As it did last year, the coronavirus pandemic dominated health care news in 2021, challenging a return to normalcy. The death toll in the U.S. alone crossed 800,000, but the availability of effective vaccines offers hope. In this post, we look back on the year’s most salient health care developments, focusing first on COVID-19 and then on other events.

  1. All Americans 5 and older became eligible for COVID-19 vaccines. Scientific breakthroughs in 2020 led to the development of three coronavirus vaccines. President Biden directed states to make every adult eligible for a vaccine by April 19, 2021; by the summer, supply was abundant. Unfortunately, the country fell short of Biden’s initial goal for 70 percent of American adults to receive at least one dose by July 4. Access barriers and political polarization contributed to this lag in uptake. Almost a year after the coronavirus vaccines were approved for adults, the U.S. Food and Drug Administration (FDA) granted emergency use authorization to the Pfizer-BioNTech vaccine for children ages 5 to 11. Vaccination rates vary widely across states, but early data show the vaccines had averted an additional 1.1 million deaths and an additional 10.3 million hospitalizations in the U.S. by November 2021.
  2. Variants impede progress. The vaccines are the good news of 2021, but the virus was by no means thwarted. The Delta variant, first detected in India and the cause of untold death and suffering there in the spring, spread widely in the U.S. in the summer. More transmissible than previous variants, it also is more likely to evade vaccines and cause breakthrough infections. Vaccination offers reasonably good protection against Delta, particularly when combined with public health measures like masking and distancing. Just before Thanksgiving, the Omicron variant, first detected in South Africa, joined Delta as a variant of concern. There is not yet clear evidence that Omicron is deadlier than previous variants, but indications are that it is even more contagious than Delta, and more likely to evade vaccines.
  3. Boosters in rich countries, no vaccines in poor ones. The U.S. and other rich countries have been criticized for authorizing booster shots for all adults, while in low-income countries, less than 8 percent of people have received even one shot. This inequity raises questions about the imperative to share pharmaceutical technology and know-how to protect the poorest and most vulnerable people in the world. Further, while boosting immunity in previously vaccinated people is important, as long as large swaths of the world’s population remain unvaccinated, the threat of new variants persists.
  4. Funds allocated to revitalize public health. The pandemic laid bare the weaknesses of the U.S. public health system; policymakers responded by funding efforts to strengthen it. Billions of dollars were earmarked for public health revitalization in the Coronavirus Aid, Relief, and Economic Security Act; the American Rescue Plan; and the Infrastructure Investment and Jobs Act. A stronger public health system is critical to ending the current pandemic and protecting the U.S. against future threats through enhanced surveillance and monitoring. The pressure is on to make sure that these investments in public health are used wisely.
  5. Supreme Court upholds the Affordable Care Act. In June, the U.S. Supreme Court upheld the Affordable Care Act (ACA), rejecting the last attempt by red states and the Trump administration to void the nation’s health care law. The Supreme Court’s ruling likely signals the end of wholesale attempts to challenge the constitutionality of the ACA, meaning millions of Americans can retain its many benefits.
  6. Administration vigorously implements ACA provisions. The Biden–Harris administration and Congress took several steps in 2021 to increase enrollment in insurance through the ACA, including more generous subsidies, longer and more flexible enrollment periods, and funding for outreach. The result is that as of December 9, nearly 4.6 million Americans have signed up for 2022 health coverage through HealthCare.gov and state-based marketplaces. Insurance is one key component to ensuring that people have access to affordable health care, more important than ever to combat the pandemic.
  7. States attack women’s right to reproductive health. In Mississippi, Texas, and other states, recent laws pose new threats to a woman’s constitutional right to abortion. The Supreme Court on December 10 left in place a Texas law that banned most abortions in the state after about six weeks. However, the Court allowed abortion providers to challenge the law in federal court. This came less than two weeks after the justices heard a direct challenge to Roe v. Wade regarding a Mississippi law that bans most abortions after 15 weeks. This case will likely be decided in 2022.
  8. Implementation of the No Surprises Act. In 2021, the Biden administration released regulations to implement the No Surprises Act (NSA), a sweeping bipartisan law protecting consumers from surprise medical bills. Under the NSA, consumers are protected from financial liability (beyond in-network cost-sharing) when they are provided emergency services by an out-of-network facility or provider, including air ambulance services, or when out-of-network providers at in-network facilities provide nonemergency services.
  9. Medicaid work requirements are reversed. The Biden administration withdrew approval for Section 1115 waivers that allowed states to make Medicaid benefits contingent on employment. These were approved by the Trump administration and led to coverage losses that could have been even more devastating during the pandemic.
  10. Annual drug overdose deaths top 100,000. America’s drug epidemic broke a new deadly record. More than 100,000 people died of drug overdoses during the 12-month period ending April 2021. Overdose deaths jumped 28.5 percent from the same period a year earlier and have more than doubled since 2015. Synthetic opioids drove the rise in deaths, fueled by widespread use of fentanyl.