What Will Be the Top Health Issues for 2020?
By Roz Plater
It's 2020 and another year of health-related topics awaits us.
What health issues will take priority? What buzzwords will we all be talking about? How might technology change healthcare?
We asked some experts to peek into their crystal balls and make a few predictions.
They tell us that how you get access to healthcare and how you pay for it will both be hot topics this presidential election year.
In fact, one expert says healthcare could help decide political winners and losers.
"Whoever comes up with a plan that will work, is affordable, and something people can understand, that will push them ahead," said Kurt Mosley, vice president of strategic alliances for Merritt Hawkins, a physician search, consulting, and research firm.
Medicare is front and center as we kick off 2020.
That's in part because "Medicare for All" is the single payer option health plan being touted by two of the top Democratic presidential candidates.
Jeff Becker, the senior analyst for healthcare strategy at Forrester Research says there are also a number of bills in Congress looking to expand access to Medicare as a public option.
"When you look at the polling numbers, our call is that Medicare for All will die in the court of public opinion and become Medicare Advantage for more," Becker told Healthline.
Affordable Care Act
The Affordable Care Act (ACA), often referred to as Obamacare, will be in the courts again this year.
In December, a federal appeals court ruled that the health insurance law's individual mandate provision was unconstitutional.
However, the justices sent back to a federal district court in Texas the issue of whether other parts of the law could continue to exist without the mandate that requires everyone to have health insurance.
Look for some sort of Obamacare case to wind up in the U.S. Supreme Court this year.
"Our call is whether or not it goes to the Supreme Court, the ACA will survive because the individual mandate is severable," Becker told Healthline.
Experts say you'll hear a lot of debate about price transparency, a move designed to increase competition and lower costs.
President Trump signed an executive order in November that requires hospitals and insurers to publish their confidential, negotiated rates for treatments.
"The reason this would be important is you'd be able to figure out what your out-of-pocket expenses would be" said Becker.
But a coalition of hospital groups has filed a lawsuit to block the rule. They argue that the public disclosure of negotiated charges would create confusion about consumers' out-of-pocket costs.
The order is scheduled to go into effect January 1, 2021.
Lower Prescription Drug Prices
"The thing about pharmaceuticals is, if you can't afford them, they don't work," Mosley said.
He predicts the move to lower the costs of prescription drugs will again be on the front burner of the healthcare debate in 2020.
"The problem is Medicare and Medicaid can't negotiate prices with these drug companies," Mosley told Healthline.
The House of Representatives has approved a bill that would do just that. The legislation also caps out-of-pocket expenses for people enrolled in Medicare Part D.
However, the prognosis for this bill becoming law isn't good.
Political observers say the legislation won't go anywhere in the Senate, and the White House has indicated the president would veto it.
Republicans in the Senate have crafted their own prescription drug price plan. The president has indicated he would sign this bill, but it would need to be approved by the Democrat-controlled House.
Access to Health Services
"One of the cross-cutting issues we see as a priority in 2020 is the social determinants in health disparities in our patients," said Amy Mullins, MD, FAAFP, medical director for quality improvement for the American Academy of Family Physicians.
"Patients need more than just access to a physician," she told Healthline. "They need access to good food, safe places to live, to exercise, transportation, community resources, access to medication."
"If you don't address those, it's really difficult to treat your patients effectively," she added.
Mullins says her group has an internal division called the Center for Diversity and Health Equity whose mission is to look at healthcare through that lens.
Mullins also says the issue of vaccine myths is one you'll continue to hear about in 2020.
"We want to do more to counter the misinformation that's out there around vaccines that may be holding some people back from getting what they need," said Mullins.
A recent study concluded that a lot of the false information is being spread on social media by a handful of anti-vaccine ad buyers.
"We're promoting vaccine education to physicians, their healthcare teams, patients, and communities" Mullins said.
A 2020 National Vaccine Plan is currently being developed by the Department of Health and Human Services' Office of Infectious Disease and HIV/AIDS Policy.
"Another of the big priorities for health providers in 2020 is vaping and e-cigarettes," Mullins said.
"We really applaud and support the work the Centers for Disease Control and Prevention and the Food and Drug Administration is doing to try and get a handle on this crisis," she said. "But these products target adolescents and we think the marketing needs more regulation."
A study released last month from the National Institute on Drug Abuse reported that more teens are vaping marijuana.
That's despite a lung illness linked to vaping that's killed more than 50 people nationwide.
Virtual Care Visits
On the digital front, Becker predicts there will be aggressive growth in virtual care visits.
That's where you interact with your doctor via text, video, or phone call.
Becker's group crunched the numbers after looking at outpatient visit data as well as talking to virtual vendors and tracking healthcare investments.
"The result was 36 million net new virtual care visits in 2020," he said.
He points to how employers and insurers are already embracing the concept. Amazon recently launched a pilot program called "Amazon Care," a virtual clinic for its employees in Seattle.
Walmart recently expanded its telehealth services to workers in Colorado, Minnesota, and Wisconsin with $4 online or video care visits.
Humana has teamed up with "Doctor on Demand" to offer a virtual primary care plan at significantly lower monthly premiums.
"Everybody is moving toward a model where we're not using high-cost care centers like emergency rooms," Becker said.
"And consumers are demanding more cost effective services, too," he added. "In 2018, consumers took out $88 billion in personal loans just to pay for out-of-pocket medical costs."
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It's going to be back-to-school time soon, but will children go into the classrooms?
The American Academy of Pediatrics (AAP) thinks so, but only as long as safety measures are in place.
Keeping Schools Safe<p>What will safer schools look like?</p><p>In a <a href="https://jamanetwork.com/journals/jama/fullarticle/2766822" target="_blank">JAMA article</a> published last month, <a href="https://www.jhsph.edu/faculty/directory/profile/1781/joshua-m-sharfstein" target="_blank">Dr. Joshua Sharfstein</a>, a pediatrician and professor at the Johns Hopkins Bloomberg School of Public Health, outlined suggestions — many of which are similar to AAP's.</p><p>Remote learning protocols must stay in place, especially as some schools stagger home and in-building learning. If another shutdown needs to occur, children will rely on distance learning completely, so it must be easy to switch to, he said.</p><p>He suggested giving parents a daily checklist to document their child's health. Kids should be screened quickly on arrival and be given hygiene supplies. Maintenance staff should use appropriate PPE and have regular cleaning schedules. A notification system should be in place if a case is identified, Sharfstein recommended.</p><p><a href="https://www.albany.edu/rockefeller/faculty/erika-martin" target="_blank">Erika Martin</a>, PhD, an associate professor of public administration and policy at University at Albany, said nutrition assistance and health services should be included. She called for tutoring programs with virtual options as well as technology access.</p>
Supporting Staff<p>Teachers and staff will be affected by safeguarding measures, noted <a href="https://directory.sph.umn.edu/bio/sph-a-z/rachel-widome" target="_blank">Rachel Widome</a>, PhD, an associate professor of epidemiology and community health at University of Minnesota.</p><p>"In order for all of the in-school precautions to work well, we'll be asking a lot of teachers and staff," Widome told Healthline. In addition to their usual workload, they'll now be asked to monitor mask-wearing, ensure children are keeping distance, and be aware of any symptoms.</p><p>Along with Sharfstein, Widome called for an increase in financial support. More employees will likely be required so teachers and staff members can keep up with the added demands.</p>
Should Kids Go Back?<p>While these guidelines may help get some schools to reopen, many people don't think children should go back to school over fears they could contract the disease and spread it to other vulnerable family members like grandparents, infant siblings, or their parents.</p><p>In a <a href="https://pediatrics.aappublications.org/content/early/2020/07/08/peds.2020-004879" target="_blank">Pediatrics</a> commentary, <a href="https://www.md.com/doctor/william-raszka-md" target="_blank">Dr. William V. Raszka, Jr.</a>, an infectious disease specialist at The University of Vermont Medical Center, argued that schools should open because school-aged children are far less important drivers of COVID-19 than adults.</p><p>But he says the risk and benefit is not equal among all students ages 5 to 18.</p><p>"Elementary schools are arguably higher priority for face-to-face schooling, since younger children are at lower risk for infection and transmission, and since parental supervision of younger children's distance learning may be particularly challenging," added Sorensen, who penned a <a href="https://jamanetwork.com/channels/health-forum/fullarticle/2767411" target="_blank">June article in JAMA</a> with reopening tips. "That means middle and high schools are more likely to emphasize distance learning."</p><p>Specific student populations, such as special education students and students with disabilities, would also benefit greatly from more time spent in face-to-face environments, Sorensen said.</p>
What Parents Can Do<p>Parents should ask for and receive frequent updates from schools about plans for the fall. They should also be informed about plans if and when COVID infections are identified, Sharfstein said.</p><p>"I'd like to see parents investing now, during the summer, in doing things that can slow and stop the spread of the virus in their communities," Widome said.</p><p>"Now is a good time for kids to practice wearing masks and get used to them as they may be wearing them for longer stretches if school starts up in person," Widome suggested.</p><p>She recommends parents try different mask designs and materials to see what children are more comfortable wearing.</p><p>"If you are using cloth face coverings, it's good to have extras on hand," Widome added.</p><p>Parents should model healthy behavior at home and while out in public — another thing that could affect how well children adapt to reopening practices, Sorensen said.</p><p>"Children may want to know more about face coverings," added <a href="https://www.linkedin.com/in/leescott/" target="_blank">Lee Scott</a>, chairwoman of the Educational Advisory Board at <a href="https://www.goddardschool.com/" target="_blank">The Goddard School</a>. "Dramatic play, such as creating or wearing a face covering, may help some children adjust to this concept." Schools can also show children photos of what faculty members look like in their masks so the students are familiar with that appearance.</p><p>Johns Hopkins University recently released its eSchool+ Initiative, a slew of resources surrounding education during the pandemic. These include a <a href="https://equityschoolplus.jhu.edu/reopening-checklist/" target="_blank">checklist for administrators</a>, report on <a href="https://equityschoolplus.jhu.edu/ethics-of-reopening/" target="_blank">ethical considerations</a>, and a tracker of <a href="https://equityschoolplus.jhu.edu/reopening-policy-tracker/" target="_blank">state and local reopening plans</a>.</p>
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