Policymaking in the wake of COVID-19

All Americans are struggling to make sense of COVID-19 pandemic and keep themselves and their loved ones safe. Public health advocacy groups are additionally working to identify and fix policy and funding gaps to address this and future public health emergencies. While the full scale of this disaster is as yet unknown, if projections about the ultimate human and financial toll are accurate, the COVID-19 pandemic could be a transformative event in domestic policymaking on the scale of the 2008 financial crisis or the September 11th attacks.

Following the September 11th attacks, the federal government massively increased investments in our national and homeland security infrastructure. The federal government doubled defense spending, stood up a new cabinet department, overhauled our intelligence agencies, granted new powers to federal law enforcement, entered into permanent war footing against real and perceived threats, and much more.

The COVID-19 pandemic and the insufficient federal response could result in thousands of deaths and hospitalizations, an economic recession due to its effects on both consumer demand and the global supply chain, and a vivid, real-time, months-long illustration of the shortcomings of the U.S. health care system. COVID-19 has exposed massive vulnerabilities in multiple areas of our public health infrastructure – insurance coverage; hospital capacity; medical equipment and supply shortfalls; testing and diagnostics, and generally the ability of federal, state, and local authorities to keep communities safe.

The amount of funding alone that will be required to respond, fix shortcomings, and rebuild capacity will be massive.

Consider that Congress acted quickly to provide $8.3 billion for state & local health agencies, vaccine and treatment development, and small business loans. Immediately following enactment, the House negotiated and passed a second package including paid sick leave, unemployment insurance, food and nutrition assistance, increased Medicaid funding, and much more. Meantime, the President declared a national emergency making $40 billion immediately available from FEMA’s Disaster Relief Fund, and the Federal Reserve has injected $500 billion and dropped interest rates to zero, none of which has been enough to stop financial and labor markets from crashing. Congress is already discussing a third emergency response package, before package #2 is even signed into law.

The policy impact of the COVID-19 pandemic could be equally dramatic. The emergency could have an impact on pre-existing efforts in Congress to protect patients from surprise medical bills, and the cost of an eventual vaccine or anti-viral could have affect the prescription drug pricing debate. COVID-19 could accelerate efforts to move closer to universal health insurance coverage through expanded Medicare or a public insurance option. Overhauling the health preparedness infrastructure, increasing hospital surge capacity, and efforts to protect vulnerable populations based on lessons learned from COVID-19 are near certainties.

The timing of this pandemic is also key. Widespread dissatisfaction with the federal response could hurt President Trump’s chances for re-election and Republicans’ efforts to keep their Senate majority in November. And with Fiscal Year 2022 the first year since enactment of the 2011 Budget Control Act to be un-encumbered by statutory budget caps or the threat of sequestration, the stage could be set for massive new investments in the public health infrastructure and health policymaking as ambitious as anything seen since the creation of Medicare in 1965.

For a multitude of reasons, we hope the projections of COVID-19’s ultimate toll on Americans, our economy, and our communities is being vastly overestimated. However, it is important for all health advocacy organizations to consider long-term impact that a more severe scenario could have on future policymaking and funding decisions, and prepare ways to engage.

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