By Grace Flaherty
Mere months ago, health care reform was on track to be the defining policy issue of 2020. Nationally, presidential candidates fiercely debated the merits of their respective reform plans. In Massachusetts, the legislature was poised to consider health care reform this summer, including Governor Baker’s proposal. However, these pre-pandemic proposals are inadequate to meet the pressing health care challenges ahead.
The COVID-19 pandemic is the number one policy priority for federal and state legislators and political candidates, and rightly so. This crisis underscores that health care policy is more relevant than ever. Millions of Americans are losing their jobs and their health insurance in the economic fallout of COVID-19. Thousands are falling ill with the virus and seeking costly emergency treatment.
Federal Reforms Face Off Against COVID-19
On the national stage, there are two primary health reform camps. The Biden Plan would retain the employer-based system, but expand coverage through a subsidized public option, similar to Medicare, available for individuals who lose their jobs, or don’t like or can’t afford insurance offered by their employer. Senator Sanders’ hallmark Medicare for All Act would end all employer-based insurance, instead creating a universal Medicare program that covers all Americans in one government-run health plan.
Now, with the economic losses from COVID-19, millions of Americans are losing their employer-sponsored health insurance and falling through gaps in public coverage. A new analysis from the consulting firm Health Management Associates (HMA) estimates that the COVID-19 crisis could lead to between 12 and 35 million people losing employer-sponsored health coverage due to job losses; an increase in Medicaid enrollment from 71 million to between 82 and 94 million; and total uninsured numbers increasing by 11 million. More acute increases are expected in states who have opted not to expand Medicaid.
Although Senator Sanders is out of the presidential race, Medicare for All still holds considerable weight in the health care debate. The plan would address the country’s patchwork of private programs laid bare by new economic losses. Medicare for All proponents argue that COVID-19 is the perfect policy window for single-payer, in so far as the sobering uninsurance projections are proving the need to move beyond employer-based insurance. However, although Sanders’ progressive base is strong, the politicization of Medicare for All dramatically limits its viability in Congress.
Presumptive Democratic Presidential Nominee Joe Biden has come out against single payer as a viable solution to COVID-19’s strains on the health care system. Instead, Biden’s COVID-19 plan would direct more funding towards hospitals and double down on protecting the gains made by the ACA which provides coverage and access protections not available in previous recessions. However, the ACA remains under threat in court, and any plans Biden puts forth are contingent on his winning the election this fall. Furthermore, Biden will likely face significant pressure to move his own plan further to the left to garner support from Sanders’ supporters and progressive Democrats in Congress.
How Health Care Reform is Holding Up Closer to Home
In Massachusetts, the legislature was gearing up to consider health care reform this summer. Governor Baker’s health care bill, introduced in October 2019, proposes a number of ambitious reforms, some of which are relevant amidst the COVID-19 crisis. The bill would improve access to telemedicine, which has emerged as an enormous need as individuals are being asked to stay home as long as possible before seeking in-person care and which MassHealth has already stepped in to address. Baker’s bill would also expand scope of practice standards for mid-level practitioners, particularly important given the heightened demand for health care professionals.
Surprise billing was another target of Baker’s reform effort. His proposal would prohibit out-of-network billing in certain instances, such as in emergency situations. A recent national analysis found nearly one in five patients hospitalized at in-network hospitals for pneumonia (one complication that can arise from COVID-19) incurred at least one out-of-network charge. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) attempts to reduce this balance billing issue by mandating that providers who accept federal funds not send surprise medical bills to patients — whether or not they test positive for COVID-19.
Despite the potential benefits of the Governor’s bill, it has been all but forgotten in a legislative standstill with state lawmakers struggling to move a continuing budget resolution due by June 30th and efforts to move forward on emergency provisions to stabilize the current crisis, effectively tabling a broader health care overhaul. Even if a health care reform bill came to debate, it is uncertain whether the state would be able to afford its provisions given tax revenues are projected to drop by more than $4 billion as state unemployment rises towards 18 percent.
At both the state and federal level, there is an obvious tension between a health care system that desperately needs to be improved to insure and treat vulnerable citizens, and the enormous financial challenges looming over policymakers and the public. Although the timeline for any state and national health care reform is uncertain, one thing is clear – any future reform proposals will need to grapple with the new political, economic, and health systems realities of a post-pandemic world.
Grace Flaherty is a dual-master’s candidate at Tufts University. She is working toward an MS at the Friedman School of Nutrition Science and Policy with a specialization in food law and regulation and an MPH at the School of Medicine’s Public Health Program with a concentration in health services management and policy.