October 2, 2024 – How will the next presidential administration make health care in the United States more accessible, affordable, and fairer?
These were the themes addressed by more than a dozen experts who spoke at a Sept. 27 symposium at the Harvard T.H. Chan School of Public Health, sponsored by the Harvard School of Health Policy and Management and the New England Journal of Medicine (NEJM). .
Eric Rubin, editor-in-chief of NEJM and adjunct professor of immunology and infectious diseases at the Harvard Chan School, and Jane Kim, the school’s dean of academic affairs, at an event held in Snyder Auditorium. He gave opening remarks.
NEJM Editor-in-Chief Eric Rubin will give the opening remarks. Back, from left: Jane Kim, Robert Brendon.
In the past, NEJM has asked presidential campaigns to write articles detailing their health care policies before elections, Rubin explained. “I found that as time went on, these statements became less and less funny,” he said. “So we thought, why not rely on real experts instead to tell us what we should expect and what to expect?”
In his opening remarks, Kim cited a number of pressing issues, including coverage challenges, barriers that still prevent millions of people from accessing the care they need, rising medical costs, and persistent health disparities.
Robert Brendon detailed the stark differences between Republicans and Democrats, based on research he helped conduct as director of the Harvard University Polling Program. “Let me explain this simply,” says Brendon, professor emeritus and Richard L. Menschel Professor of Public Health and professor of health policy and political analysis at the Harvard Chan School. “Democrats think we need to spend more after the election on all the big problems this country has, and even if we’re spending enough, we need to invest more in stocks. For Republicans, the reason inflation is so high is government spending, and we need to cut government spending.”
Beyond that simple calculation, there are some nuances, he said. Republicans largely oppose spending increases, but support expanding health care funding for veterans and Medicare. “Medicare is incredibly popular in both parties,” Brendon said. However, Republicans are more supportive of coverage provided through Medicare Advantage (a type of Medicare plan offered by private companies), and Democrats are more supportive of imposing stricter price controls to limit health care costs. I am doing it. Insured person. He also noted that while Democrats support access to abortion in most scenarios and Republicans largely oppose it, the two parties are united in supporting in vitro fertilization (IVF) treatment. did.
During a panel discussion on accessibility, Sherry Greed, dean of New York University’s School of Public Service, began with the good news that health insurance coverage has increased to record levels, with only 8% of Americans currently uninsured. Ta. Additionally, changes in tax credit subsidies since the American Rescue Plan and the Inflation Control Act have increased enrollment in state health insurance exchanges. But the bad news is that these subsidies are set to expire next year, costing $335 billion to renew, and the choice between continuing to increase access to health care or eroding it remains with the next president and Congress. will be left behind.
Ben Somers, the Huntley Quelch Professor of Health Economics at the Harvard Chan School, said one of the challenges with Medicaid is that the federal policy protects millions of people by requiring states to maintain coverage for most people. We discussed the decrease in the number of subscribers due to the termination. Enrollment during the pandemic. She said state and federal policies are helping people maintain coverage by allowing continued eligibility periods even if a family’s income changes or by extending the length of time a child can be in the program. He said he may be able to help. He also pointed to one of the issues surrounding health care accessibility: 10 states, mostly in the South, have not expanded Medicaid coverage under the Affordable Care Act. Also mentioned. He said expansion remains popular among the public, but conservative governors and lawmakers often oppose it. Somers said state referendums and additional federal incentives have helped expand Medicaid in a few states, but many more are unlikely to see it. He noted that Georgia’s recent plan to expand Medicaid in exchange for higher work requirements could be a step forward for other states as well.
J. Michael McWilliams, a professor of health policy at Harvard Medical School, said during a panel discussion on affordability that while federal subsidies have made health insurance more affordable for individuals, It noted that the increase in spending across the system could make it difficult to access subsidies. You won’t be able to keep pace and you’ll be useless. Another issue is Medicare Advantage, he said. These plans aim to lower costs by eliminating unnecessary care and better managing spending. But the plan is more costly for governments and taxpayers than traditional Medicare, and there are concerns that private insurers are pocketing the proceeds rather than improving affordability. McWilliams said he believes stronger regulations are needed to ensure that savings from Medicare Advantage plans are passed on to enrollees.
Vanderbilt University health policy professor Stacey Duseczina outlined improvements to the issue of prescription drug affordability under the Biden-Harris administration. Medicare currently allows price negotiations on some prescription drugs, with caps ranging from $35 for insulin to $2,000 for insulin. Annual out-of-pocket costs for prescription drugs. Given Donald Trump’s track record on prescription drug prices, recent cost-cutting efforts would likely be scaled back if Trump were to become president again, but cost-cutting efforts would likely decline if Harris became president. It is likely to expand, he said. But Dusetsyna warned of potential unintended consequences of Harris’ stated plan to extend existing price caps to private insurance plans. “It doesn’t necessarily help people the way you think it will,” she said. “Ultimately, it protects consumers from price, but they still pay for it through higher premiums and lower wage increases.”
Rukaija Yearby, a health law professor at The Ohio State University, spoke during a panel discussion on health equity about how structural determinants of health, such as structural racism built into federal policy, affect health outcomes. He pointed out the importance of examining whether this creates inequality. But that effort could be complicated by the Supreme Court’s recent Chevron decision, which shifts the power to overturn federal agency decisions to judges. “We have to be careful about who we choose because they are going to decide which judges we appoint,” Yearby said.
Marcela Alsan, professor in the Department of Health Policy and Management at the Harvard Chan School, spoke about the role of interest groups in shaping public policy. She points out that after World War II, the American Medical Association (AMA) played the biggest role in shaping the current private health insurance system, and that it is today the best in terms of access, affordability, and equity. I pointed out that it’s causing a lot of the problems we’re seeing. No matter who is elected president or Congress, it’s important to be wary of these invisible figures who can influence health policy, she said. After all, she noted, four of the top 10 spending federal lobbyists come from the health care industry. [Blue Cross Blue Shield, the AMA, the American Hospital Association, and the pharmaceutical industry]. She says it’s important to pay attention to who has special interests and to whom they are beholden.
– Michael Blanding
Photo: Kent Deighton
