No Aspect of Health Care Will Be Untouched by COVID-19
By David Wild
With the COVID-19 pandemic derailing nearly every aspect of health care, experts are speculating that the ongoing crisis will reshape everything from drug pricing reform initiatives to universal health care policy debates and insurance accessibility.
Health Care Reform
By the time Congress gets to proposed health care reforms, the political landscape may be very different than it is today; this could even include a different president, noted Chris Sloan, an associate principal at Avalere, a health care consulting firm in Washington, D.C.
“Assuming the focus remains on COVID-19, the next opportunity for major health care policy reform might not be before 2021,” Mr. Sloan said during a recent Avalere podcast. If former Vice President Joe Biden wins the election, his health care proposals will look “very different than some Republican priorities, when it comes to Medicare drug pricing negotiations, for example,” he said.
Melissa Andel, MPP, the vice president of health policy at Applied Policy, a health policy and reimbursement consulting firm in Alexandria, Va., agreed that Congress and the Trump administration’s preoccupation with the immediate health care and economic needs created by the COVID-19 pandemic are putting pending drug pricing initiatives on hold.
“I think the chances of there being any big headline-grabbing health care and drug pricing reforms has diminished significantly since the outbreak,” said Ms. Andel, who was not a webinar participant. Those pending reforms include legislation on drug pricing negotiation, Medicare Part D redesign, inflationary rebate penalties, price transparency requirements, reform to the generic and biosimilar approval process, and a proposed rule to develop an international index pricing system, she noted.
Addressing Drug Supply Chain Weaknesses
Although some initiatives are stalling due to the COVID-19 crisis, others will be prioritized because of their relevance to the current pandemic, experts believe. For example, shortages of health care supplies and a recent shutdown of pharmaceutical manufacturers in Baddi, India—a key drug manufacturing hub—will likely accelerate initiatives to fix vulnerabilities in the drug supply chain and reduce dependence on China and India, Ms. Andel said.
“In fact, the third phase of the stimulus package that Congress passed during the COVID-19 crisis included a pretty significant increase in funding that could be used by manufacturers to repatriate some of their activities back from overseas into the United States,” she noted.
Impact on the Medicare-for-All Debate
Additionally, the argument in favor of a Medicare-for-all system could be bolstered in light of an increasing number of unemployed and uninsured individuals and “negative health care experiences,” such as surprise hospital bills for COVID-19 treatment, Ms. Andel noted. However, not all agree with that assessment.
According to Mr. Sloan, personal views on the topic of universal health insurance “are so heavily entrenched that even a global pandemic isn’t going to sway many peoples’ minds. What I do think we may see are some state-specific efforts to widen the availability of patient health care safety nets, like Medicaid,” he said. “Losing commercial insurance coverage in New York is very different than losing coverage in Texas, where Medicaid is limited, so I think some states with less generous social programs may be pressured to expand these programs.”
Ensuring Access to Care, as Much as Possible
Health care stakeholders are keeping a close eye on how much the pandemic affects health care utilization both now and after it resolves, Mr. Sloan noted. With most clinic appointments, tests and elective procedures postponed, pharmaceutical manufacturers, insurers and payors are trying to preserve as much access as possible to treatments and are encouraging adherence to medications.
“Everyone has an incentive to avoid a spike in new diagnoses and complications and a wave of uncontrolled medical costs after things subside,” he said.
One way stakeholders have been addressing some of the gaps in care is through the use of telehealth, which is now being widely reimbursed, according to Mr. Sloan. Because it facilitates access to care for underserved populations, telehealth likely will continue to be paid for and used more frequently even after the pandemic is resolved, he suggested. (For details on how the Centers for Medicare & Medicaid Services is encouraging the use of telehealth and streamlining payments for the technology, see bit.ly/3582Iuq.)
What Is the Cost to Plans?
The financial effects of current and future changes in health care utilization are keeping health plan managers up at night, Matt Kazan, a senior health policy advisor at Avalere Health, noted during the podcast.
“They’re looking at how the unanticipated costs of treatment for members who develop COVID-19 weigh against any savings from reduced utilization of health care services during this time,” Mr. Kazan said. Moreover, plans are anxious about another set of costs that will come after the health care system opens up again and clinic visits, elective procedures and tests resume, and patients start treatments for new diagnoses that have been missed or complications from existing conditions that have been poorly managed during the pandemic, he added.
“This is coming right when plans are setting their premiums for 2021, so it’s yet to be seen how all of these costs will affect the price of insurance,” Mr. Kazan noted.
Along with the loss of insurance that tens of millions of newly unemployed Americans are facing, possible higher premiums would place health insurance further out of reach for many, he said.
The sources reported no relevant financial relationships.