New US leadership may bring brighter public health outlook: Health advocates hopeful for change
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* Mark Barna

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/51/1/1.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/51/1/1.1/F1)

In 2019, nurse practitioner Macy Kim examines Abel Rodriguez at Denver’s Inner City Health Center, which provides care for people who lack insurance or are underinsured. Increasing the number of people in the U.S. who have health insurance is a goal of the new presidential administration.

Photo by RJ Sangosti, courtesy MediaNews Group/The Denver Post/Getty Images

A new presidential administration with a commitment to progressive health approaches — and a shift in the majority in Congress — has many leaders optimistic about America’s public health landscape in the coming year.

President Joseph Biden and his team took office in January, along with nearly 70 new members of Congress. The change could mean more policies and programs that are favorable to public health, as well as a much-needed boost in funding. But elected leaders will also have to contend with roadblocks to health put in place by the Trump administration.

U.S. public health policies were under constant attack during the last administration, including scores of rollbacks to major environmental safeguards, limits on reproductive health access and erosion of discrimination protections. The administration also worked to undermine the Affordable Care Act by enacting barriers to its success.

“Some of the orders and measures enacted by the Trump administration, such as the global gag rule, can quickly be rescinded, but others will take time,” Don Hoppert, APHA’s director of government relations, told *The Nation’s Health.* “There’s a lot more opportunity for improvement to U.S. public health programs and policy, but it’s not going to happen overnight.”

Among the issues the Biden administration was expected to address in its early weeks and months include reentering the Paris Agreement, which sets goals for countries to reach on climate change, and reestablishing U.S. ties with the World Health Organization. Former President Donald Trump removed the U.S. from both relationships.

Hoppert said the new congressional leadership is likely to result in more support for Medicaid expansion and more legislation aimed at pandemic relief, climate control and possibly gun violence. APHA’s legislative priorities, as well as those shared by other public health groups, match up well with health goals announced by the Biden administration.

Nancy Krieger, PhD, a social epidemiologist in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, credits public health advocates for helping get issues on Biden’s agenda.

“They are there because of the extraordinary organizing that people have done to bring these ideas front and center,” she told *The Nation’s Health.*

APHA Executive Director Georges Benjamin, MD, said he expects the Biden administration to approach public health in a comprehensive and science-based way. In the months leading up to Biden taking office, APHA advised the incoming administration on COVID-19, environmental health and other key public health issues.

“We should recognize that Biden’s goals are ambitious but focused,” Benjamin told *The Nation’s Health.* “There is a great deal of overlap on the priorities being targeted, and they all have health equity within them.”

The new membership in Congress, giving Democrats control of the House and the Senate, may mean a greater willingness to create and pass legislation that supports public health, including expanding Medicaid, said Sara Rosenbaum, JD, professor of health, law and policy at the Milken Institute School of Public Health at George Washington University.

> “There’s a lot more opportunity for improvement to U.S. public health programs and policy, but it’s not going to happen overnight.”
> 
> — Don Hoppert

“It will not be easy, but it becomes much more feasible to move forward to make coverage and care more affordable and, above all, redress the exclusion of millions of people from insurance in states that refuse to expand Medicaid,” Rosenbaum told *The Nation’s Health.*

## COVID-19 first up on US health agenda

On day one, the Biden administration began grappling with the nation’s largest immediate priority: COVID-19. As of Jan. 17, more than 23 million cases of the disease had been reported in the U.S., with 395,000 deaths. On Jan. 12, over 4,400 deaths were reported, the most in a single day up until then.

The Biden administration will be tasked with ensuring fast, equitable disbursement of COVID-19 vaccines, even as it works to counter dangerous misinformation spread by the past presidential administration.

In a seven-point COVID-19 plan released ahead of inauguration, the Biden administration pledged to follow science and “ensure public health decisions are informed by public health professionals.” Among its goals are to ensure that all Americans have access to free, reliable testing; provide clear, consistent, evidence-based guidance on how communities should navigate the pandemic; implement mask mandates nationwide; and rebuild and expand preventive measures to mitigate future pandemic threat.

Biden has pledged to create a Public Health Jobs Corps, which would mobilize 100,000 workers in vaccine distribution, contact tracing, testing programs and other areas to defeat COVID-19.

Racial and health equity are also priorities, and the administration has created a COVID-19 Racial and Ethnic Disparities Task Force to explore inequities in the U.S. health care system.

Nadine Gracia, MD, MSCE, executive vice president and chief operating officer of Trust for America’s Health, who served in the Obama administration as U.S. deputy assistant secretary for minority health, said the administration’s approach offers a path to remedying racial and health inequities.

“They have prioritized equity, and that is really critical when we see the stark systemic and structural inequities that the COVID-19 pandemic has exposed and exacerbated,” Gracia told *The Nation’s Health.*

## More funding for public health crucial

High on public health leaders’ wish list for the new administration is strengthening U.S. public health infrastructure. Public health was critically underfunded throughout Trump’s term, despite a growing workforce shortage, increases in health inequities and decreases in U.S. life expectancy. The need for greater support became clear as the public health system struggled to keep up with overwhelming demands during the pandemic.

In legislative priorities submitted to the Biden team and Congress, APHA called for increased funding for federal public health agencies, including creation of a $4.5 billion fund for core public health infrastructure at the Centers for Disease Control and Prevention and state, local, tribal and territorial public health departments. To support the public health workforce, the Association also called for a loan repayment program for public health professionals who agree to serve two years in a local, state or tribal health department.

“The public health workforce is the backbone of our nation’s governmental public health system at the county, city, state and tribal levels,” APHA said in its recommendations. “These skilled professionals deliver critical public health programs and services and are on the front lines of combating the COVID-19 pandemic.”

![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/51/1/1.1/F2.medium.gif)

[Figure2](http://www.thenationshealth.org/content/51/1/1.1/F2)

With equity at the core of the Biden administration’s health agenda, advocates are hoping for health system improvements.

Photo by FG Trade, courtesy iStockphoto

In addition, APHA wants to protect and strengthen the Affordable Care Act. The Biden administration is expected to reverse policies that were put in place by the Trump administration that undermined the law, such as shortening the federal health insurance marketplace enrollment period. The new administration supports re-invoking cost-share subsidies to insurance companies to keep them in ACA health exchanges, which lowers premium costs.

Supporting Medicaid expansion and enrollment under the ACA is on the Biden administration’s agenda as well. Currently, Medicaid expansion allows people who earn up to 138% of the federal poverty level to enroll in the program. Rosenbaum suggested that officials test and evaluate raising qualification to 100% of the poverty level. That move might be enough for remaining states to embrace expansion, resulting in more low-income people gaining health insurance.

Biden has shown support for a health insurance program run by the federal government that would compete with private health insurance, which has the potential to drive down premiums.

The change in U.S. priorities under the new administration will make a major difference to the health of the nation, as will the change in leadership, said Benjamin.

“I think leadership matters and I think character matters,” Benjamin said. “So I am looking forward to getting both, and I am most hopeful that we will.”

For information on APHA’s legislative priorities for Congress and the new administration, visit [bit.ly/aphaplan21](http://bit.ly/aphaplan21).

*   Copyright The Nation’s Health, American Public Health Association