ACP Annual Meeting: Despite Progress During Biden's First 100 Days, More Work Needed in US Health Care

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During a presentation at the virtual ACP Internal Medicine Meeting, Andy Slavitt and Cynthia Cox discussed progress made and progress still necessary

May 7, 2021 (ACP) – Speaking virtually to a national audience of American College of Physicians members, a high-ranking representative of the Biden administration touted the inroads they have made in health care during his first 100 days in office. But an independent expert noted that the new reforms come with significant limits, and a top ACP lobbyist cautioned that more fixes are needed.

“We have made a lot of progress in the first 100 days, and expanding coverage under the Affordable Care Act (ACA) is beginning to address the costs of care. Meanwhile, the vaccination rates in the U.S. are really promising,” said Bob Doherty, senior vice president for governmental affairs and public policy, at the ACP Internal Medicine Meeting 2021: Virtual Experience, held April 29 to May 1. “But we still have challenges ahead to achieve a vision of a health care system that covers everybody and addresses barriers to care.”

Doherty spoke during a presentation titled “The First (and Next) 100 Days: What's in Store for Health Care in Washington?” He was joined by Andy Slavitt, senior adviser to the White House COVID-19 response team, and Cynthia Cox, vice president at the Henry J. Kaiser Family Foundation and director for the Program on the ACA.

Slavitt, who served as acting administrator of the Centers for Medicare and Medicaid Services for two years during the Obama administration, began his comments by praising ACP. “I think of you guys as the people who begin with the values that matter most in health care and then put the business side slightly behind that,” he said. “This distinguishes you, and makes you a better partner, quite frankly. If we want to talk about doing what's right for health care, we have to start with the patient, the system and the populations. It's much easier to talk to people who begin their own thinking that way versus people who begin the conversation with what's in it for them.”

According to Slavitt, President Biden came into office with a mission to unite the nation around the COVID-19 vaccination effort. “It was going to be especially important for us to level with the public, start making sure we can put out reliable data, and allow the medical science to reemerge as an independent voice,” he said. “We really spent a lot of time trying to make sure that people understand that nobody's perfect, but in the U.S., we have the gold standard.”

The vaccine effort also required an acknowledgement that the world is “a tilted playing field” with inequalities built in, he said. “If you face implicit barriers, because of discrimination based on where you live or the color of your skin, … you've got to fight that much harder,” he said.

Slavitt said they learned that “showing respect for the fact that people may take a little bit longer to make up their minds about getting vaccinated is a whole lot more effective than belittling someone and targeting or labeling them.” He added: “We believe that if people get straight answers to their questions, the vast majority will choose to get vaccinated. Why? Because it's a darn good product.”

Cox, vice president of the Henry J. Kaiser Family Foundation, spoke about the progress that President Biden has made toward his health care goals. She noted that he has boosted subsidies for federal and state marketplace insurance and has followed through on “lowering deductibles and rolling back some of the Trump administration changes to the ACA.”

However, subsidies will only be in place for two years, she said, and come with a hefty federal price tag. Meanwhile, she said, the American Rescue Plan “does not expand subsidies to those people who are in the Medicaid coverage gap. This is about 2 million people who live across 12 states that have refused to expand Medicaid under the ACA.”

While the plan does offer incentives to those states to expand Medicaid, she said, “we aren't really sure that any state is going to take advantage of it.”

Cox added that undocumented immigrants have also been left out. Still, “among American citizens, the vast majority of uninsured people are now eligible for significant financial assistance either through Medicaid or the ACA exchange markets,” she said. “In fact, at least half of the remaining uninsured population in the U.S. is now eligible for a free health plan. So, it would cost them nothing each month to sign up for coverage.”

Going forward, Cox said she is skeptical that there will be a public option or that the Medicare eligibility age will be lowered, even though Biden supports these reforms.

Also during the presentation, Doherty emphasized that ACP has laid out a roadmap for the future. In the “Comprehensive Policy Framework to Understand and Address Disparities and Discrimination in Health and Health Care,” published earlier this year in the Annals of Internal Medicine, ACP laid out a framework that confronts the intertwined segments of U.S. society that contribute to poorer health outcomes. ACP also proposed specific policy recommendations to address challenges in education and the health care workforce, in specific populations, and in criminal justice practices.

“Better,” Doherty said, “is possible.”

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