The known unknowns of healthcare and health policy

It seems like eons ago that we were all out and about—mask-less and mingling with others. But things have certainly changed in the months since the pandemic struck. We’ve had to make some major shifts in our lives, and phrases like social distancing, virtual learning, and Zoom calls have become part of our everyday vocabulary.

Our world has changed a fair bit—especially so in healthcare

At Discovery Health Partners, we have transitioned to a fully remote workforce—as many of you have—and we are getting pretty good at navigating this new normal.

In our ever-evolving landscape, we’re thinking about what the next 12 to 18 months may look like and what unknowns we face. Here are some of the trends we’re watching and the implications they may have:

  • Reduced elective procedures during the pandemic—and how it affects member acuity
  • Increase in the telehealth adoption—and payment integrity issues surrounding appropriate telehealth billing patterns and coding
  • Reduced motor vehicle traffic during the pandemic and potential long-term reduction in motor vehicle traffic from a shift to working from home—and how this affects subrogation activity

We recently hosted a virtual client council meeting to discuss the future of healthcare and payment integrity with healthcare policy analyst Susan Dentzer as our keynote speaker.

In her “Health policy and the 2020 elections: what’s ahead?” keynote, Susan shared her fascinating perspectives with us about the “known unknowns” we can expect to encounter in this highly uncertain time.

Expected changes in health insurance coverage

According to Susan, we’ve never seen anything like our current set of circumstances any time before in modern history:

  • Known knowns: COVID-19, a weakened economy, ~30 million jobless, more uninsured
  • Known unknowns: the course of the pandemic this fall and winter, the outcomes of presidential and congressional elections, the course of economic recovery
  • More known unknowns: depending on the outcomes of all the above, what health policies will be on the table? What will or can be enacted?
  • Unknown unknowns: how will 2021 overall look in relation to 2020—in almost every respect?

She shared her insights about the impact of the coronavirus on the economy (“covidomics”) and what we could possibly expect to be the future of healthcare.

One of the biggest changes we can expect to see, according to Susan, is the rise in the uninsured rate. Even before COVID hit, she says, there were forces underway that would affect health law changes.


Projections show 3.3 million of those people will regain employer-sponsored insurance by being added to a family member’s policy, 2.8 million people will enroll in Medicaid, and 600,000 people will enroll in the individual market, mainly via the Affordable Care Act’s marketplace. Still, 3.5 million people will become uninsured.


“In a fair number of states,” Susan commented, “we’ve had at least modest rises in the uninsured rate. We knew that we were going to have this uninsured problem even before the pandemic, and then the pandemic hit.”


An estimated 48 million nonelderly people in the United States will be part of a household in which someone loses a job due to COVID-19, based on an assessment of pandemic-related job loss.


She pointed to Urban Institute research on coverage projections in the wake of pandemic-related job loss, in which 48 million people live in families with a worker who will have experienced COVID-related job loss in 2020.

“The Urban Institute estimates are, when you net all this out, about 3.5 million more people are likely to become uninsured as a consequence of the pandemic,” Susan said. “We had a big pool of uninsured, and now we’re adding potentially 3.5 million more people who are dreadfully uninsured as a consequence of this pandemic. The implication of this rise in uninsured population will likely be….???”

Rising Medicaid enrollment strains states’ budgets

Susan also discussed with us the impact of rising Medicaid enrollment on states’ budgets—already stretched too thin—and the toll that Medicaid providers are experiencing. “Medicaid enrollment has risen, and we have states in an enormous amount of fiscal difficulty at this point,” said Susan. “The degree to which that particular set of increments to Medicaid can be sustained is really in doubt. In some cases, the states’ revenues are so damaged that the state has compensated by cutting payments to providers.” This is not a sustainable solution by any stretch—some providers will stop accepting Medicaid, while others may continue to accept Medicaid but provide less care. Ultimately, this could create an inability to access quality care for a large segment of the country’s population.

And the challenge to state Medicaid programs will not get any easier in the near term. According to the Center on Budget Policy and Priorities, the unemployment rate will average 10.6 percent over 2020 and still be at 7.6 percent by the end of 2021. That would be the highest annual unemployment rate since the 1930s. Coupled with that, the U.S. economy is declining more sharply compared to the Great Recession of 2008. Certainly, Medicaid will be a key central issue over the coming months as states devise strategies to provide healthcare coverage to more people, control the pandemic’s impact on individuals’ health coverage, financially support providers’ viability, and balance their budgets.

What’s ahead

As we all know, a host of other healthcare issues remain—affordability, regulation of pharmaceutical prices, value-based payments, data sharing, and price transparency. Amid these multiple uncertainties, we will continue to monitor how the pandemic has transformed the healthcare policy landscape and share our insights with you.


About Susan Dentzer

Susan DentzerSusan Dentzer is one of the nation’s most respected health and health policy thought leaders, top healthcare keynote speaker, a frequent commentator on television and radio, including PBS and NPR, and an author of commentaries and analyses in Modern Healthcare, the Annals of Internal Medicine, and the New England Journal of Medicine. She is also the editor and lead author of the book Health Care Without Walls: A Roadmap for Reinventing U.S. Health Care.

Jason BrownThe known unknowns of healthcare and health policy

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