Prioritizing COVID-19 Policies Beyond the Pandemic

During a session presented at the America’s Health Insurance Plans (AHIP) National Health Policy Conference, experts laid out potential policy priorities for states in the wake of the COVID-19 pandemic.

In addition to vaccinating as many residents as possible against COVID-19, states are currently tasked with preparing for a potential booster vaccine in a few months and effectively monitoring vaccine efficacy against new COVID-19 variants, explained Hemi Tewarson, MPH, JD, a visiting senior policy fellow at the Duke Margolis Center for Health Policy at Duke University.

“States are going to have a role, not only to get shots into the arms, but also to make sure they’re tracking those folks once they’ve been vaccinated to see what the effects are, and to continue to monitor for outbreaks in different communities,” Tewarson said.

Ensuring accurate information is disseminated among residents will also help tackle hesitancy among groups at the state level. “The next challenge is going to be, ‘How do we reach the populations that aren’t asking for [the vaccine]?’” she asked, noting the importance of accurate racial and ethnic data reporting. Adding to these challenges, states must strike a balance when it comes to lifting occupancy requirements and certain pandemic-related safety measures while still emphasizing the importance of mitigation efforts like mask-wearing and physical distancing.

In addition to the newly emphasized calls for an increased focus on social determinants of health and health care disparities at the state level, officials also discussed how the pandemic has shed light on challenges presented by the existing health care infrastructure, affordability, and long-term services and supports.

Once the pandemic has ended, states will need to decide which regulations will stay in place, specifically with regard to telehealth protocols and funding, explained Trish Riley, the executive director at the National Academy for State Health Policy. Discussions on what the public health infrastructure should look like, how it should be paid for, and any changes regarding increased hospital capacity implemented during the pandemic will need to be had.

“How will we implement the American Rescue Act? Will states expand Medicaid?” Riley asked. “Conversely, once the public health emergency is over, might states—no longer having the maintenance of effort in Medicaid—see rollbacks in Medicaid coverage and benefits?”

Despite the widely acknowledged importance of social determinants of health, the question as to who pays for advancements in this area remains unanswered, Riley said. “I think what the public health structure looks like in the future will be really important.”

When it comes to affordability, hospital costs have remained front and center at the state-by-state level, and concerns regarding hospital consolidation have prompted a number of initiatives around the country. Noting that consolidation drives prices without any improvements in quality, “those increased prices remain a serious concern to states,” Riley explained, while the proposed solution of a public option “only works if hospital prices are brought in check to make the product more affordable.”

Reflecting on the goals of one state in particular, Jessica Altman, the insurance commissioner for Pennsylvania, underscored the role of state government in leading and supporting residents as they recover from the COVID-19 crisis.

“COVID is not just a public health problem,” Altman said. “It's an economic problem, a workforce problem, an education problem, a mental health problem, and somehow states need to, and really are finding ways to, prepare for this multifaceted recovery while still doing what we need to do to make sure that we get to that recovery as quickly as we possibly can.”

Citing Pennsylvania’s success in launching a state-based exchange and reinsurance program and efforts to expand access to telehealth, Altman stressed that in addition to understanding lessons learned from COVID-19, “we should also feel some validation that states have been focused on the things that matter and take the opportunity of the revitalized focus and energy coming out of COVID on these issues, to really move forward on policies that matter to people.”

Federal goals outlined in the American Rescue Act will also help drive state-level initiatives to address the challenges brought to light by the pandemic. “Even though these enhancements are only temporary, at least for now, this is a real opportunity to get people covered that have previously found coverage to be unaffordable,” Altman said.