Big Questions for the Health Policy Community Emerging From the Coronavirus Crisis

With so many Americans dying, and so many more suffering severe economic hardship, it’s hard to look over the horizon at the larger questions the COVID-19 crisis will bring. The current emergency requires everyone’s attention 24/7. But an emerging set of questions will fall right in the bailiwick of the health policy community.

In the shorter term:

• How many people will lose insurance in the economic crisis? Who are they? How many will gain it back? Government data are robust but not timely. Multiple organizations should take a crack at this critical question, so we can get a fix on the best answers. We certainly will at KFF.
• What will the impact of COVID-19 be on health spending? Will health outcomes deteriorate after the virtual shutdown in “elective” procedures, and what are the lessons, especially if outcomes do not fall off appreciably?
• Will the economic fragility facing so many hospitals and medical practices force even further consolidation in the health care industry? How rapidly and with what effects? A big health policy question is the potentially significant impact further consolidation may have on consumer costs and overall health spending, as well as on safety net institutions and access to care for low income people.  How should government respond in a largely anti-regulatory era?
• States are being handed responsibility for the coronavirus pandemic response at exactly the moment when their budgets are cratering. How will states address budget crises in the months and years ahead and how will people and health programs be affected? The impact on Medicaid will be especially important to watch.

Then next up:

• The pandemic has truly brought health care disparities to the surface with a vengeance in the African American, Latino and Native American communities, and has spotlighted the need to focus more on the social determinants of health. There is an opportunity to focus with new urgency on this disproportionate impact. One challenge will be to do so while also underscoring the risk the whole country, including “red America,” faces from the social determinants of health, so coronavirus is not dismissed as “someone else’s problem”, or a problem primarily affecting voters from one party.
• What opportunities will emerge out of the current crisis and eventual recovery for transforming health care? The obvious big one is virtual health. Market forces and larger health systems that operate at scale will drive innovation, but market forces go where the profit is and do not always yield socially desirable outcomes for everyone. What will need to be done to assure that these innovations benefit lower income, less educated, and minority populations, and Americans who are not online? What reimbursement and coverage policies will be required to give consumers access to an adequate range of providers and to avoid abuse and outright fraud?

Longer term:

• The American people have stepped up and met the challenge of social distancing. But this has taken a toll on many people, and underscored the importance of mental health and the consequences of social isolation. Can this experience trigger a much more meaningful focus on mental health issues?
• Nursing homes have been a focal point of the crisis. States have responded in highly variable ways, with more testing, and swat teams, and specialized facilities for infected patients. What has worked, and what policies are required to avoid a similar catastrophe next time?
• Just as it has never been the way we fight a real war, the idea of the federal government as “backup” to the states is clearly not the way to respond to an unprecedented national emergency. How should the nation prepare for the next pandemic? What is a federal and what is a state responsibility? What should the national stockpile look like and who should manage it? How should critical equipment be procured and distributed? Next time, what is the national plan?
• As the country sorts out what workplaces will look like in the future, the answers we arrive at will have big implications for the nature of work, job satisfaction, and equity issues. People go to work to make money, but they also go to work to interact with coworkers, get the satisfaction of doing something productive, and sometimes just to get out of the house. People who work with their hands will have no choice but to go back to the auto body shop or Target or the dry cleaner. Tech companies — on the other hand — may over-correct, leaving a workforce scattered everywhere and anywhere, gradually eroding any sense of organizational identity or culture. The coming gap between those who can work at home and those who cannot constitutes a new inequality with repercussions we only dimly understand now.

This is a long list of big questions, but it is also a very partial list. Public discussion so far has been dominated by scientists, epidemiologists and physicians who have made invaluable contributions to the country as we have struggled to fashion a fact and science-based response. Many of these emerging questions will require a similar effort from the health policy community.