The Seven Biggest Public Health Policy Issues on the Hill in 2020

December 09, 2020 | Jeffrey Ekoma

As a truly historic year comes to an end, many public health policy issues received a considerable amount of attention in 2020. From the pandemic that will live on in infamy, racial health disparities, and the future of the Affordable Care Act (ACA), these are just a few of the major health issues that took center stage on Capitol Hill this year.

Read on for the biggest public health policies considered by Congress, as well as the current Administration, that are also expected to shape health policy in the coming year.

Ongoing Response to COVID-19

As expected, the response to COVID-19 global pandemic was the principal issue of the year. From the first confirmed case in Washington State back in January, the country is now facing the largest number of daily reported cases and hospitalizations. However, Pfizer/BioNTech and Moderna’s COVID-19 vaccine candidates has provided welcome news in advancing overall response activities.

As state and territorial health departments prepare to receive vaccines from the federal government through Operation Warp Speed, ASTHO and the Association of Immunization Managers requested additional supplemental funding to expand and strengthen federal, state, local, territorial, and tribal capacity for a timely, comprehensive, and equitable mass vaccine administration campaign.

As Congress considers additional supplemental funding to mitigate the effects of the pandemic, it is expected that there will continue to be increased attention to address the pandemic. The incoming Biden Administration also highlighted the pandemic as one of its four main priorities.

EVALI and Tobacco Control

Before COVID-19 took control of our daily lives, tobacco control was the latest emerging public health matter impacting our health and well-being. In mid-summer 2019, there was a national outbreak of e-cigarette, or vaping, product-use associating lung injuries (EVALI) that eventually peaked in Sept. 2019 and resulted in a total of 2,807 hospitalizations or deaths across the country as of Feb. 18, 2020.

EVALI cases have declined as a result of increased public awareness of the risks associated with using e-cigarettes and vaping products, as well as the removal of substances, such as vitamin E acetate from its products.

A federal year-end legislative package in Dec. 2019 increased the age of sale for all tobacco products from 18 to 21, so tobacco control advocates turned their attention to the premarket tobacco product application deadline for companies seeking permission to market products to be sold in the U.S. The original deadline was set for May 12th, however, an extension was granted as a result of COVID-19.

For background, all tobacco-related products that were on the market as of Aug. 8, 2016, were required to submit applications to the FDA. Products without applications were to be pulled from the market. The FDA has one year (deadline is Sept. 9, 2021) to review applications, which will determine what tobacco products and flavors will be permitted to remain on the market.

Future of the ACA

A decision on the ACA and its provisions are likely to be decided by the U.S. Supreme Court next year. Current litigation (California v. Texas) before the court challenges the merits of the ACA’s individual mandate, which requires that individuals purchase health insurance.

The impact of a decision, whether the ACA is left in place with or without the individual mandate or if the law is completely struck down, will have ripple effects across all sectors of health policy. If the entire law is struck down this specifically could impact the future of the Prevention and Public Health Fund which funds approximately 12% of CDC’s overall budget.

Public Health Data Modernization

Efforts to modernize our public health data infrastructure continued in 2020. Congress provided $500 million for the CDC’s Data Modernization Initiative (DMI) through the passage of the Coronavirus Aid, Relief, and Economic Security Act. Although funding was provided as a result of the ongoing pandemic, it represents an enterprise-level commitment to building the necessary infrastructure to support a much-needed public health data superhighway.

Sustained funding, on an annual basis, will be critical in subsequent years to ensure that the CDC has the necessary resources to execute its DMI. It's also important to note the real-time accurate data will be necessary to support COVID-19 mass vaccine distribution campaigns.

Health and Racial Equity

The disproportionate impact of COVID-19 on communities of color increased Congressional attention to the overall health and racial equity issues across the country. Most recently, the Democratic staff of the Senate Committee on Health, Education, Labor, and Pensions released a report of recommendations that Congress could act upon to address racism and inequality in the healthcare system.

In addition to the Senate, the House held multiple hearings focused on addressing this issue as it related to the pandemic and this issue. Considering the level of importance that the incoming Biden Administration has placed on advancing solutions to issues centered on racial inequity, this matter is more than likely to be on the top of the list for both Congress and the Administration.

Opioid Epidemic

Deaths associated with drug overdose rose by 13% in the first half of the year, compared with data from 2019. This increase comes at a dire time when pandemic has reduced access that individuals have to addiction and substance use disorder (SUD) services. The incoming administration is expected to address the epidemic by focusing on investments rooted in providing prevention, treatment, and recovery services, limiting over-prescribing, and stopping the distribution of illicit drugs into the country.

The House passed several measures to provide resources to states and territories to address SUD within their jurisdictions, revise regulations around the prescription of narcotic drugs, and procedures for the safe handling of opioids.

Reducing Health Care Costs

Pricing transparency received a considerable amount of attention this year, with the administration finalizing a rule that requires all U.S. hospitals to publicly disclose their charges for items and services in a searchable, consumer-friendly format. The rule intends to support competition, which will increase quality and lower the cost of healthcare. Also, President Trump signed executive orders to lower the cost of prescription drugs for those living in the U.S.

Notably, the orders would require federally qualified health centers to pass on savings from the purchase of insulin and epinephrine directly to patients and permit states, wholesales, and pharmacies to engage in plans that allow the importation of prescription drugs from other countries, such as Canada.

Each chamber of Congress also separately passed legislation related to drug prices with the House passing the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3) and the Senate Finance committee approving the Prescription Drug Pricing Reduction Act (S 2543). However, progress on this legislation stalled due to the other emerging priorities on the Hill and it is unclear if these bills will become law before the end of the year.

Proposals to protect patients from surprise medical bills were also a concern of Congress. Options for discussion include:

• A payment standard or a formula used to calculate charges for out-of-network providers.
• An independent dispute resolution process for out-of-network providers.
• A combination of the two that provides a payment standard with the option for out-of-network providers to challenge payments made to them through a dispute resolution process.

The consensus among both bodies of Congress is utilizing a hybrid approach, however, an agreement has not been made. It is expected that Congress will resolve this issue in 2021.

Although much of 2020 was dominated by the overall response to the COVID-19 pandemic, many other health priorities were of interest to federal lawmakers and the Administration. Looking ahead to 2021, ASTHO expects health policy to be a top priority for the incoming administration and members of Congress.