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How Do Biden’s and Trump’s Public Health Platforms Compare?

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The November 2020 election is widely anticipated to have important implications for how the US responds to COVID-19.

Under the Trump Administration’s COVID-19 response, states have largely been responsible for COVID-19 testing infrastructure, social distancing requirements, and the dissemination of pandemic preparedness supplies such as personal protective equipment (PPE) and ventilators. As the administration prepares for the eventual distribution of a novel COVID-19 vaccine, the Centers for Disease Control and Prevention (CDC) and the Department of Defense will likely rely heavily on existing state and territorial infrastructure for vaccine program implementation.

Both the Trump Administration’s and the Biden–Harris campaign teams’ plans to respond to the ongoing pandemic are front and center in the 2020 election. Pandemic response, public health infrastructure, beneficiary cost-sharing and coverage during the public health emergency, and overall preventive health services access and funding are areas to watch in anticipation of the November 2020 election.

COVID-19 Response and Public Health Infrastructure for Pandemic Preparedness

The November 2020 election outcome will lead to potential changes to the ongoing US response to the COVID-19 pandemic. While federal versus state COVID-19 response, vaccine distribution planning, public health funding, and global health coalition-building have all been foci of important infrastructure to combat COVID-19, the next administration will have the opportunity to shape these efforts of response in planning for the future of pandemic preparedness. COVID-19 response and public health investment and infrastructure are likely to differ between a Trump and Biden administration, as outlined in the following table:

Trump Administration Biden–Harris Campaign
Federal vs. State Response on Pandemic Preparedness Deferred significant authority in the pandemic response to states. States have taken markedly different approaches to testing, social distancing requirements, and PPE distribution. Geographic variation persists in testing rates and COVID-19 cases across states. Specified various proposals to intensify the federal government’s response, including calls to increase the availability of COVID-19 testing and employ the Defense Production Act to ramp up production of personal protective equipment.
Federal Vaccine Distribution Planning Released a COVID-19 Vaccination Program Interim Playbook for Jurisdiction Operations on September 16. The plan aggregates materials previously released and presented by the Advisory Committee on Immunization Practices (ACIP) and other stakeholders and relies heavily on state-based infrastructure, including Immunization Information Systems. Has not released an official distribution plan, and while a response strategy under a new administration is likely to rely heavily on state infrastructure, the extent to which Biden’s plan may more clearly outline avenues for state support remains unclear.
Funding for Existing Public Health Infrastructure Beginning in FY 2018, the President’s annual proposed budget has included cuts to emergency preparedness and other long-standing public health programs through the CDC. The President’s FY 2021 proposed budget included a 16% reduction in CDC budget and $2.9 billion in cuts to the National Institutes of Health (NIH). While the Obama Administration prioritized overall global health funding through the NIH to combat AIDS, tuberculosis, and malaria, the former administration annually proposed cuts to CDC funding, and a Biden administration’s public health funding priorities remain unknown. The proposed healthcare platform includes public health infrastructure policies that would reinstate the White House National Security Council Directorate for Global Health Security and Biodefense, expanding the CDC disease detective workforce, and strengthening relationships with the World Health Organization (WHO).
Global Response to the COVID-19 Pandemic Announced the US will not participate in the COVID-19 Vaccines Global Access (COVAX) facility, a pooled procurement initiative co-led by the WHO, Gavi, and the Coalition for Epidemic Preparedness Innovations to address overall access concerns in eventual global distribution of COVID-19 vaccines. This follows just a few months after the Trump Administration notified the United Nations Secretary-General of its intention to withdraw from WHO. While the Biden campaign has indicated that it would restore the US relationship with WHO and rebuild and restart other global health initiatives, the deadline to financially commit to the COVAX facility occurred in September.
Patient Affordability and Cost-Sharing Supported the passage of the Families First Coronavirus Response Act; the Coronavirus Aid, Relief, and Economic Security Act (CARES); and the Paycheck Protection Program and Healthcare Enhancement Act. However, continued safety net funding has stalled under a divided Congress and a Trump Administration. While the CARES Act mandates zero cost-sharing for COVID-19 testing, patients can still face cost-sharing for diagnosis and treatment for COVID-19. Joint guidance released in June of this year from the Department of Labor and the Department of Treasury requires commercial plans to cover COVID-19 testing without cost-sharing or medical management requirements. Stated intention under his potential administration to require all private plans to cover all COVID-19 testing, treatment, and potential vaccines.

Looking Ahead: The Potential to Expand Access to Preventive Health Care

In addition to the topics outline above, the federal government and states have taken critical steps to protect and expand access to healthcare during the pandemic. For example, recent policy changes have reduced reimbursement and coverage barriers for telehealth services, and many patients can now use telehealth to access a broader range of services and providers via different virtual modalities. Additionally, the Department of Health & Human Services  has used authority under the Public Readiness and Emergency Preparedness  Act to allow state-licensed pharmacists to order and administer COVID-19 tests. Similar authorizations allow state-licensed pharmacists and pharmacy interns under supervision to order and administer pediatric ACIP-recommended vaccines and future COVID-19 vaccines. Regardless of election outcome, the next administration will play an important role in determining which flexibilities related to telehealth, scope of practice, and other preventive health access tools will become permanent.

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