Health Care in 2020: Year in Review

Recent years have been unusually turbulent in the world of health care policy, but none could compare with 2020. The coronavirus pandemic hasn’t just dominated health care news, it’s had a chaotic and cruel impact on the lives of every American. Given its oversized influence, we devote the first half of this piece to the pandemic. But believe it or not, there are other health care happenings to report.

1. COVID-19 hits the United States. On January 21, a Washington state resident became the first person in the U.S. with a confirmed case of the 2019 novel coronavirus. He returned from Wuhan — the Chinese city regarded as the origin of the pandemic — on January 15. Although the Centers for Disease Control and Prevention (CDC) initially believed that nontravel-related COVID-19 did not begin spreading until the end of February, subsequent evidence shows that there was limited community transmission from late January into the beginning of February.
2. Pandemic takes a devastating toll on health. As of the writing of this piece, almost 18 million people in the United States have been infected with the coronavirus and at least 317,800 have died. The highest single-day death toll crossed 3,600 on December 16, three weeks after many Americans traveled for Thanksgiving. The U.S. has more recorded cases and deaths than any other country, and accounts for nearly one-fifth of the 1.7 million recorded global deaths.
3. Economic fallout. The coronavirus also has wreaked havoc on the economy. When many parts of the country were abruptly locked down in March to curb rampant spread, millions lost jobs overnight. For several weeks, only essential businesses were allowed to operate. In November, the unemployment rate was 6.7 percent, down from a 14.7 percent high in April, but almost double the rate in February. A patchwork of federal programs and unemployment benefits have provided some respite, and on Sunday night, Congressional leaders finally reached an agreement on a $900 billion stimulus package. As many as 7.7 million workers lost jobs with employer-sponsored insurance as of June 2020 because of the recession. This is alarming — a health crisis is precisely the time when people need access to care.
4. FDA authorizes coronavirus vaccine and distribution begins. One ray of hope in an otherwise bleak year: the scientific community worked at unprecedented speed to develop several COVID-19 vaccines. In December, the U.S Food and Drug Administration (FDA) approved the emergency use authorization for Pfizer and BioNTech’s vaccine, as well as the Moderna version. According to the pharmaceutical companies’ clinical trials, these vaccines are more than 90 percent effective at preventing the disease. Both are now arriving at health care institutions throughout the United States; distribution to the public is around the corner but likely to be complicated. The CDC recommends that health care workers, residents of nursing homes, and people with underlying health risks receive the vaccine first.
5. Dramatic leapfrogging in telehealth. The pandemic dramatically altered the delivery of health care. In the early months, many people delayed nonurgent care and practices deferred elective visits and procedures. The use of telemedicine increased dramatically; the CDC recorded a 154 percent increase in telehealth visits during the last week of March 2020, compared with the same period in 2019. A Commonwealth Fund study found that visits to ambulatory providers fell nearly 60 percent by early April, but by October had returned to prepandemic levels. Nevertheless, the increase in telehealth for some services is likely here to stay.
6. Racial injustice protests draw attention to health disparities. A disproportionate burden of COVID-19 falls on people of color — Black, Hispanic, and Native American people are more likely to contract the virus, be hospitalized, and die from it than are white Americans. These data emerged at the beginning of the summer, when a spate of police violence against Black Americans drew public attention to systemic racial disparities. This is not new — access to care and health outcomes for people of color have always lagged — but the injustice of these disparities has appeared more intolerable in the face of the pandemic.
7. The future of the Affordable Care Act is still unknown. The Trump administration’s effort to repeal and replace the ACA began in 2017, but the health law is still standing — albeit with seemingly never-ending legal challenges. This year, the Supreme Court heard oral arguments in California v. Texas. The case was initially brought in 2018 by a group of Republican state attorneys general led by Texas to invalidate the ACA and made its way through lower courts. In November, it went to the nation’s highest court; a ruling is expected next spring.
8. Medicaid expansion continues at a slow and steady pace. Oklahoma and Missouri passed ballot measures to expand Medicaid; in October, Nebraska began to implement its expansion. This trend indicates a strong public sentiment in favor of expansion and brings the number of states that have not expanded to 12. Medicaid expansion offers some respite to the millions needing health care for COVID and the growing number of Americans forced into poverty by the pandemic. Nearly 8 million Americans have fallen into poverty since the summer, pushing the poverty rate to 11.7 percent in November.
9. Joe Biden is elected president. In a fraught election, against the backdrop of a raging pandemic, Americans went to the polls or mailed in ballots in record numbers to vote President Trump out of office. Key battleground states like Arizona, Georgia, Michigan, Nevada, Pennsylvania, and Wisconsin swung Democratic. In his campaign, Biden vowed to strengthen the ACA, which was passed during his tenure as vice president. Even as the Trump administration undermines Biden’s transition to office, the president-elect is making plans to tackle the pandemic.
10. Biden appoints new health care team. President-elect Biden evidently believes that an experienced and capable team is key to tackling the pandemic. This month, he nominated Xavier Becerra as Secretary of Health and Human Services, Jeffrey Zients to coordinate his COVID-19 response, Vivek Murthy as Surgeon General, Rochelle Walensky to lead the CDC, and Marcella Nunez-Smith to chair his COVID-19 Equity Task Force. Anthony Fauci, who has provided invaluable public health guidance, will be Chief Medical Advisor on COVID-19 to the President. Biden also chose Susan Rice to head his Domestic Policy Council, which has often played an important role in health policy.