South Florida Hospital News
Tuesday January 19, 2021
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January 2021 - Volume 17 - Issue 7
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What Now?

Come January 20, we also will have a new President and Vice President, President Joe Biden and Vice President Kamala Harris. And along with these changes in administration, we will also have a new Secretary of Health and Human Services, a new Director of the Centers for Disease Control and Prevention and a new Surgeon General among other significant staffing changes. So what may this mean for our health care sector going forward into 2021 and beyond? I would suggest to you, in construct, probably not that much. How could that be? Well let’s see.

For the next year, much of the country’s attention will continue to be focused on the Pandemic and, given the significant logistics associated with the production and dispensing of essentially over 450 million doses of the vaccines, this is an awe-inspiring undertaking. Why 450 million plus doses? The numbers being put out by public health experts is that one needs at least 70 percent of the population to be adherent to the vaccination program. In other words, for the vaccine to be effective nationally, one needs to have a minimum of approximately 231 million people inoculated. Given that the current vaccines are a two-dose regimen, one will need 462 million doses. This exercise will take us well into the year to accomplish. The process involves convincing a skeptical population of adhering to the advice of public health specialists regarding taking the vaccine in the first place, the follow up of the second dose, as well as the significant logistics associated with transporting “the last mile.” It is easier to transport to a central distribution point. But from there, to get to areas for dispensing, this is where things get much more complicated.
 
And, what about other aspects of health care policy going forward? With the realization that the Patient Protection and Affordable Care Act essentially survived the past four years including the first two years of President Trump’s term when the House, the Senate, and the Executive branch were aligned politically, it is almost assured that the Affordable Care Act will continue on and will be built upon over the next four years.
 
And even though the Individual Mandate had been eliminated as a driver for people to sign up for health insurance through the Exchanges, nonetheless the number of individuals signing up voluntarily for an insurance plan through the program continues to be significant.
 
With incoming President Biden having been directly involved in the development of “Obamacare”, and with the realization that this has been the law of the land now for over ten years we can anticipate that this will continue as law over at least the next four years. Yes, it is true that the Supreme Court has been asked to review the constitutionality of the law and is expected to rule this Summer of 2021. The Supreme Court rarely overturns a piece of legislation that has been ratified through Congress, especially after it has been law for this many years. I would be surprised to see the law overturned, though the unknown is how several new Supreme Court Justices will review the situation.
 
One aspect of the Biden/Harris policy concept is that a federal Medicare type program be available as an option for those not happy with their private insurance options. This option is also seen as a policy goal for those individuals who reside in states that have not expanded Medicaid (such as Florida) and who have an income level below 138 percent of the Federal Poverty Level.
 
Another area where the Administration will have a policy focus will be to bring down pharmaceutical prices. There is a desire by the Administration to enable the Medicare authorities to negotiate down the prices paid for the pharmaceuticals. Surprise billing is an additional policy goal.
 
One other area that has not been on anyone’s radar but needs to be is the fact that Medicare Part A is expected to become insolvent in the year 2024. This has been stated by the Trustees of the Medicare system itself. It should be noted that this has recently been moved up from the year 2026 due, in part, to the COVID Pandemic and its impact on the Medicare population. We must remind ourselves that 2024 is but three years away. This means that the Biden/Harris Administration and Congress will have to be aware and potentially act. There are three variables in dealing with the inability of the Medicare program to fully fund its expenditures. These variables are to cut benefits to Medicare recipients, increase Medicare taxes on the working population, or to cut reimbursement to providers. It has been the latter exercise that has been a significant part of our process for the last several years. Deeper cuts however will be required. None of these scenarios are pretty.
 
So, there we are. We will see where we ultimately end up with healthcare policies, processes, and outcomes. I have a feeling we will be having future discussions through this and other venues as we go forward. Please stay safe.

Dr. Steven G. Ullmann, Professor and Chair, Department of Health Management and Policy, Director, Center for Health Management and Policy, and Special Assistant to the Provost at Miami Herbert Business School, University of Miami, can be reached at (305) 284-9920 or Sullmann@miami.edu.

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