An Expert Look at Presidential Pandemic Plans

In the waning days before the election, President Trump and President-elect Biden laid out their thoughts on the pandemic. President Trump touted that COVID was all the media could speak about and added that talk of the virus would disappear November 4, but President-elect Biden said he plans to meet COVID-19 head-on.

In this month’s political analysis, four experts tell us what they believe President-elect Biden’s plan is for the pandemic and what he is likely to do leading up to inauguration day. Consider this sequence of events: 

• On the morning of November 7, Joe Biden was projected to be the winner of the 2020 US presidential election.
• On November 8, a front-page headline from The New York Times declared that, “A ‘Terrifying’ Coronavirus Surge Will Land in Biden’s Lap.”
• On November 9, a headline in The Wall Street Journal announced “Biden Targets Virus to Begin Transition.”

President-elect Biden is jumping in headfirst, as he promised to do during the campaign. Most pre-election polls indicated that the economy and COVID-19 were the top two issues for Americans as they cast their vote. Both have become inseparable, since economic vitality is largely reliant on addressing the deadly virus. Add in the political undertones that seem to impact just about every public health decision—along with the winter months likely producing a rise in cases similar to what occurred during the second winter wave of the 1918 flu pandemic—and we arrive where we are now, with a massive undertaking that awaits the new president. (Editor’s note: At the time of publication, majority of major media outlets had declared Joe Biden the official president-elect. The Trump administration had just begun court proceedings to contest.)

The election results are not yet technically official—as is typical until the presidential electors meet in mid-December. And this year results are being challenged by President Trump, who is alleging voter fraud, but not yet produced the kind of evidence involving enough votes that would tilt the outcome in his favor. The courts would have to agree that the evidence is strong enough to pursue. As of November 10, that has not occurred, nor has the president conceded. 

Despite the uncertainty, barring a major uncovering of election misdeeds (which many experts agree is highly unlikely), it is all but assured that President-elect Biden will take office on January 20. Against that backdrop, we asked four of our trusted managed care experts to give us their high-level thoughts on how the Biden administration will tackle the COVID-19 public health crisis once he is in charge. Following are their responses, which have been edited for clarity. 

Melissa Andel, principal with CommonHealth Solutions in Washington, DC

I hope that increased testing in key settings like hospitals, health care facilities, and schools will be something that can be accomplished. Opening schools and daycare centers as much as is safe is something that is so important, not only for the kids, but also for the economy. 

I am also hoping to see more or better messaging about how Americans can reduce their risks when they do decide to leave home. Everyone is suffering from pandemic fatigue, so it is somewhat unreasonable to expect Americans to follow strict stay-at-home orders, as they may have been willing to do at the start of the pandemic. So, the question becomes: How can we reduce risk if and when we do decide to interact with one another? It is true that there are a lot of things that we don’t know, since the virus is novel. But we are learning and we have observational data that can help guide us toward making better choices. That data needs to be communicated to Americans in an accessible format.

It is going to be challenging, especially in a divisive political climate. Public health messaging is difficult to begin with. And Americans are notoriously bad at following messaging that says, for instance, “We would prefer that you avoid large crowd gatherings, but if you are not going to, here are steps you can take to reduce your risk.” 

On top of that, we have been living with COVID for almost 9 months now, so many Americans have made up their minds one way or the other as to what is appropriate and what is not. Mask wearing is an obvious example of something that has become almost 100% political. How does President Biden reach out to the Americans who think that masks are never appropriate, especially if they did not vote for him and may even dispute the results of the election? This same problem will also apply to the vaccine, since some Americans may be skeptical to receive it because they are skeptical of vaccines in general, or because they fear that the vaccine approval process has been politicized.

Vaccine distribution will be challenging; specifically, distributing the doses of vaccine in an equitable and safe manner, since there will be complex handling requirements. If the vaccine requires multiple doses, that will be another challenge. And all of those challenges would exist even if 100% of the population was willing to receive it. Once you layer the vaccine skepticism on top of the fundamental challenges, it is difficult to be optimistic. The early reports from Pfizer’s vaccine study are certainly promising; I think if  a vaccine ends up having a high rate of effectiveness, people may be more willing to take it.

As for payers, I think the main keys are coverage of and access to testing, particularly if that may require plans to expand their lab testing network to meet increased demand, or reconsider payment terms to implement something similar to the Medicare policy to pay labs an additional fee for more quickly turning test results around. Not only are we seeing an increase in cases, but it also looks as if a Biden administration will also encourage access to testing. Plans are already doing this in some capacity. For example, United Healthcare has distributed home testing kits to high-risk Medicare Advantage members. But I imagine efforts would be broader and more coordinated in 2021.

Perhaps this is wishful thinking, but if a Biden administration is successful at navigating a more coordinated masking and social distancing policy nationwide, we could also see an early spike in costs (due to increased testing plus higher baseline case rates) followed by lower costs if the spread is able to be better controlled than what we have done so far.

Larry Hsu, MD, medical director, Hawaii Medical Service Association in Honolulu

Biden has already established his task force and appears to be hitting the ground running. Since there are already processes in place for personal protective equipment (PPE) and vaccine development, it is very realistic to see these things proceed on a track where we see progress. PPE distribution is the easiest since the process is already in place. This will be critical, especially if cases surge this winter. Funding will be the most challenging for the new president, since it has to go through Congress, Republicans are likely to still be in control, and Democrats will control the House, albeit with a smaller majority. This will present major challenges. 

As for the contention that much of what Biden has planned President Trump already put in place, I say, yes and no. Yes, the Biden plan is similar to the Trump plan because the fundamentals of managing a public health crisis are known and there are only so many best practices. So, there is overlap. But the big difference is in the message coming from the top for prioritization and implementation of these actions. As such, we need a national policy that all or most governors can buy into. 

Edmund J Pezalla, MD, founder and CEO, Enlightenment Bioconsult in Hartford, CT

Biden has stated that he will rely on science and medical experts to guide the national response to the current pandemic. With more resources put into making testing available and more tracing, payers will need to prepare to continue to cover testing and treatment and to do it for more people. Right now, treatment is limited to hospitalization and a few interventions, but payers have been preparing for covering more testing.

More important will be how we handle new treatments. Some antibody therapies could be approved in the quarter 1 to 2 timeframe. It will be interesting to see how we pay for vaccines, since the costs will certainly start to add up. I suspect that early vaccine rounds will be for first-responders and others deemed critical. We will probably rely on federal payment. After that there may be a combination of federal funds and private payers as ACIP [Advisory Committee on Immunization Practices] will weigh in and most private plans will be obligated to provide first dollar coverage. This will make federal funds go farther, which may be necessary if Biden cannot get enough money from Congress. As for treatment, I think there will be a split of federal vs private, again to allow for some private contribution to extend federal dollars.

Working with the states is important as many things in the United States are done at the state and local level. Even Republican governors have been interested in federal funds and cooperation so we may see more actual working together. Some things will be impossible for governors to change. They won’t voluntarily change their position on masks, but they have also had a wake-up call regarding how many people in their state did not vote for Trump. They need to keep that group somewhat happy and they need to take positive steps to allow for fuller participation and growth in their economics. 

The CDC will play a big role in setting guidance, establishing better testing, and providing more resources and technical assistance to the states. This will take a while to improve as it has been demoralized and is clearly underfunded. Leadership will be important. We will probably see a big-name appointment from a major center such as Johns Hopkins.

The keys to taking the CDC to independence and more science orientation will be: better funding, removing the specter of running out of funds or asking for more; big name leader with public mandate; transparency, allowing agency to actually respond to issues and to go to the public; oversight body of nonpoliticians; and clear and explicit support from elected leaders including in the Congress as well as the White House.

In terms of payer preparation, insurers have anticipated more testing and introduction of vaccines and treatments. Under Biden they will likely have more financial liability and less ability to ask for copays. Big expenses are unrelated to politics and elections and are more related to the science. Even if the FDA is cautious in approvals, we will most likely have both vaccines and treatments by the end of 2021. Even without mandates for coverage or first dollar preventive coverage, payers will need to cover these due to obligations to pay for medically necessary treatments and to avoid the costs of the continuing pandemic.

F Randy Vogenberg, PhD, RPh, principal at the Institute for Integrated Healthcare in Greenville, SC

I am of the mind that Biden will face the same or similar issues as Trump, so it will be difficult at best. Expect pretty much what we have seen to date. In fact, one could argue that Biden might get less done, given his record in government. Biden and his team have a history of being less aggressive and more concerned with efforts that help somewhat but do not go far enough. More is needed to address a public health crisis where there are a lot of unknowns. Gridlock is likely to continue, especially if the GOP holds the majority in the Senate—plus Biden will have to deal with a smaller majority in the House. It is not going to be any easier just because Biden is in the White House. 

We have seen how misguided some states have been in their efforts vs others. I am thinking New York compared with Florida or Georgia. Avoiding bias in communications is critical to fully informing the public with transparent messaging toward useful, meaningful actions to take against this virus. We can do much better on this issue.

The CDC is antiquated like much of the other health-related government agencies. There still needs to be an ability to retain expertise and knowledge that will be helpful for the next 10 to 30 years. Lack of balance in hiring expertise, lack of effective or timely collaborations, and funding shortfalls have all contributed to the problems seen today. We need to continue more private and public sector collaborations to speed or aid responses in such crises.

As for managed care stakeholders, testing and tracing needs to be improved and be done faster and more consistently in all states. The lack of consistency combined with slow-to-respond efforts available with novel technologies underscores the need for more open collaborations between private and public sector. The early response regarding testing is understandable. But now the situation has become confusing and misunderstood by many to the benefit of select testing firms or manufacturers. Those abuses and lack of changes to reflect what is known today need to be quickly addressed regardless of who is in the White House.