As a year unlike any other in living memory nears a close amid a horrific climb in the daily cases of COVID-19, three of the AMA’s top experts gathered recently to discuss their outlook for health care’s landscape in 2021.

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The three AMA leaders—Senior Vice President of Advocacy Todd Askew, General Counsel Brian Vandenberg, and Chief Health and Science Officer Mira Irons, MD—joined AMA Chief Experience Officer Todd Unger during a recent episode of the “AMA COVID-19 Update.”

Looking ahead cannot begin without acknowledging the grim realities of COVID-19 and the politicization of the pandemic. Human life and the ability to save human lives should be above politics, Dr. Irons said, and yet there is still immense reluctance to even wear a mask despite evidence of its positive effect on reducing the spread of the coronavirus.

“We have found ourselves now where wearing a piece of cloth over your face or not wearing a piece of cloth is some grand statement of your ideological beliefs,” Askew said. “And we've got to get beyond that.”

Learn more about the AMA’s call for everyone to #MaskUp to stop the spread of COVID-19.

Moving beyond that debate starts with leadership, all three speakers said. Dr. Irons said she was encouraged by the actions already taken by President-elect Joe Biden on this front. That includes choosing as co-chairs of his coronavirus task force the former surgeon general Vivek Murthy, MD, former Food and Drug Administration Commissioner David Kessler, MD, and Marcella Nunez-Smith, MD, MHS, Yale University associate professor of medicine and epidemiology.

“If you look at what [Biden’s] plan is really based on,” Dr. Irons said, “it's based on listening to science, letting public health officials actually lead a public health emergency, and also transparency.”

Health care in 2021 will be shaped by a number of additional topics beyond COVID-19, including the status of the Affordable Care Act (ACA). In 2017, a group of 20 Republican-led states challenged the constitutionality of the ACA and sued the federal government after the ACA’s individual mandate tax was reduced to zero. Three years later, the case is now before the Supreme Court, which, according to Vandenberg, raises three interesting questions:

  • Do the states and individual plaintiffs have standing to bring the case in the first place?
  • If the plaintiffs have standing, does zeroing out individual mandate tax render the mandate unconstitutional?
  • If the mandate is unconstitutional, is it so intertwined with the rest of the ACA that the entire law should be deemed unconstitutional?

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The AMA has aggressively advocated for the ACA and filed briefs from the district court level all the way to the Supreme Court, defending it on legal grounds and because of the benefits it provides.

“We've been big supporters of the Affordable Care Act from the very beginning,” Askew said. “It's essentially what we've called for, for many years. It's access to private health insurance in a well-regulated market and subsidies for people who can't afford it. So, it's been a good piece of legislation and it's provided a lot of help for a lot of people.”

If the ACA is not upheld, tens of millions of people would lose their health insurance, a fact that is particularly alarming amid the ongoing pandemic, Dr. Irons said.

“That happening at any time would be a problem,” she said, “but doing so during a pandemic … would be especially tragic.” 

Learn more with the AMA about seven major downsides if the ACA is overturned by Supreme Court.

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Other actions at the federal level that will have a big impact on U.S. health care, the experts said, include rejoining the World Health Organization, President-elect Biden’s work on firearms violence, and the future of the Deferred Action for Childhood Arrivals program.

“There's no shortage of issues,” Vandenberg said, “and we'll continue to watch, wait and respond.”

Find out how the AMA is fighting every day to remove the obstacles physicians face while confronting the COVID-19 pandemic.

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