Legislative Recommendations to Fight the Pandemic and Build a Health Care System That Works for People

The Biden-Harris Administration and Members of the 117th Congress face an unprecedented public health emergency and economic crisis. As a result, the COVID-19 pandemic has shone a light on longstanding inequities and flaws in our health care system.

Despite consistently being told people living in America are divided, there is actually wide agreement in our country that we need to make improvements to our health care system in the wake of the pandemic. Overall, 84% of voters agree, and a majority (54%) strongly agree, that we must build a better, more equitable health care system in the wake of the pandemic. This sentiment cuts across the political spectrum, with 71% of Republicans and 93% of Democrats calling for solutions. Just 13% want to see the health care system remain as it is.

Our nation must unite around a set of shared needs regarding the pandemic response and how the health care system should work for everyone. Across our listening work and national public opinion surveys in May and November 2020, our research reveals that throughout the pandemic people want:

• A reliable health care system that is fully resourced to support essential workers and available to people when it is needed, both now and after the pandemic.
• A health care system that cares for everyone, including people who are vulnerable and those who were already struggling before the pandemic hit.
• Accurate information and clear recommendations on the virus and how to stay healthy and safe.
• Being able to provide for ourselves and our loved ones, especially as we are worried about the pandemic’s financial impact.

Now is the time for Congress to come together and take immediate action to respond to the COVID-19 pandemic. Congress can do this by building a foundation for a better health care system based on people’s needs in these four ways:

1. By supporting a reliable health care system that is fully resourced to support essential workers and available to people when it is needed, both now and after the pandemic.

• Congress should provide $20 billion in funding to scale and implement the nation’s vaccine distribution capabilities.
• Improve access to quality mental health care and addiction recovery services nationwide by:
  • Investing in and incentivizing workforce development – including Graduate Medical Education targeted specifically to mental health professions, fellowships and loan repayment programs – to broaden and improve the pipeline of behavioral health providers nationwide.
  • Permitting licensed health professionals to practice telehealth and in-person care across state lines during
    national emergencies.
  • Increase the Medicaid FMAP for behavioral health providers practicing in health professional shortage areas.
• Address barriers people experience when accessing virtual care in order to give individuals the option to choose – when and where clinically appropriate – the type of interaction they want with their provider. Congress should:
  • Structure provider incentives to support offering a mix of in-person and virtual care visits (both video and telephonic) to patients. Policymakers should ensure providers are not incentivized to steer patients to certain methods of care based on reimbursement.
  • Allow patients to have access to audio-only/telephonic virtual care and remote monitoring devices by ensuring coverage reimbursement for these services. This will facilitate patients who do not have video capabilities the option to connect with their provider virtually.
  • Continued investment in expansion of broadband access to rural and underserved areas to increase access to virtual care services and close the “digital divide.”
• Transform how our health care providers are paid by establishing a COVID-19 Health Care Resilience Program. Many health care providers, most particularly individual and small group practices and primary care physicians, continue to face significant financial challenges due to COVID-19. By providing federal incentives in exchange for an agreement to move towards greater value-based care, we can both help these critical front-line providers while also improving the value people receive when they see a health care professional.

2. By creating a health care system that cares for everyone, including people who are vulnerable and those who were already struggling before the pandemic hit.

• Strengthen health care coverage to help more people get access to the care they need:
  • Establish new incentives for states to increase Medicaid eligibility. States could be incentivized to expand Medicaid by offering a 100% federal match for those enrolled in coverage through Medicaid expansion.
    The 100% match would be available to all states, regardless of whether they previously expanded Medicaid.
  • Make health care coverage more affordable by expanding access to Advance Premium Tax Credits to purchase health care coverage, limiting premium costs to 8.5% of income.
  • Fix the Family Glitch by amending the eligibility calculation for Advance Premium Tax Credits by attaching the affordability standard to the coverage cost of an entire family rather than just one individual’s coverage.
  • Invest in navigators, marketing, and outreach to help people understand their coverage options and enroll.
  • On a temporary basis, cover the full cost of COBRA assistance for those who have lost job-connected health insurance.
• Support state efforts to explore innovative approaches to coverage and care delivery by modernizing waivers. Congress can provide startup funding and planning grants while also creating additional flexibility in budget neutrality to help states test ways to meet their unique needs.
• Create a new public health workforce to help with contact tracing and community testing. In the long term, these workers can connect vulnerable communities to care, particularly if they are recruited from the communities in which they will work and utilize the expertise and local knowledge of community health workers.

3. By providing accurate information and clear recommendations on the virus and how to stay healthy and safe.

• Congress should appropriate $200 million for a vibrant public education effort that provides comprehensive and accurate information on the pandemic and the ongoing vaccination effort. We are in a precarious moment of deep public mistrust of government. A campaign to educate people regarding public health issues should demonstrate
  how we all benefit from public health and how testing, vaccination and pandemic response is implemented and why it is safe.
  • Any public education campaign should prioritize outreach to disproportionately impacted and potentially undervaccinated/underserved populations.

4. By ensuring people are able to provide for themselves and their loved ones, especially as they are worried about the pandemic’s personal financial impact.

• Appropriate $350 billion for state and local funding. Additional support for state governments and localities allows them to maintain the critical health care programs and services which help people take care of their families.
• Enable schools to safely reopen by providing funding for weekly testing of K-12 students, teachers and staff. Schools are the anchors of their communities and a key link to our entire economy. By providing schools with the resources and supplies necessary to reopen, even in a risk managed way, we can both restore normalcy for children and provide stability for our economy to recover.