According to one definition in the Oxford English Dictionary (Third Edition), “reform is the action or process of making changes in an institution, organization, or aspect of social or political life, so as to remove errors, abuses, or other hindrances to proper performance” Viewed from that perspective, the term signifies an effort to make improvements. Although the U.S. in recent decades has made significant strides in the realm of health care through efforts to reduce the ranks of the uninsured, more work continues to be necessary. The Patient Protection and Affordable Care Act, also known as the ACA, that became law in 2010 represented an attempt to increase the number of individuals with health insurance, reduce costs, and improve quality. Some positive results were achieved, but not enough.

Apart from deliberate efforts by policymakers to bring about such improvements, unanticipated events also can play a decisive role. The COVID-19 pandemic that continues to wreak havoc across the entire U.S. in 2020 offers a vivid illustration of such an occurrence. Responses to the coronavirus have varied extensively depending on where individuals live, such as in mandates involving social lockdowns and wearing masks. Two different governmental approaches are characterized by having both upsides and downsides. A top-down orientation would place the federal government in charge of all major decisions affecting individual and community health status. An implicit assumption is that officials in Washington, DC have the expertise to devise plans that will work equally effectively in mid-town Manhattan and Los Angeles as they would in Wetumpka, Alabama and Valley City, North Dakota. An opposing point of view is that all major decision-making should be located at a more local level in order to take into account key demographic factors that distinguish inhabitants of different parts of this nation. Thus, COVID-19 furnishes an excellent opportunity to begin to give thorough consideration to whether a more unified approach to any future pandemics should be implemented instead of relying on what presently amounts to a series of disjointed state-by-state responses.

The U.S. Supreme Court And The Individual Mandate
Senate confirmation hearings on the nomination of Judge Amy Coney Barrett to occupy a seat on the U.S. Supreme Court revealed a concern by many Democrats that placing her on the federal bench would jeopardize the Affordable Care Act. In November 2020, in the case of California v. Texas, the high court undertook an effort to rule on the constitutionality of the ACA. The case was brought by a group of Republican-led states and is supported by the Trump administration. Their argument is that since Congress eliminated the individual tax mandate in 2017, the entire law now must be invalidated. Some members of the court, including Chief Justice John Roberts, signaled they would support allowing the individual mandate to be severed from the remainder of the 2010 health care law, meaning that the rest of the ACA would continue to exist.

What To Expect From A Biden Administration

According to a report from the Blue Cross Blue Shield Administration, millions of children have missed routine vaccinations this year, causing a precipitous drop in immunizations that threatens to leave communities throughout the U.S. at risk of losing protection against highly contagious diseases, including measles, whooping cough, and polio. Not only will health officials chosen by President Biden be involved in the distribution of coronavirus vaccines that become available, they will be faced with the task of ensuring that vaccinations against these other diseases achieve more acceptable levels.

Democrats will continue to control the U.S. House of Representatives in 2021-2022. If they can do likewise in the Senate, certain policy goals will be easier to achieve. Otherwise, it will be necessary to seek compromises with Republicans on the following issues that will require the passage of legislation: (1) Expand and support Affordable Care Act (ACA) coverage provisions, including the expansion of existing tax credits to more individuals. (2) Create a public insurance option for individuals to enroll voluntarily, with automatic enrollment for certain uninsured individuals and no premiums for Medicaid-eligible individuals in the 14 states that chose not to expand Medicaid, and (3) Lower the eligibility age for Medicare from 65 to 60 years. Apart from legislation, a tool that the new administration can use to influence coverage and other health reforms is waiver authority. The Centers for Medicare & Medicaid Services (CMS) have the ability to do so for both state Medicaid programs and for insurance reforms.

return to November 2020 trends

HEALTH REFORM DEVELOPMENTS

More November 2020 TRENDS Articles

CHANGING OF THE GUARD

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

POPULATION HEALTH SCIENCE AND THE COVID-19 PANDEMIC

MOVING FROM A GERM THEORY OF DISEASE TO THE MICROBIAL THEORY OF HEALTH