape in Los Angeles and beyond” because of the cuts to Medicaid.

“We’re looking at 3.4 million Californians falling out of coverage, and an estimated loss of $30 billion in federal funding for California,” McCarthy said. “If these folks don’t have coverage, how are we going to get them access to specialty care, to hospitals? We’re probably going to see a lot of hospital closures, and we won’t have places to send our patients.”

Staffing is also a big challenge, Rhee said, noting CHCs typically have a team of 10 providers to treat 1,000 high-need patients, who often live below poverty level.

McCarthy echoed that sentiment, saying it’s “really, really hard” as a nonprofit to “recruit and compete against larger, more resourced organizations.”

Though he’s only led NACHC for a short time, Rhee already scored a major win in March 2024 when CHCs received the first increase in federal funding in nearly 10 years, bringing the total to $4.4 billion annually.

Rhee said he considers this one of his biggest accomplishments during his tenure at the nonprofit.

“The fact that we’ve been nonpartisan and gotten bipartisan support is part of what I’m very proud of in my first couple years at NACHC,” he said.

Looking ahead, in order to meet NACHC’s goal of treating 1 in 3 people by 2045, “we need funding, we need workforce…we need to protect Medicaid,” Rhee said.

“We need to demonstrate that we’re a core part of making America healthy.”

National Association of Community Health Centers’s Kyu Rhee on the future of community health centers

These clinics rely heavily on Medicaid funding, which was slashed in the One Big Beautiful Bill. 

Kyu Rhee on the future of community health centers

The first year of a new presidential administration is always busy, but so far 2025 seems to have past years beat, as President Donald Trump has signed a record number of executive orders in just his first 100 days.

Now that we’re a little over halfway through the year, we wanted to look back on what has happened in the healthcare industry so far.

With a new administration comes the appointment of new department heads. That has included 

 being named secretary of the Department of Health and Human Services (HHS), 

 tapped to lead the Centers for Medicare and Medicaid (CMS), 

 as director of the National Institutes of Health (NIH), Marty Makary to run the FDA, and Susan Monarez to head up the CDC.

However, these departments also saw major staffing overhauls. The NIH saw top officials 

 in mid-February, with hundreds of layoffs following. HHS announced in late March it would lay off 10,000 employees—on top of 10,000 who had resigned already—which has impacted specific research areas like 

Across all agencies, funding has also been 

, impacting the industry from developing research to funding grants to keeping 

One of the concerns that came up frequently during RFK’s confirmation hearings was his past associations with vaccine disinformation and skepticism. Since taking over HHS, he has vowed to 

 that would analyze private medical records.

The spike in proliferating misinformation has public health and pharma experts 

. In particular, mRNA has come under fire (again), and some researchers are worried cuts might 

Previously, the Biden administration had also implemented a program that allowed CMS to negotiate drug prices directly with drugmakers. Trump took that a step further by signing an executive order that would 

 to be more in line with the lower costs other countries pay.

And speaking of more transparency around pricing, he also signed an executive order in late February that updated a ruling from his first administration, requiring hospitals to 

Before the election, experts were speculating about how Medicare and Medicaid 

Since cutting federal spending was a major goal of this administration, it perhaps comes as no surprise that one of the 

But, canceling out any potential savings made there, CMS announced in early April it would 

 average Medicare Advantage payments to 5.06%—a $25 billion increase—from 2025 to 2026.

Then on May 22, the House of Representatives passed a 

 that called for significant Medicaid cuts (nearly $800 billion, according to KFF) and a revamped 

, potentially leading to millions without insurance coverage. Before it was passed in the House, a report found that Medicaid cuts of this scale could lead to more than 

Across the board, diversity, equity, and inclusion (DEI) initiatives have been targeted by this new administration. Healthcare has been no different, with 

While Trump signed an executive order in late January to ban clinicians and defund institutions providing 

 for young patients, a legal expert told us the law 

. (Though that didn’t stop some institutions from pausing this type of care, at least temporarily, 

Collage of the Capitol building and hands wearing medical gloves holding pills and a vaccine bottle, arranged within abstract shapes.

Here are some of the healthcare policy highlights from the first half of the year

Because the news cycle has been so slow these last six-ish months, amirite?

Cassie McGrath

It hasn’t been easy to be an LGBTQ+ health facility in 2025. From 

 to recent HIV prevention funding cuts, LGBTQ+ healthcare has been going through a tumultuous time.

 in a 2022 study of 6,442 adults, including 958 LGBTQ+ people, that 50% of queer respondents had an “ongoing health condition” but were more likely to report a “range of negative provider experiences” and less likely to have a regular doctor compared to non-LGBTQ+ patients.

This Pride Month, we asked health experts working with the LGBTQ+ community about what challenges they’ve faced in the last six months, how they’ve changed strategies to adapt, and their goals for the rest of the year.

These interviews have been lightly edited for length and clarity.

Liana Douillet Guzmán, CEO of Boston-based LGBTQ+ provider Folx Health

Over the past six months, we’ve continued to navigate a wave of anti-trans legislation, executive orders, and harmful rhetoric—much of it intentionally misleading and meant to cause confusion around care options. Our goal is to provide resources and remind people that Folx is still here providing gender-affirming care. We’ve shifted our strategy to focus more on rapid response communications, community events and partnerships, and education efforts to help people understand their rights and access to care.

Our top priority is making sure LGBTQIA+ people can access the care they need, especially as threats to trans healthcare continue. That means expanding services that treat the whole person and offering as many options as possible for affirming, accessible care. We’re growing our partnerships with insurance providers so more members can use their plans to cover clinical visits, lab work, and hormone treatments. We’ve also expanded our therapy offerings to 17 states, with more to come.

Gaurang Choksi, founder and CEO of New York-based LGBTQ+ provider Violet

Our mission has always been clear: to make healthcare more equitable, effective, and human so that people can find providers who really see them, whether that means understanding their gender, race, background, or any other facet of their lived experience. That part hasn’t changed.

What has changed is how we speak about the work we’re doing. Over the last six months, we’ve had to navigate an increasingly politicized landscape—where words like “equity” and “inclusion” have started to create unnecessary roadblocks, especially for our partners working in Medicaid and other government-funded programs.

So we’ve evolved. Instead of focusing on labels, we’re doubling down on what matters most: whether providers have the skills to deliver care that is personalized, effective, and compassionate.

Our main goal is to ensure all Americans can access the personalized healthcare we deserve; we are reaching this goal by enabling health plans to identify and increase the amount of providers that are best equipped to serve key patient populations with better, more effective care. And in markets where gaps in access to person-centered care exist, we help health plans close access gaps with targeted clinical education.

Chris Viveiros, director of communications at Boston-based community health center Fenway Health

In the last six months, we’ve faced dual pressures: increasing political threats to LGBTQ+ healthcare—particularly 

—and financial constraints that challenge the sustainability of 

. In response, we’ve doubled down on coalition-building across sectors, expanded legal partnerships, and invested in rapid-response work to protect access and affirm our communities. We’re also reimagining how care is delivered, moving beyond traditional clinic walls to meet patients where they are and working to grow telehealth to stay nimble and ensure continued access to care.

We are building infrastructure that makes care more accessible, especially for trans and nonbinary patients, BIPOC communities, and young people. We’re also restructuring our medical leadership team to better support clinicians and streamline decision-making, with an emphasis on innovation and wellness. At the same time, we’re working to deepen community trust through local partnerships and culturally responsive care while protecting gender-affirming services at the policy level.

Healthcare worker holding transgender and rainbow pride symbols while advocating for inclusivity in medicine

How LGBTQ+ providers are maintaining access this Pride Month

Leaders at providers Fenway Health, Folx Health, and Violet share thoughts on LGBTQ+ care.

Remember the beginning of the Covid-19 pandemic? (How could you forget, right?)

The illness has so far caused 1.2 million deaths in the US, according to the World Health Organization, and cost the national economy an estimated $16 trillion to date.

 and the ongoing mental health effects, especially on 

 due to Covid as well and have faced ongoing challenges in the years since the WHO declared Covid-19 a pandemic, including 

 may be one of the best ways to prevent infectious disease outbreaks and pandemics, according to a 

 from the University of Georgia and Oklahoma State University.

“Understanding some of the factors that lead to disease outbreaks is really important because we want to understand how to control them, how to manage them, how to prevent them,” Payton Phillips, lead author on the study and postdoctoral researcher at the University of Georgia, told Healthcare Brew.

 To conduct the research, Phillips and her team looked at the 100 biggest outbreaks of zoonotic pathogens, or diseases spread through animals, like tuberculosis, plague, and salmonella between 1977 and 2017.

The team pulled information from the Gideon Pathogen Database, which tracks disease online across the world. They also used previous research by Patrick Stephens, assistant professor at Oklahoma State, another author on the study, to reach their conclusions.

Stephens’s research pulled the 100 biggest diseases, and in this more recent study, the researchers broke each down by 48 different disease drivers—like food and water contamination, livestock production, sewage management, and deforestation—and sorted them into either 

 like climate change, weather patterns, and 

 were more likely to cause viral diseases. Meanwhile, socioeconomic factors like antibiotic use, contaminated water and food, sewage management, and public health infrastructure were more likely to cause bacterial outbreaks.

The data showed a large outbreak was more likely to be bacterial if a socioeconomic condition was reported compared with an ecological condition.

“But then we ended up finding an interesting pattern where the viral outbreaks would end up being bigger if there were more socioeconomic drivers,” Phillips said. “So they weren’t triggered by those socioeconomic things, but they would grow because of them.”

One of her key takeaways from the research, Phillips said, was that addressing socioeconomic factors is key to preventing disease.

“Preventing that from the get-go would save a lot of lives, probably save a lot of money, and at least prevent people from getting sick,” she said.

Close-up of a faucet with a large water drop hanging from spout, the water drop has a virus inside.

Preventing outbreaks comes down to addressing socioeconomic and environmental factors, study finds 

Addressing things like water contamination can prevent disease outbreaks. 

Imagine working multiple jobs at once to provide healthcare access to the most vulnerable residents of your community while operating on razor-thin margins and also saving the overall US healthcare system money.

That’s what it takes to be the CEO of a community health system (CHCs), according to Andrea Schwab-Galindo, chief exec of the Tiburcio Vasquez Health Center in the San Francisco Bay Area.

, which means it’s an outpatient clinic that’s eligible for certain types of state and federal funding. The health center was founded in 1971 and now operates 14 sites, treating about 30,000 patients across roughly 113,000 visits annually.

“Unlike other CEOs at other health systems, as a community health center CEO you have to wear multiple hats,” Schwab-Galindo told Healthcare Brew. “I joke around and I tell our staff that if you work at a community clinic you can work anywhere because you really have the opportunity to learn so many things and to do a lot more than you would at a private hospital.”

Schwab-Galindo took over the reins at Tiburcio Vasquez in 2020 after working her way through various leadership roles starting in 2013. Before starting at Tiburcio Vasquez, Schwab-Galindo spent four years at another community health system, Bay Area Community Health.

At Tiburcio Vasquez, providers care for a “really complex patient population” of mostly children and Medicaid beneficiaries, Schwab-Galindo said.

“They come to us either because their parents don’t have access to healthcare” or because of the quality of care health centers can give patients, she said.

Having a high Medicaid population (70%, or roughly 20,000 patients) means “the total cost of care for us typically exceeds what we get reimbursed for each visit,” according to Schwab-Galindo.

The health center works with foundations and private funders and receives grants that help offset some of the costs, she said, but “funding is the No. 1 challenge that we have.”

And that isn’t unique to Tiburcio Vasquez.

CHCs typically have very thin margins, with roughly 42% having 90 days of cash or less on hand, according to Amy Simmons Farber, communications director for the advocacy group the National Association of Community Health Centers (NACHC). For the last two years, CHCs have relied on extensions of a continuing resolution to provide a large chunk of their funding, which is set to expire on Sept. 30.

Wait…what exactly is a community health center?

CHCs were first established in 1965 as part of President Lyndon B. Johnson’s “war on poverty,” and provide healthcare to everyone regardless of insurance status or ability to pay.

The health centers are typically composed of a group of outpatient clinics that provide primary care services in addition to dental care, mental health care, nutritional care, and more, according to Simmons Farber.

Today, there are roughly 1,500 CHCs serving about 32.5 million people in the US in both urban and rural areas. Of those patients, roughly 90% have low incomes (at or below 200% of the federal poverty level, which in 2025 is $32,150 for a household of four), 18% are uninsured, 64% are people of color, and 62% have public health insurance, according to an NACHC fact sheet.

Additionally, the health centers employ roughly 310,000 providers including physicians, nurses, and advanced practice professionals.

The purpose of the centers, aside from providing greater access to healthcare, is to save the overall healthcare system money by preventing costly emergency room (ER) visits and hospitalizations, according to NACHC. ER visits cost the US $80.3 billion in 2021, according to the most recent data from the Agency for Healthcare Research and Quality, a division of the US Department of Health and Human Services.

In 2023, the Congressional Budget Office estimated that funding CHCs would reduce spending on federally subsidized health insurance by $3.4 billion between 2024 and 2033 because the health centers “could provide more cost-effective patient care.”

The financial challenges of running a community health system could become even greater if significant Medicaid cuts being floated by Congress are passed.

While Congressional Republicans have said they don’t intend to cut Medicaid, the House of Representatives in February 

 a budget resolution that calls for $880 billion in budget cuts from the Energy and Commerce Committee, which oversees Medicaid and Medicare.

If the cuts are passed, Schwab-Galindo said she and other CHC leaders would be forced to consider reducing staff and closing clinics, which would jeopardize healthcare access for the thousands of patients she says rely on Tiburcio Vasquez.

And in the long term, Medicaid cuts would likely mean more costs for the overall health system, because inadequate access to primary and preventive care could lead to 

“Community health centers and clinics could be forced to cut back services,” Schwab-Galindo said. “That’s really jeopardizing the work and access for millions of patients. For us, it’s thousands of patients, and for folks in California, it’s hundreds of thousands of patients that need access to critical care.”

CEO Andrea Schwab-Galindo on the challenges of running a community health center 

Running a health center on razor-thin margins and unstable funding is no easy feat. 

What it’s like to run a community health center 

HCBR-Gender affirming care audio embed

Lawmakers are increasingly working to restrict gender-affirming care.

As of March 2025, 27 states have banned or put restrictions on gender-affirming care for minors, according to data from the nonprofit think tank the Movement Advancement Project. And in January, President Trump issued an 

 directing agencies to limit access to those services, though it’s unclear how the order would be enforced.

Much of that legislation is fueled by “misinformation” and misunderstanding of what gender-affirming care for minors entails, Elana Redfield, federal policy director at the Williams Institute, a think tank and research organization at the University of California, Los Angeles, told Healthcare Brew.

“What we’re seeing with trans healthcare is that ideology is being treated as far more important than reality, and the result of that is, unfortunately, that a lot of trans people, especially trans kids, could get harmed by that,” Redfield said.

Gender-affirming care includes a range of “social, psychological, behavioral, or medical…interventions designed to support and affirm” someone’s gender identity, according to the WHO. Most major medical associations, including the American Medical Association and the American Academy of Pediatrics, recognize gender-affirming care as vital to trans people’s well-being.

For kids as well as adults, gender-affirming care can include social interventions like wearing clothing or hairstyles that affirm someone’s identity or legal measures like changing identity documents, Redfield said. Medical interventions, she added, include treatments like hormone therapy, puberty blockers, and surgical procedures.

While President Donald Trump and other conservative politicians have 

 that “countless children” are accessing gender-affirming medications and procedures, data shows that’s not the case.

For those under 18 in the US, receiving medical treatments like prescription drugs or surgical procedures is uncommon, studies show. Plus, minors undergo medical assessments and “a pretty strenuous set of protocols” before they can access such care, Redfield noted.

There are about 20.9 million people ages 13 to 17 in the US, and of those, about 300,100 (or 1.4%) identify as transgender, according to the Williams Institute, a research institute that focuses on sexual orientation and gender identity law and public policy.

Children must meet a specific set of criteria to be prescribed gender-affirming medications, including displaying signs of gender dysphoria over a “sustained” period of time and showing “emotional and cognitive maturity” to give informed consent for the treatments, according to diagnostic standards from the World Professional Association for Transgender Health. Gender dysphoria is the “feeling of distress that can happen when a person’s gender identity differs from the sex assigned at birth,” according to the Mayo Clinic.

 published in January found that over a five-year period, for every 1 million people under the age of 18, 180 had ever been prescribed a puberty blocker and 370 had ever accessed hormones. Plus, no trans or gender-diverse children under age 12 received any hormones.

Gender-affirming surgeries or procedures for minors are even rarer.

 published in June 2024 analyzed the prevalence of surgeries among transgender and gender-diverse minors in 2019.

Researchers found that for patients between ages 13 to 14, the rate of surgeries was 1 per 1 million and for those ages 15 to 17, it was 21 per 1 million. No children under age 12 underwent a gender-affirming surgery or procedure, according to the study.

“We know from working with clinicians that surgeries have always been rare for those under the age of 18, and the surgeries that were most typical to occur were mastectomies for those at older ages of adolescence,” Landon Hughes, a postdoctoral research fellow at Harvard and an author on both studies, told Healthcare Brew.

Additionally, of the 151 breast reductions performed on minors in the second study period, 146 (or 97%) were performed on cisgender males, who undergo the procedure due to conditions like gynecomastia, which causes increased breast tissue due to a hormonal imbalance, according to Cleveland Clinic.

“It’s important to note…that gender-affirming care is for everybody,” Hughes said. “It’s really important for us to begin thinking about gender-affirming care as not just something that transgender people engage with.”

There’s a “pretty wide body of evidence” that shows gender-affirming care improves trans people’s well-being, Redfield said.

For example, the What We Know Project at Cornell University 

 56 peer-reviewed studies published in English between 1991 and June 2017 that researched the effects of gender transition on people’s well-being, and found a consensus that “gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals.”

Early results from the 2022 US Trans Survey, conducted by the nonprofit Advocates for Trans Equality Education Fund, also found that 98% of respondents who had received hormones and 97% of respondents who had received a surgical procedure to affirm their gender identity were more satisfied with their lives.

On the other hand, lacking access to gender-affirming care is associated with negative mental health outcomes like depression and suicidality, research shows. A 2022 study from the University of Washington, Seattle, found that people ages 13 to 20 who received puberty blockers or gender-affirming hormones were 60% less likely to develop depression and 73% less likely to show suicidality.

“With these bans, [providers] expect, unfortunately, kids to commit suicide,” Hughes said. “Some of the kids, their friends, may only know them as one gender, and now they’re going to go through the puberty of another gender, so they’ll be outed and [that’ll] cause stigmatization and harm in that way.”

A medical cross colored in with the transgender flag colors