Readings To Consider vs. The Occasional Perspective - 1/18/21

Books and Articles worth a Review… 

An Overview of Biden Administration Health Care Priorities – The mainstream media has provided some coverage on “parts” of the health care priorities articulated by the incoming Biden Administration. I thought it might be helpful to provide an outline on those priorities starting with Covid-19 and continuing on to other important considerations.

  1. Covid-19 Plan – Biden in a major speech as well as through releases has stipulated a “7-Point Plan to Beat Covid-19”. The essence of the plan is as follows:
    1. Scale up testing – the intent will be to increase the number of testing sites offering “cost-free” as well as support the development and availability of at-home/rapid testing. In addition to testing, the plan calls for mobilizing 100,000 health care workers focused on supporting state and local efforts to conduct effective contact tracing and testing of at-risk populations.
    2. Provide adequate PPE supplies – While PPE supplies are less of an issue compared to several months ago, there are still issues. The plan calls for scaling up production and to restore national stockpiles utilizing the Defense Production Act. Another key element of the plan is to facilitate/support “domestic” production to ensure American independence.
    3. Engage the federal government as a leader of the response – The intent is to have the CDC step up with clear guidelines on criteria for responding to Covid-19 in terms of: when to open/close businesses, bars, restaurants, schools, gyms and other places where groups convene. A major component of this portion of the plan is to work with Congress to provide financial relief to state governments, local school districts and other adversely affected by the pandemic along with a Corona Relief Package for individuals taking them from the new $600 package to a total of $2000 in general relief.
    4. Deploy an equitable vaccination allocation plan – $25B is to be set aside for the manufacture and distribution of FDA-approved vaccinations. The intent is to make the process “free” to the public. In addition, transparency will be a requisite focus of the information which will be distributed widely for review and critique.
    5. Set a priority on elderly and high-risk individuals (NOTE: As I approach my 70th birthday in February, I leapt with joy when I read this portion of the plan – Thank Goodness 😊) – The Administration intends to establish a Racial and Ethnic Disparities (RED) Task Force to develop recommendations for managing these populations as well as the disparities issues. The CDC will also be establishing a national Pandemic Dashboard that denotes transmission rates by zip code for use by citizens.
    6. Restore national biodefense programs – The Trump Administration discontinued many of the in-place programs designed to monitor such world-wide problems as the global Covid-19 pandemic. The incoming Administration intends to re-establish the Obama Administration’s National Security Council Directorate for Global Health Security and Biodefense.
    7. Masks, Mask, MASKS! – Biden has been clear that masks are a priority ever since he made his first speech. He intends to put forward a “national mask mandate” for the first 100 days of the new Administration (= April 30, 2021) as well as advocate that the Governors and Mayors issue similar mandates in their respective jurisdictions.
  2. Return to a Use of Science-based Management in Public Health – The Administration intends to lead with science as the driver of decisions, the reliability of FDA-approved vaccines or medications.
  3. Override Executive Orders – The Administration is expected to override many of President Trump’s executive orders that were designed to undermine the Affordable Care Act. In fact, we should expect that the Democrats will focus on generally on increasing access and improving affordability plus expanding access in medically underserved communities in rural and urban America. The public insurance option will no doubt be back on the table as a competitor to private insurance as well as being made available to those with employer-based health plans. Elements that are likely to be included are 
  • Reinstatement of affordability requirements – to ensure that waivers do not adversely impact low-income consumers.
  • Reinstate HRA funded health plan purchases – so that retirement plans are not adversely impacted through use of funds for current rather than long-term needs.
  • iii. Tighter federal regulation – to increase benchmark plan requirements and levels of financial assistance for consumers in the marketplace.
  • iv. Protect coverage of contraceptives services – to recreate these services as an “essential” benefit as defined by the ACA and to reduce religious and moral exemptions.
  • v. Reinstate Obama-era regulations that strengthen marketplace risk pools.

4. Prescription Drugs – The most important of the various initiatives under consideration will be the passage of H.R. 3 and H.R. 1425 whereby the government will be able to negotiate directly with the manufacturers of drugs on pricing. Those negotiations are likely to not only include a government price but also an inflationary ceiling rate as well.

5. Reproductive Health – The Democrats’ agenda calls for the repeal of the Hyde Amendment that bans the use of federal funds to pay for abortions – except for life endangerment, rape, or incest) as well as restoration of funding for Planned Parenthood.

6. Broadband – The new Administration is also very committed to addressing the digital divide. Through the global pandemic, most everyone has become convinced that we need to “do something” to solve the lack of broadband in certain areas of the nation. Having kids sit in cars outside of Starbuck’s to do homework and hamstringing medical care delivery due to lack of sufficient bandwidth is increasingly recognized as a major problem. Biden’s “Lifeline Program” provides about $20B in funding to support the initiative. There is actually strong bipartisan support and a bridging between the urban and rural areas on this issue. As a result, we should not be surprised if this is not part of the “infrastructure” package discussed by Congress and the Administration (NOTE: I’ve been an advocate for some time of a National Broadband Infrastructure Deployment Initiative similar to the Interstate Highway funding of the 1960’s to dramatically alter the landscape of broadband capability across the nation. Such a broadband infrastructure could not only be used for education and health care but also for local commerce, remote workers and a vast number of other activities in our evolving digital society.). A secondary issue will likely be the restoration of the Federal Communication Commission’s (FCC’s) authority to enforce net neutrality principles and prohibit blocking, throttling and/or paid prioritization by broadband providers that raise consumer prices or impact competition.

On the other side of the equation, it is my strong sense that Medicare for All will be set aside in favor of re-enactment of those portions of the ACA that were set aside by the Trump Administration. In addition, I suspect that we will see a re-emergence of a strong focus on creating value-based care delivery plans by the Biden Administration as a move toward managing costs more effectively. In the later years of the Obama Administration there was a strong focus on value-based care which was sidelined during the Trump Administration. Expect a re-focus on this model of insurance with experimentation allowed under Medicare. With the large numbers of elderly already moving into Medicare Advantage programs – growing from 12 million to 24 million members – this could very well be one of the prime movers (or, the Big Gorilla in the Room) in the coming health care environment.

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