Without doubt, a lingering pandemic and the anticipated post-Christmas spike in new cases tops the incoming administration’s list of problems requiring immediate action. The American Hospital Association (AHA) stands ready to help.
Representing almost 5,000 hospitals, health systems and clinical partners (including more than 270,000 affiliated physicians, 2 million nurses and other caregivers) and 43,000 healthcare leaders, members of the AHA have played pivotal roles on front lines of the COVID-19 pandemic. In my estimation, they are uniquely qualified to offer advice to the incoming administration. They did so in a letter to President-elect Biden earlier this month in which they urged him to make ending the COVID-19 pandemic the nation’s highest priority. Their recommendations for Biden’s first 100 days focused on several key areas: relief for hospitals, health system recovery, rebuilding the healthcare system for sustainability, and addressing critical ongoing challenges.
Relief for America’s Hospitals. The AHA asserts that the government must ensure that hospitals will have the material and financial resources necessary to care for their communities throughout the pandemic — for example:
- Ensure the extension of the public health emergency (currently set to expire on January 20, 2021) to preserve needed flexibilities.
- Protect vital federal funding for public programs (e.g., stop unlawful payment cuts that fail to recognize legitimate differences among provider settings).
- Require that private plans serving Medicare, Medicaid, and Affordable Care Act marketplace programs eliminate administrative and financial barriers to coverage for COVID-19 testing and treatment, and ensure that providers are adequately compensated for this care.
Recovery for the Healthcare System. The pandemic demonstrated the vital importance of access to high-quality, affordable, and comprehensive health care – irrespective of employment status or income level. Beyond caring for patients with COVID-19 and safely delivering necessary health care services to others, the AHA calls on the government to help ensure that the nation can “coexist with COVID-19.” This will entail things such as:
- Undertaking outreach and enrollment efforts to capture millions of individuals who are eligible for, but not enrolled in, some form of subsidized coverage.
- Opening a special enrollment period for health insurance marketplaces during the current public health emergency.
- Encouraging states to extend coverage and care to their populations through innovative state waivers with appropriate safeguards against eligibility reductions and cost-sharing increases.
- Allowing states to delay Medicaid eligibility recertification during the public health emergency.
- Implementing a communication effort on vaccine safety (particularly among populations that justifiably mistrust such efforts) and ensure tracking to better understand long-term outcomes and effectiveness.
Rebuilding the Healthcare System. Many changes brought about by the pandemic are irreversible – and this presents an unusual opportunity for the government to reimagine our healthcare system as one that better protects patient access to care, advances affordability, improves quality and patient safety, and transforms healthcare delivery and financing.
Addressing Critical Challenges. The long-standing vulnerabilities in our healthcare system have been amplified by the pandemic, and tackling these challenges will require the help of the government. The AHA assigns the highest priority to:
- Equity issues (unequal access to care, disproportionate disease burden, and disparities in health outcomes). The AHA recommendations include rescinding the “public charge” rule that has contributed to disparities in enrollment in minority communities; repealing the June 2020 final rule that narrowed the scope of non-discrimination protections under the Affordable Care Act; and empowering the Secretary of Health and Human Services to undertake a broad interdepartmental effort to address social and structural determinants of health.
- Workforce issues (diversity/inclusion, child care, housing, personal protective equipment, priority access to vaccines). AHA recommendations include expanding the physician supervision requirement waiver to nurse practitioners; coordinating with the Department of Defense and other agencies to provide direct staffing relief in hard-hit communities; and reducing the variability in scope-of-practice laws to allow caregivers to practice at the top of their license.
- Behavioral health issues. Stress related to unemployment, social isolation, and grief over the loss of loved ones are likely to have long-term effects. The AHA recommendations include: working to enforce the Mental Health Parity and Addiction Equity Act (requires insurers who cover behavioral health conditions to use standards comparable to medical/surgical services) and enhancing the behavioral health workforce.
The new administration would be wise to heed the AHA’s advice during the current crisis and in the longer term. As I have always contended, anyone who believes the system that brought us to the brink of total failure is the same system that can take us successfully into the future just doesn’t get it!
David Nash, MD, MBA, is founding dean emeritus and the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy at the Jefferson College of Population Health. He serves as special assistant to Bruce Meyer, MD, MBA, president of Jefferson Health. He is also editor-in-chief of the American Journal of Medical Quality and of Population Health Management.
Last Updated January 04, 2021