A Pandemic Policy Prescription for 2021
By: Wazir Akbar Khan
Tags: Biden, Health, Politics, Pandemic, Covid 19

A Pandemic Policy Prescription for 2021

Photo: Anton Petrus/Getty Images

OnJanuary 20, Joseph R. Biden will be sworn in as the 46th president of the United States, taking the reins during an era of unrivaled conflict as a nation, divided in its battle over a deadly, worldwide contagion. The new administration will seek to change course from an anti-science, anti-health care, uber-individualistic — if not outright narcissistic — outgoing president. During the run up to the election, Biden campaigned on protecting the Affordable Care Act, creating a public option to enroll more people in health coverage, increasing the value of tax credits available to those in purchasing coverage in the individual market, closing the Medicaid gap, and allowing Medicare to negotiate pharmaceutical prices, among many other policy prescriptions.

With Congress likely divided between the two parties, and with narrowing margins for each, Biden, who will enjoy the support of more Americans than any other president in history, will not have much room to maneuver his arguably modest policy proposal. On what, then, should the incoming administration focus their efforts?

First and foremost, a swift and strong response to the Covid-19 pandemic is the greatest priority for the incoming administration. Second, coverage losses due to the prior administration and the pandemic should be reversed. Third, America must focus on the most vulnerable — seniors, Black, Brown, and Native peoples — as our health care system progresses.

The greatest threat to our nation, our economy, and our American way of life continues to flow from the unrelenting push of the coronavirus across the United States. Public health countermeasures, beginning with masks and physical distancing but encompassing financial support to encourage people to remain at home as long as possible until mass vaccination can produce herd immunity, are the first priority of the incoming government. As I described with Ali Khan, MD, MPP, in a previous essay, a meticulous and coordinated pandemic response is immediately necessary in the coming months. Following the science and trusting the scientists must become the practice of our politicians.

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In order to staunch the impact of the virus on people’s lives — millions of whom have lost health care due to job losses — it is critical to provide a mechanism to expand coverage. Biden must assertively ask Congress to expand financial subsidies to make health insurance more affordable for middle-class Americans obtaining coverage through the Affordable Care Act’s marketplaces. And for the working poor and those below the poverty line, the incoming administration should find a way to expand Medicaid to individuals locked out of coverage by stubborn Republican state legislatures. To do so, he should push forward with the idea of a Medicaid public option, offered on the healthcare.gov marketplace, that provides a premium-free insurance plan with minimal cost-sharing to anyone residing in a state that has yet to implement the Affordable Care Act’s Medicaid expansion up to 138% of the federal poverty level. This action alone could cover more than 2 million Americans reversing the coverage losses experienced under President Donald Trump.

In its first 100 days, the Biden administration will need to focus diligently on health equity, examining the impact of hundreds of years of systemic racism on Native, Black, and Hispanic communities that have been violently struck by the coronavirus pandemic coupled with a severe disparity in health coverage. While one in 12 whites lack insurance, one in eight in the Black community and approximately one out of every five Hispanic or American Indian/Alaskan Native persons goes without coverage. Nearly half of the uninsured are minorities.

America must, therefore, invest heavily in these communities. Health care resources should be heavily devoted to these historically neglected communities, including vaccines and tests, technology such as telemedicine and broadband internet, and public health jobs such as epidemiologists and contact tracers.

In many ways similar to my policy prescriptions from prior years, the outlook for 2021 focuses heavily on coverage, but it must also emphasize the modernization of a private health and public health delivery system that refuses to leave anyone behind. The new administration has a lot of work to do, and, as it is evident with the recommendations for several key administration positions, it should start right away.