With the pandemic receding, what’s next for healthcare?

With three years left of the Biden administration, many are unsure about what’s to come for the nation’s healthcare priorities. The previous two years left little to consider about healthcare policy not directly related to the pandemic.

“Thanks to the progress we have made in the past year, COVID-19 no longer need control our lives,” President Joe Biden said in his first State of the Union address on March 1. The president continued, discussing various healthcare priorities in his seemingly bipartisan “unity agenda,” touting efforts to promote American-made products.

“We pay more for the same drug produced by the same company in America than any other country in the world,” Biden said. “Just look at insulin. One in 10 Americans has diabetes.”

“Let’s cap the cost of insulin at $35 a month so everyone can afford it,” he said, urging Congress to allow Medicare to negotiate the price of prescription pharmaceuticals.

Arielle Kane, director of healthcare at the Progressive Policy Institute, said the move to cap out-of-pocket insulin costs is “fantastic.”

“This has the ability to make real, tangible differences,” she said. “Healthcare costs too much, regardless of whether you have health insurance or not. Everyone is aware of this, and it’s the thing that resonates the most with Americans. … The average American is thinking about cost when they think about their healthcare.”

Kane emphasized that the Biden administration must focus on wins for healthcare beyond COVID-19, taking the pandemic’s lessons to sure up U.S. healthcare system preparedness, too.

“We need to beef up the [Centers for Disease Control and Prevention], get better data on the ground, improve our surveillance systems and domestic manufacturing,” she said, also highlighting wins of the pandemic and asking the president to make telehealth changes permanent.

“The benefit over the past few months to patients shows that this is a policy that must be made permanent,” she said.

The president also focused on women’s health during his address.

“If we want to go forward, not backward, we must protect access to healthcare. Preserve a woman’s right to choose. And let’s continue to advance maternal healthcare in America,” he echoed. Yet the CDC’s recent reports have indicated that the U.S. maternal mortality rate has climbed from 17.4 deaths per 100,000 in 2018 to 23.8 deaths per 100,000 in 2020. For black mothers, the risk more than doubled.

“We need better data,” Kane said. “We don’t have cohesive data because we collect at the state and local levels. Maternal death definitions vary greatly as well.”

McKenzie Richards, a policy associate at the Pacific Research Institute, said the president hadn’t clarified how to solve maternal health problems.

“What does the president mean by advancement? Examining the contents of the Build Back Better Act gives us a clue,” she said. “Build Back Better Act’s maternal health provisions include investing $3 billion in new funding for maternal health. However, the maternal health problem does not stem from a lack of access due to affordability. It is a lack of access due to supply: There are simply not enough maternity care providers relative to the number of pregnancies. Increasing funding to help women see an obstetrician will not make more obstetricians magically appear.”

In a brief from December, the Biden administration reviewed the initiative for the “first-ever White House Maternal Health Day of Action.” It said that the administration is also working to encourage states to expand postpartum coverage for Medicaid programs, up to 12 months from 60 days, and establish “birthing-friendly” hospital designations.

Kane believes the expansion of Medicaid postpartum coverage is an essential first step.

“We need to make sure everyone has health insurance,” she said. “It’s no good if you’re getting coverage when you’re three months pregnant. It’s better to ensure people have health concerns under control before getting pregnant. States that expanded have fewer maternal deaths.”

On the other hand, Richards believes the solution is more in tune with the organizational structure of U.S. healthcare.

“In developed countries with low maternal mortality rates, there are many more midwives than OB-GYNs,” she said. “Research findings consistently demonstrate that prolific midwifery care throughout a country can significantly lower maternal mortality rate. To address the issue more effectively, it would be better to urge states to roll back restrictive regulations that are currently prohibiting alternative maternal health providers such as nurse practitioners, midwives, or birthing centers from entering the marketplace.”

West Virginia is one of the states attempting to tackle this problem through state-based regulatory reform. House Bill 4643 hopes to remove certificate of need regulations from birthing centers, citing the inaccessibility of the healthcare option. The state only has one birthing center.

Georgia Gov. Brian Kemp, taking a coverage-based approach, included postpartum coverage expansion in his state budget recommendation to “address the problem of maternal mortality.” Alabama and Mississippi are also considering proposals to extend Medicaid postpartum coverage.

All of the legislation is pending.

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