The Health System Trump will Pass onto Biden

2021 will be a pivotal year for healthcare with the pandemic as only a piece of the equation. 

President Biden faces a number of monumental challenges in 2021, one of the first and most pressing being the Pandemic and the suffering healthcare system. The healthcare system itself is sick, overburdened with a very sick population, huge financial losses due to skipping preventative care in 2020 and an overwhelming number of hospitals in the red. 

But we see that some hospitals are worse off than others. A disproportionate number of hospitals that care for low-income and communities of color are facing the largest risk while private hospitals that served wealthier and whiter demographics are in much better shape. 

Of the policies that Biden has promised in his first 100 Days, are how to incorporate telehealth into care models while the pandemic continues or to pursue new stimulus packages to the healthcare system. All of these choices will shape the long-term outcome of the health system for the United States. Healthcare has needed an overhaul for a long time and the nature of disasters is that they create change. The question is whether the change will be positive or negative. 

In one of our earlier articles we stated how partnerships between payers and providers were going to be essential to pushing the needle to improve patient outcomes and reduce cost. However with the financial losses incurred in 2020 due to a lack of preventative and primary care procedures, the financial tensions could cause insurance companies and providers to be at loggerheads. There is also a fear that any progress in health equity made by the ACA has been eroded by the Pandemic and the Trump Administration. This could result in skyrocketing healthcare prices while some providers disappear from the marketplace altogether, reducing care options. 

From 2010 to 2016 we saw exponential growth in America’s health system with spending rising and healthcare jobs reaching an all-time high. Insurance enrollment also increased during this time period with the ACA covering more people than ever before. Although the Trump administration pushed some of the growth back, more people are insured than at the start of the decade. The growth over the last decade didn’t only increase the gains for healthcare, it increased access and equity for individuals. 

We saw that historically underprivileged populations were seeing historical lows in uninsured and inequities faced by Black and Latino people. However by 2018, we see this start to backslide as well. Another area that we saw growth and a simultaneous decline under Trump is Medicaid expansion providing increased health equity in outcomes like infant and maternal morality. One specific decline was in health coverage for children. 

All of these gains are eroding after 4 years of President Trump and now with a pandemic, the healthcare system is bracing for record losses. The trend of declines was accelerated with the pandemic forcing practices to cancel primary care, elective surgeries and other lucrative procedures. Without much help from the Federal government, our healthcare system is in rough shape. There is some uptick in income and job growth but these gains are happening disproportionately among wealthier hospitals. The nation faces a shortage of nurses, but we are seeing nurses scouted by wealthier hospitals that can pay better salaries while rural communities are forced to hire short-term traveling nurses. Nurses know they can get a better salary elsewhere, and they are taking the offers. Many hospitals feel discouraged after working arguably harder than ever, and are met with the “reward” of huge financial losses. 

In order for hospitals and practices to stay afloat, they need income. With continual state-wide shut downs, elective and primary care procedures are the first to be cut. How can these healthcare providers continue to serve the community if they can’t pay their bills? Many hospitals are furloughing workers in order to breakeven. Of course these are the hospitals in low-income communities where people don’t have the technology to accommodate telehealth visits either. It gets worse, for everyone who has chronic conditions and missed their preventative/primary care visits, they are sicker this year than ever before. Higher rates of suicide and other mental health illnesses are also rising. Addiction treatment is not available during Covid and this has resulted in a skyrocketing rate of overdose deaths and remission from sobriety because of lack of access to care and support networks. 

A decision Biden will face is to continue paying the high reimbursement rates offered for telemedicine visits. Costly but necessary? If the answer is yes, it could expand to more beneficiaries of Federal programs. Other decisions are whether to provide additional stimulus funding to health providers and who will be the lucky recipients. The Biden administration will need to create policy to determine how the sickest and most vulnerable receive care with reduced insurance coverage. Do you expand Federal programs like Medicare and Medicaid to take more people under the Federal umbrella? Or would a restoration and expansion of the ACA do the trick? Of course Congressional approval is necessary for any of this to take place. 

We can say we don’t envy the Biden Administration for these mounting priorities but we do hope he makes the right decisions. Only time will tell.