A New Congress and A New President: What to Expect
What happens when you take four policy and public affairs professionals from two different parties and ask them what they think the health policy agenda looks like following the 2020 elections? Well, surprisingly you get a good deal of consensus.
The Focus on SDOH Will Take Off
Viewpoint from Patrick Brady
As JPA Health’s policy and public affairs professionals game plan the 117th Congress and a Biden Administration, we keep returning to an overarching framework that will drive health policy for the next two years: the need to address social determinants of health, health equity and the conditions that arise from our lack of investment in them.
For many years, research into social determinants of health (SDOH) had been the province of foundations, academicians and public health researchers. It has only been in recent years as health care delivery and payment transitioned to a value-based model that physicians, hospitals, pharmaceutical companies and other market sectors have recognized they cannot, and will not, successfully improve patient health, unless SDOH are addressed. Broadly defined, SDOH recognizes the conditions in which people are born, grow, live, work and age have a major influence on health and health care costs. This includes factors like socioeconomic status, education, neighborhood and physical environment, employment, nutrition/food security, access to health care, and social support networks.
According to The Physicians Foundation 2018 survey of more than 8,500 physicians, almost 90 percent said their patients had a serious health problem linked to poverty or other social conditions. Today, because of COVID-19, we can see just how devastating the combined impact of a pandemic and SDOH are to traditionally underserved communities.
According to recent data from the Centers for Disease Control and Prevention (CDC), non-Hispanic American Indian or Alaska Native people had an age-adjusted COVID-19 hospitalization rate about 5.3 times that of non-Hispanic white people. COVID-19 hospitalization rates among non-Hispanic Black people and Hispanic or Latino people were both about 4.7 times the rate of non-Hispanic white people.
To date, there is no evidence these populations have genetic predispositions making them more likely to become sick from COVID-19, but they are more likely to have other conditions like diabetes, obesity and asthma (among others) that are strongly tied to SDOH.
The stark reality that communities of color are getting sicker and dying at a greater rate than white communities, coupled with the nation’s growing, and hopefully sustained, commitment to racial equity, means policymakers are serious about addressing SDOH and other health inequities. Already President-elect Biden has signaled a strong commitment to the topic by choosing Dr. Marcella Nunez-Smith to lead the transition’s coronavirus response effort. As Politico noted, this “…puts the fight against the virus in devastated Black, Latino and Native American communities smack in the center of his pandemic response.”
To be clear, the incoming administration doesn’t own the SDOH agenda. There are already several bills in Congress seeking to address social determinants and endowed organizations like the Kaiser Family Foundation, the Commonwealth Fund, and even the Humana Foundation have begun investing resources in SDOH. But now there is significantly greater attention given to the topic. The insurance industry is advancing efforts on SDOH significantly. America’s Health Insurance Plan, the trade association of health insurers, recently increased internal staff focused on SDOH. Finally, a coalition of insurers, managed care organizations, insurance and hospital trade associations have developed an organization called Aligning for Health, which spent $300,000 lobbying on SDOH issues in 2019 and more than $200,000 so far this year.
As my colleagues, Ryan and Adjoa, note, we know how policymaking will proceed like this year. Given the connection between SDOH and value-based care, it’s only a matter of time before the entire healthcare echo chamber is advancing solutions to address SDOH. The question I’m most interested in answering is, who will drive policy on SDOH? Want to take a crack at it? Give us a call.
Politics Will Dictate the Legislative Process
Viewpoint from Ryan Shucard
To predict the policy landscape is to also predict the politics that shapes it. If recent electoral history is any indication of what to expect for the next two to four years, it is that unlikely events seem more possible and the traditional norms seem sparse. This may change with a new presidential administration, but the volatility of our politics makes the certainty of policymaking less certain. Even in a post-pandemic world, healthcare will remain among the top issues for voters and they will expect Congress, the Administration and its agencies to tackle serious challenges. But how will this happen when the last three election cycles delivered unexpected results and gridlock on Capitol Hill remained?
While nobody in Washington has a crystal ball, it’s a safe bet to say that any meaningful reforms to healthcare will come via smaller legislative packages or, most likely, by executive order and regulatory issuance rather than comprehensive and full-scale overhauls to wide sectors of the industry.
As the current administration exits, it will continue to look for ways to finalize regulatory guidance it hopes can withstand reversals from the incoming administration. And, with so many unresolved legal battles making their way through the courts and ultrathin majorities/minorities in Congress, it’s likely the new administration will demonstrate progress on its policy priorities, including a slew of potential shifts in healthcare, by leveraging its executive authority.
However, executive orders will only go so far. If Republicans retain control of the Senate (although 2020 has proven to be a year of surprises), we anticipate the Biden Administration will face stiff opposition in confirming key cabinet and agency positions. This will hinder a Biden Administration’s ability to fully implement bureaucratic changes at regulatory agencies and likely slow new rulemaking processes.
None of this means the work of issue advocacy should cease. Despite the aforementioned challenges, as significant and frustrating as they are, the country is still in a healthcare crisis. This crisis has stretched our healthcare system to the breaking point while laying bare the failings and shortcomings of our current system and its costs, access and quality issues. Now is not the time to stop in the face of divided government, advocates must continue to affect change in Congress and the Executive Branch with the understanding traditional avenues may remain closed, requiring creative approaches to influence the landscape – that’s where JPA comes in, as. As creativity is at our core.
Looking at how a Biden-Harris Administration May Impact Executive & Regulatory Action on Health
Viewpoint from Adjoa Adofo Kyerematen
Due to a divided Congress and healthcare still being a top issue among the American public, the Biden-Harris Administration is predicted to rely heavily on executive and regulatory actions to address key health issues. Moreover, President-elect Biden has moved quickly to announce a task force to address the ongoing coronavirus pandemic primarily comprised of former Obama-Biden appointees and clinicians. A few on the task force are expected to occupy top positions at the Department of Health and Human Services (HHS) and health adviser roles at the White House. Former Surgeon General Dr. Vivek Murthy, who currently leads the task force, led Biden’s healthcare team during the campaign and is widely discussed as a top choice to lead HHS.
Another name likely to be considered to head HHS is Governor Michelle Lujan Grisham (NM), who once led efforts looking into implementing a public option for healthcare at the state level through Medicaid and currently co-chairs Biden’s transition team. The ultimate choice may shed light on what the Biden-Harris Administration will focus on during its first term. Do they anticipate managing the pandemic to remain the top priority for the entirety of its first term or will they respond to continuing pressures to expand access to affordable healthcare?
With this backdrop, we should expect a few things:
- Public health initiatives will regain focus – With the urgency of the coronavirus pandemic, stress on health systems and hospitals as well as a campaign emphasis on science, expect more funding, staffing and stakeholder outreach towards federal and state public health programs, particularly under CDC and NIH. Unsurprisingly, the FDA is expected to be inundated with a vigorous and urgent process to review and approve drug authorizations to address COVID-19.
- Stabilizing the Affordable Care Act. Biden will likely look to stabilize an Obama-Biden era legacy program that has experienced a lot of executive orders and court battles in recent years designed to diminish the program’s scale. A Biden-Harris administration may also seek to bolster enrollment through more education, communication and outreach initiatives as well as Medicaid expansion.
- Addressing Healthcare Costs: A looming question is what will happen to President Trump’s drug pricing executive orders. Will a Biden-Harris Administration scrap them to start over, or will they build upon them? One immediate action around drug pricing could center around increasing transparency. However, drug pricing is only a part of the conversation around the cost of care; there is interest in addressing Medicare out-of-pocket costs.
- The value-based care drumbeat will go on. With the expectation of many Obama-Biden-era health officials making a return to serve the incoming Administration, value-based and health-outcome measures that were largely born under former HHS Secretary Sylvia Burwell and grew under the Trump Administration are expected to carry on. CMS Center for Innovation may be invigorated to pursue reimbursement model demonstrations address costly social determinants of health, similar to the Medicare diabetes prevention program, particularly in areas where there are health equity issues.
These areas of focus represent tremendous opportunities for private sector and nonprofits looking to partner on the federal government level at a time when stakeholder engagement will likely go into hyperdrive to tackle urgent challenges. With rich federal government agency and executive branch experience, JPA’s public affairs team is ready to help both government agencies and the stakeholder community navigate the rapidly changing landscape to amplify the work to improve people’s lives.
A Bipartisan Issue Demanding Action: Addressing an Opioid Crisis in the Midst of a Pandemic
Viewpoint from Ben Shannon
The incoming Biden Administration will face many challenges, from addressing the COVID pandemic to rebounding a sagging economy that is inextricably connected to the virus.
Another major challenge will be how to fight the country’s ongoing opioid epidemic, which is being made worse by the economic stress, job loss, and social isolation due to COVID-19. Overdose deaths were rising even before COVID-19, contributing to lower life expectancy in the U.S. compared to its peer countries, like Germany, Britain, and France. Now the pandemic further complicates efforts to address the crisis.
For President-elect Biden, addressing the opioid epidemic is personal. He spoke openly during the 2020 campaign about his son Hunter’s struggles with addiction, most prominently at the first Presidential debate. Biden has an ambitious plan to fight the opioid crisis. It would dedicate $125 billion over 10 years to scale up addiction treatment, and other prevention/recovery programs. His plan would also place a higher tax on pharmaceutical companies that manufacture opioids, instruct the Department of Justice to “make actions that spurred this crisis a top investigative and, where appropriate, civil and criminal enforcement priority”, and ban manufacturers from making payments or incentivizing doctors from prescribing their products.
Pending the outcome of the two Senate races in Georgia, Republicans are more likely to retain the U.S. Senate—meaning that other major Democratic policy priorities, such as major economic investments, health care reform, and addressing climate change—are unlikely to be become law. But the opioid crisis is different. Several Republican senators from states hard hit by opioid overdoses have signaled interest in addressing the crisis.
To put it another way: the opioid crisis is one of the few issues facing the country where there is bipartisan interest in working together to fight it. As such, it is likely to be top-of-mind for the incoming Biden Administration. In a country with pre-pandemic numbers of “roughly 1 in 10 American adults” who have struggled with drug addiction, taking action to fight the opioid crisis is more urgent now than ever.
At JPA Health, addressing the opioid crisis is an issue many of our team members are passionate about. Give us a call if it’s your passion too.