Combatting the COVID-19 pandemic is likely to dominate at least the early stages of the new presidential administration’s health care agenda, but myriad health-related concerns and policy considerations will face President Joe Biden and Vice President Kamala Harris.
The pandemic has laid bare inequities in American health care and led to an increase in mental health and substance abuse issues. Then there are the ongoing matters many administrations have addressed: cancer research, women’s health, affordable health coverage and HIV/AIDS.
“It’s going to be hard to focus on any major health care effort until the administration has dealt with the pandemic,” notes Michael Altschule, executive director of government relations for UCLA Health.
Here is a look at some key health care areas the new administration is likely to focus on and what UCLA Health experts hope to see over the next four years:
COVID-19: Biden is pledging $400 billion to fight the pandemic and promises the administration of 100 million vaccine doses in his first 100 days in office. He says most kindergarten-through-eighth-grade schools will open during this period.
Biden has said mass vaccination is a priority and he intends to draw on "the full strength of the federal government" to support vaccine production and administration. He promises a widespread education campaign to restore trust among vaccine-hesitant Americans and that resources will be equitably distributed with an eye toward underserved communities.
Biden, on Jan. 21, unveiled his national strategy for responding to the pandemic. 21. It includes support from the Federal Emergency Management Agency (FEMA), which will establish vaccination centers, train vaccinators and serve as liaisons for each state; directives to the departments of Education and Health and Human Services to provide guidance and resources to reopen schools and childcare centers; and the establishment of a COVID-19 testing board. The strategy also calls for mandatory testing and quarantine for travelers coming to the U.S. from other countries and a request that all Americans wear masks for the first 100 days of his term - a "patriotic act," he says, that could save 50,000 lives.
Biden has also said he plans to use the Defense Production Act to increase supplies of personal protective equipment (PPE). On his first day in office, he signed executive orders requiring masks and physical distancing at all federal buildings and lands, including national parks and forests, and restoring the National Security Council's global health security team.
“Increasing the vaccine and PPE supply will further help protect UCLA Health workers and patients,” says Annabelle de St. Maurice, MD, MPH, co-chief infection prevention officer for UCLA Health.
Affordable Care Act: Biden intends to restore and protect the landmark health insurance legislation passed while he was vice president alongside President Barack Obama.
Biden has said his approach will insure 97% of Americans. Elements of his plan include: offering a public health insurance option, like Medicare; expanding Medicaid access for people with low or limited income; and increasing the value of tax credits to lower insurance premiums. He intends to lower prescription-drug prices by allowing consumers to buy medications from other countries, improving the quality of generic drugs and limiting price increases to the standard inflation rate. He also said he plans to restore funding to Planned Parenthood and community clinics.
Nearly 70% of patients treated within the University of California’s academic health centers are covered by Medicare or Medicaid, or are uninsured.
Cancer research: Antoni Ribas, MD, PhD, director of the UCLA Jonsson Comprehensive Cancer Center Tumor Immunology Program and president of the American Association for Cancer Research, is optimistic about the role the new administration will play in the future of cancer research, based on past support from Biden and Harris of annual funding increases for the National Institutes of Health and the National Cancer Institute.
Ribas singles out Biden’s work to secure authorization of $1.8 billion over seven years for the Cancer Moonshot Initiative through the 21st Century Cures Act, signed into law in December 2016, which was designed to help accelerate medical research and bring new innovations more quickly to patients who need them. “Biden’s sage efforts had a monumental effect on the research community,” Ribas says.
He also notes that Biden and Harris have been personally touched by cancer. Biden’s eldest son, Beau, died in 2015 from a brain tumor. Harris’ mother, Shyamala Gopalan Harris, PhD, was a breast cancer researcher who died of colon cancer in 2009.
In addition to increased funding for cancer research, Michael Teitell, MD, PhD, director of the UCLA Jonsson Comprehensive Cancer Center, says he hopes to see greater equity in access to cancer care and clinical trial participation. He’s also excited to see genomics and epigenomics – the study and mapping of genetic material -- play a larger role in cancer research and clinical care.
Dr. Teitell says the policies that might have the greatest influence on reducing cancer rates would be state and federal programs that promote cancer screenings and alcohol and smoking cessation, along with healthy-lifestyle education programs for elementary and high-school students teaching behaviors that reduce cancer risk, such as avoiding obesity, smoking and alcohol.
Health equity: Biden was the first president-elect to establish a federal task force to address racial disparities in health care. He tapped Yale physician and professor Marcella Nunez-Smith, MD, MPH, to lead the COVID-19 Racial and Ethnic Disparities Task Force, introduced in April, 2020 by then-California Sen. Harris. Dr. Nunez-Smith has said her commitment to addressing racial health disparities go beyond health care to include factors such as housing stability, food security and educational equity.
UCLA Health was one of the first health systems in the nation to create an office of health equity, diversity and inclusion to advance health equity among patient populations and increase diversity and inclusion at all levels of the health system, including its medical centers and the David Geffen School of Medicine at UCLA.
The University of California health system supports the provision of additional funding for federal Health Career Opportunities programs to increase representation of minority students in health professions; and for Teaching Resource Centers that place physicians and nurses in underserved neighborhoods and among underserved patient populations.
HIV/AIDS: Irvin Chen, PhD, director of the UCLA AIDS Institute, says he hopes to see an easing of restrictive policies around fetal tissue research, which contributes to so many scientific advances in medical research. The Trump administration instituted additional review requirements for use of fetal tissue for National Institutes of Health-funded research.
LGBTQ++ health: Amy K. Weimer, MD, founder of the UCLA Gender Health Program, wants to see the federal government ensure access to gender-affirming care for transgender people.
“Ensuring access to care entails clarifying nondiscrimination policies to state explicitly that health care institutions and insurance providers may not discriminate based on gender identity and sexual orientation,” she says. “Services that are provided for other medical indications must also be provided for the purposes of gender affirmation.” The 2012 Insurance Nondiscrimination Act provides such protections in California, she says.
Mental Health: Kristen Choi, PhD, MS, RN, expects a greater investment by the Biden administration in mental health care after the stress and uncertainty caused by COVID-19.
“The pandemic has highlighted many longstanding fragilities in our health care systems and made clear where innovation is needed. This is especially true in mental health care,” says Dr. Choi, an assistant professor at the UCLA Fielding School of Public Health and UCLA School of Nursing. “I hope to see the Biden administration expand our mental health workforce in underserved areas, invest in technology to support mental health service delivery and reduce rising rates of suicide and substance use disorders.”
Substance abuse: Addictive disorders kill more than 700,000 Americans each year, a figure that doesn’t include the thousands who die of cancers and other diseases compounded by addiction and those who survive overdoses. Timothy W. Fong, MD, a UCLA Health psychiatrist and addiction specialist, notes that the disease of addiction affects 12% to 15% of the population and merits a coordinated, national response.
“We need a ‘Moonshot’ for addiction,” he says. “We need treatment and prevention infrastructure.”
Dr. Fong says he hopes to see the Biden administration recognize addiction as a public health crisis with widespread impact on other health care and societal issues, from COVID-19 to racism, and take a more “humanistic” approach to treatment. “Biden should establish an easier, nationalized response, just like with vaccines,” Dr. Fong says. “We need biological, psychological and social infrastructure.”
Women’s health: Access to quality health care and contraception for all women is essential, says Aparna Sridhar, MD, an obstetrician and gynecologist at UCLA Health.
“I hope the Biden-Harris administration expands access to contraception coverage,” she says. “I would hope that all the health care policies pertaining to contraception and reproductive health are science and evidence based, so that we as physicians can provide individualized care without the interference of politics in our exam rooms.”
All women should have coverage and access to all U.S. Food and Drug Administration-approved contraceptive options, Dr. Sridhar says, as contraception is key to preventing unwanted pregnancy and the mortality and morbidity associated with it.
Prioritizing maternal health care also is of utmost importance, she says, because the U.S. has some of the highest rates of maternal mortality and morbidity among developed nations. The new administration has acknowledged the issue. Surgeon General Jerome Adams also issued a call-to-action, in December, 2020, to remedy this problem.
“Policies should focus on eliminating the preventable causes of maternal mortality,” says Dr. Sridhar, which the Centers for Disease Control and Prevention estimate at 60%. “I was happy to see the Biden-Harris administration agenda acknowledges California’s strategy to improve maternal mortality and has plans to expand it nationwide.”
The maternal mortality issue is also a health equity issue, she notes.
“Women of color — especially Black women — are two to three times more likely to die from pregnancy and related complications,” Dr. Sridhar says. “I hope the new administration recognizes the structural racism and supports policies that prioritize the needs of communities of color.”
