As part of the revival of the Washington Health Foundation announced this past September, the plan was to write a second WHF Blog prior to the presidential election of 2020. It would have contextualized the health policy issues at play in a tense and divided contest.
As election day got closer, it seemed less important to do so. The election continued to seem extraordinarily consequential, but adding to the discourse about it far less so. Really, what new point of view could have been added to the extensive and intense commentary out there. Nor could we see many who had not made up their minds long ago on how they would vote.
Now, the election is largely behind us, save for the legal contests and recounts. I don’t see those changing anything in terms of outcome, only delaying the reality that there will be a new executive branch filter for America and its health policy soon.
So, now it is time to consider the health issues that we will be dealing with in this next wave of American health policy setting. This WHF November 2020 Blog is but a first installment on considering this question.
Certainly, the first policy issue in the shoot is abundantly clear- the need to address Covid-19, and especially its dangerous recent growth. We can only hope that politics will finally take a secondary role in defining our response, and pray that it is not too late to stem the tide. And that our decisions will also get us prepared for any other pandemic maladies that may follow. We were not ready for this one, and must be for what may come in the future. Surely we can at least agree on that!
Soon to follow will be a need for major consideration of the Affordable Care Act. That this review will happen is inevitable under any circumstances- it remains a central issue for the American people and a major bone of contention between the two political parties. What will put it upfront and more immediate would be the United States Supreme Court deciding it lacks constitutionality in a case coming before the Court early this month.
This was a hot topic in new Justice Amy Coney Barrett’s confirmation hearing. Democrats asserted she would be the vote to overturn the ACA during a pandemic, while Republicans suggested that this wasn’t likely. Now, I suspect their messages will flip.
Count me as one who believes the legal case is a weak one and that the Court will not strike down the ACA, at least in this case. From the beginnings of this lawsuit, it has been hard to find other than strident ideologues who saw a legitimate legal basis for it. One would think that those who label themselves as strict constructionists would see the legal logic supporting the need to sever any possible constitutional defects of a law passed by Congress- and never repealed by this legislative body.
Especially when the constitutional defect alleged was created by a subsequent act of Congress regarding the penalty related to the individual insurance mandate. If this was supposed to be a fatal change to the overall ACA, Congress should have said so when it made this change. But it didn’t- because it couldn’t then. The Court should not be the place to clean up this failure to act legally to repeal the ACA.
But that is all prediction, not a certainty. Suffice it to say that if the Court does strike down the ACA, finding a way to insure and protect millions of Americans will become imperative. Such a decision would not have immediate effect, as it would most likely not even be announced until Spring. But, if it comes, its implications would weigh heavily on Americans. The Biden Presidency, and Congress, would have to find some way to deal with the chaos such a ruling would cause.
There will be a litany of other health policy issues to follow in the year and years to follow. A more precise speculation of those will have to wait for another day. One important factor in such an evaluation is the outcome of the Georgia Senate run offs on January 5, which will dictate whether health policy will contain a major change context or be more a matter of smaller, incremental and administrative shifts of emphasis under a divided government.
It is imperative that whatever the health policy issues and the change context, equity is a driving consideration going forward. It has been the case for quite some time that racial and ethnic disparities have defined the problems within our health care system in terms of outcomes and process, even more than health insurance status. This pandemic, and the awakenings of many to institutional differences around race over the past summer, have brought this fact to the surface of American thinking more than any time I can remember. Now, it is time to do something about it- by eliminating racial and ethnic disparities.
Stay tuned. The new Washington Health Foundation will have more to say about all of these issues- and more- in the months to come. If you want to get a push email of our WHF Blog sharing our thoughts, send an email to me at gregvigdor@cox.net. Or visit our new website: washhealthfoundation.org.
Greg Vigdor
President, WHF