The coronavirus pandemic and U.S. health policy

In taking stock of the coronavirus pandemic and U.S. health policy, a group of experts speaking Tuesday at a Stanford Institute for Economic Policy Research virtual event examined how past government decisions are affecting health care now, how lives and livelihoods are being affected today, and how the delivery of health care can be improved.

The event was broadcast live on SIEPR's YouTube channel and can be seen here.

When it comes to health insurance coverage, the pandemic has exacerbated the problems that existed before the outbreak and raised new policy challenges, said Kate Bundorf, a senior fellow at SIEPR and an associate professor of Health Research and Policy at the Stanford School of Medicine.

Employment is the backbone of health care coverage for the working-age population, so the sudden, steep loss of jobs during this pandemic means millions of people are suffering “twin problems” from the loss of income and health insurance, she said.

The Affordable Care Act extended a safety net for many Americans, but some states chose to not expand their Medicaid programs, leaving a large group of individuals without medical coverage.

From a policy standpoint, “we really need to be focused on what we are going to do for people who are low-income and for states that did not expand their Medicaid programs,” Bundorf said.

Another pressing challenge is figuring out how overall health care spending will be impacted by the pandemic, including being prepared to deal with the forthcoming surge in non-COVID-19-related cases — treatments and preventive procedures that were deferred to avoid contracting the disease.

For instance, “where have the hospitalizations for heart attacks and strokes gone?” Bundorf asked.

The lower usage of health care for situations not related to the coronavirus is threatening the financial viability of a broad set of medical care providers, she said. “We need to think about how hospitals can treat both COVID and non-COVID patients in a sustainable manner.”

In the meantime, reopening gyms, massage parlors, hair salons and other service businesses in coming days — as the state of Georgia has proposed — “is risky and a mistake,” warned Drew Altman, the president and CEO of the Henry J. Kaiser Family Foundation and a leading expert on national health policy.

Without comprehensive, reliable testing, the infection and mortality rates of the coronavirus are still being debated. But even if the prevalence of the virus turns out lower than previously thought, Altman said, “I don't think it means anyone can take their foot off the accelerator because there are many population groups who are really at risk, and we don’t have a vaccine.”

States are all handling the pandemic differently, so “you’ll see a bunch of pacesetters, but you’ll also see laggards, even resistors,” Altman said. “In my decades of experience, that’s what you’ll always get when you leave discretion to the states without clear federal leadership and metrics.”

“It’s just magnified here because the stakes of the epidemic are so big,” said Altman, who served as Commissioner of New Jersey’s Department of Human Services before joining KFF in the early 1990s.

A bright spot has surfaced amid the crisis, however, as health care providers have been forced to resort more to technology, such as online video visits, to care for patients, said Kevin Schulman, a professor of medicine at the Stanford School of Medicine and director of Industry Partnerships and Education for the Clinical Excellence Research Center at Stanford.

And thanks to the coronavirus-induced relaxation of legal restrictions on medical information and changes in Medicare policies related to geography and payments for services, there has been a rise in the usage of digital methods for not only medical visits, but also financial transactions and medical records.

“This has been a debate for more than two decades about whether we can move to a world with remote visits with physicians or clinicians,” Schulman said. Now, over a short period of time, “we’ve been able to dramatically change the way we do business.”

Patients were never given a choice before. They had to go to a medical office to see their doctors, take time off from work, pay for parking, and sit in a waiting room to finally see someone for a 15-minute appointment.

Today, at Stanford, about 16,000 doctor visits are done remotely per week — up from nearly nothing in the beginning of the outbreak, Schulman said. And across the nation, patients are doing about 20,000 virtual visits per day with Teladoc, a telemedicine service provider.

“This is still not a transition to digital medicine,” Schulman said. “We went from in-person visits to virtual visits, but we still haven’t unleashed the full armamentarium of digital tools that we can think about that could be really useful for COVID.”

Following the panelists’ presentations, Mark Duggan, the Trione Director of SIEPR who served as the senior economist for health care policy at the Council of Economic Advisers during the Obama administration, sought their input on the barrage of ever-varying information related to the pandemic.

Loosened FDA rules designed to speed up testing options or a vaccine for COVID-19 means “we are muddying the waters” with all kinds of poor quality or even counterfeit coronavirus tests, Schulman said.

“It must be really terribly confusing to just figure out what the facts are, and what’s actually true when a governor decides to open up massage parlors,” Altman said. “All of this has profound implications for the American people — to hear one thing every day from the White House, and then they’ll hear about this study or some other study. It’s a real challenge.”

Still, “understanding the prevalence of infection is incredibly important,” Bundorf said, because that will affect estimates, which in turn, will affect planning strategies.