Amber Hewitt on which candidate has the best policies to address inequities in healthcare

Hewitt will be a part of Vator's Healthcare in Politics salon on Sept 9 and October 7

With the election right around the corner Vator and HP will be hosting their latest salon on October 7, called Healthcare in Politics (register for the event here!) where multiple panels of experts, policy makers and lawmakers who will be on hand to discuss topics related to healthcare policy and decision making. 

One of the panels will center specifically around the healthcare policies of the two candidates, Donald Trump and Joe Biden, particularly how they will help underserved communities, who have been hit the hardest by the COVID-19 pandemic.

On hand will be Dr. Amber Hewitt, Director of Health Equity at Families USA. I spoke to her about the COVID-19 pandemic, which policies will help us get through it and which presidential candidate has the best plans going forward. (Hewitt will also be part of our breakout session on September 9).  

VatorNews: Tell me a bit about yourself and your organization

Amber Hewitt: Families USA is a national, nonpartisan health consumer advocacy organization. Our mission is to be supportive of policies that ensure families have access to the best health and healthcare, and that it's affordable and equitable for all. In my role as Director of Health Equity I work with our senior leadership team to develop priorities that advance health equity, and we view health equity as ensuring that no one in our nation faces any barriers to achieving their optimal health based on who they are, what language they speak, how they identify or where they live. Equity is one of our four focus areas; the other three are coverage, so we support policies that ensure comprehensive health coverage and affordable coverage. Our other focus area is consumer experience, and we really want to make sure that we are elevating stories of health consumers that really center the consumer experience in our policies. 

One of the trends that we're seeing is a push for healthcare that focuses more on value versus volume. We have been very supportive of policies that are pushing for value in the healthcare system, and making sure that we have greater health care quality, while also making sure that we also are looking at the reduction of disparities in health and healthcare outcomes. So, we  have a strong focus on internal equity and health systems transformation efforts as our country is shifting from volume to value.

VN: One of the big questions is, from a health policy standpoint, how would you grade this administration with regards to COVID, even as Biden's policies seem to be similar going forward, such as free testing and COVID treatment and development of a vaccine?

AH: To really answer that question we have to look at the data: we're seeing an exacerbation of healthcare and equities due to COVID-19 and what we really needed at the beginning of the pandemic was a comprehensive effort to really test, trace and quarantine individuals. What is lacking, and has been lacking, is a coordinated strategy. So, we also need to make sure that we're prioritizing resources in communities that need it most. We have that data now but, early on in the pandemic, it was advocates, like Families USA, that really pushed for comprehensive data collection on COVID-19 infections, deaths and testing. So, we've seen improvements in data collection, but if you really look at where we are now it speaks to some of the inconsistency out of the CDC, out of the administration. 

Part of your question is that Biden and Trump have similar policies, and there's a difference between policy talking points, what was said at a convention or a press briefing, and policy action. Right now, families deserve action and families deserve a plan. So, I'm going to answer that question by sharing some data that we've recently analyzed, which shows that 13.6 million Americans are without jobs last month, in August. This is both a health and economic crisis, and fewer Americans have access to health coverage through their employer, we've seen over 3,000 veterans who have lost their life to COVID and, going back to some of those disparities in COVID-19 outcomes. For example, Black or African Americans are 2.4 times more likely to die from COVID, and then Latino, American Indian and Alaskan natives are 1.4 times more likely to die. That would be my answer to your question: looking at where we are and some of the inconsistency and lack of a national coordinated strategy to fully address the pandemic.  

VN: Should Trump have instituted a national policy around COVID? What would that look like if he did?

AH: In May of this year, the administration, or the Department of Health and Human Services, released what they called a national testing strategy, but it really lacked a national testing strategy if you looked at it in detail. A lot of the focus was to put things on the states, but state budgets are crippled, states need fiscal relief and what that plan lacked was coordination at the federal level, and the funding necessary for those states to really provide effective and accessible testing. 

A couple things that we are pushing for, in addition to additional funding for states, is for the CDC, in coordination with FEMA, to really fulfill its role in developing a national strategy. These are functions of those organizations, as well as developing a national purchasing and dissemination strategy. So, making sure that states and localities have the right amount of testing and medical supplies, and really just making sure that the strategy is science-based. There was also some tension there in the current administration, so just making sure that we're setting clear, science-based national benchmarks for reopening. We need to be guided by science, and what that national strategy would do is make it easier for states to do their job and really address the needs at the local level. 

VN: Healthcare is more than just going to the doctor, and many are now taking a more holistic approach, where the social determinants are just as important. Do you see any policies from Joe Biden or Donald Trump that would help move in that direction? 

AH: Those social and economic drivers of health account for around 70 to 80 percent of health outcomes and we, at Families USA, are strong advocates for investing in the social determinants of health. In the current administration, Secretary Azar has gone on the record of talking about the importance of the social determinants of health, so that has been encouraging. Recently, the administration launched a child-centered payment model that looks at the integration of physical and behavioral health for kids, called the Integrated Care for Kids model. So, that's a promising model and we'll see what comes out of that with the states who are awarded those funds. Biden and Harris have definitely been on the record for the importance of allocating funds for programs to address the social determinants of health, so it seems like both parties have identified addressing the determinants social determinants of health in their policy priorities.  

Again, it goes back to action and a defined plan. One example of that is that the CDC, under this administration, has talked about inequities in the social determinants of health; we’re all impacted by those social determinants, but it's the inequities in those determinants, such as poverty or healthcare access, that makes a difference. And it's really important to remove those barriers to make sure that everyone has the opportunity to be as healthy as possible. We have to look at which administration is actively trying to remove barriers, and I'm talking about barriers such as discrimination and racism, being uninsured. Which administration is really active in removing those barriers? There have been actions within the current administration which would call into question if they are doing that. 

VN: Do you see telemedicine as one way of helping bridge inequality in healthcare? I’ve heard some doctors say they like doing video calls, for example, because it allows them to see inside the patient’s home, and get a better sense of their environment, so they can better help them.

AH: One thing that came out of the administration was CMS allowed for audio-only reimbursement of telehealth services and that's an example of recognizing that not everyone has access to devices to do a video visit. That was a promising approach, to allow people to access their providers through audio only So, removing those barriers to increase access to health is important.

VN: What do you think of Opportunity Zones? The idea with those is to spur investment into underserved communities. Do you think that’s a good way to help reduce inequality? 

AH: In theory, opportunity zones sound like a good policy that would address inequality, but, as you probably have heard, we're concerned that, in practice, it doesn't really benefit the communities and people who need those tax incentives the most. There was a recent report that I came across that showed that Opportunity Zones and investors appear to be more focused on real estate and luxury apartments and hotels and they're not really using those investments to increase affordable housing or make investments to help communities.

So, one thing that would be helpful is to make sure that there are requirements for transparency in reporting; that level of oversight is what's missing in order for us to really answer that question. We won’t really know the full impact without that aspect, which is somewhat lacking in the current statute.

VN: It seems as though Republicans want to invest in underserved communities, whereas the Democrats want to bring underserved communities into America's suburbs. Which direction do you think has more legs? 

AH:  I definitely try to look at things holistically, and not ‘either or’ but just my gut reaction to that question is investing in communities, especially communities that needed the most. I'm not sure if my thinking aligns with the premise of the question that one side of the aisle wants to invest in communities and one side wants to bring underserved communities into the suburbs. I don't align with the premise of that, but we also need to unpack what does it mean to be underserved. So, underserved means that, for example, there has been a history of community disinvestment, there's been a history of unjust policies, like redlining and other factors. Through our health equity policy lens, we’re really try to zoom out and look at the context, and what we call the ‘political determinants’ and how that impacts what we're seeing.

I want to link this question to the current pandemic: I also did a report on COVID-19 and health equity and one of the analyses that we looked is this the area deprivation index. It's really a measure of investment in communities and we saw that the counties that had the most disinvestment in their communities also have the highest rates of disparities in COVID-19 outcomes. So, that shows the importance of making sure that we're investing in those communities. This moment really calls for policymakers to really address some of the long-standing systemic barriers, such as structural racism, that are impacting the ability for folks to achieve their optimal health.  

To answer your question more simply, I would say it's about understanding how those community conditions were created in the first place. Recognizing that and also making sure that we're investing in those communities and also harnessing the strengths within those communities. Sometimes, when we say 'underserved communities' or 'marginalized communities,' we aren’t really recognizing the strength within those communities. An example of that would be traditional health workers and community health workers; these are frontline workers from the community, who understand the culture and understand the language, who really serve as a broker between these communities and healthcare system. Tying this back to COVID-19, we've been pushing for community health worker to be central in contact tracing strategy. It's about investing in communities and also recognizing that these communities have been resilient, they still exist and that they're thriving. That needs to be part of the conversation as well. 

VN: Education ties into COVID as well, with many states struggling with the idea of whether or not to reopen schools. If schools remain closed, does that disproportionately hurt underserved communities? 

AH: The current state of our country and the fact that schools are closing, some are reopening and having surges, is impacting all kids. Children and families really need to be at the center of policy making. All children have experienced some level of disruption in their life but children of color, low income children, immigrant children are most likely experiencing an increased level of stress and economic instability. So, we have to look at the impact on low income and rural communities, for example. Do children and families have access to sufficient broadband, to devices, such as laptops? What about kids whose parents or caregivers are essential workers and who are putting their lives at risk serving communities or working in the healthcare industry?

So, yes, it would have a disproportionate impact, particularly on low income children and children in rural areas, when it comes to really being able to fully access virtual learning. But I don't think we should forget that COVID-19 is not impacting children at the same rate: we are seeing a disproportionate impact on children of color, and children of color are more likely to be hospitalized and experience long term complications.

VN: Which candidate is best addressing that issue?

AH: I would ask if the current administration is guided by the best public health strategies and science when it comes to reopening schools. Are we putting in enough resources for kids who don't have to do the things they need to be optimal students at this time? It appears that there's lots of inefficiencies in the current administration's approach. I'll take it back to what I said about making sure that the policies are evidence and science-based and it seems like there have been tensions between those two things in the current administration as far as policies being informed by the best available evidence.

Biden has gone on the record of talking about investment in childcare, investments in the social determinants of health and being science-driven. Biden said something about the lockdown; the exact quote was, ‘I would shut it down and I would listen to the scientists.’ So, I would say the current administration has not been listening to the scientists, and it seems like Biden would be. It seems like his strategies would be more beneficial to what the country needs right now.  

VN: Doing a mandatory lockdown/shutdown could have effects on our mental and financial health. Do you think there should be a national policy to lock down the entire country if the scientists say there should? 

AH: I don't have a position on a mandatory lockdown or shutdown, and I do understand that the question is hypothetical but I don't have a position on that aspect of his statement. I would say that the other more important question is, what are the policies needed to prevent an uptick in COVID-19 and are we following adequate public health guidance? It needs to be a coordinated approach. 

The part of the question about the impact on mental and financial health is very important because this isn't just a health crisis, it's an economic crisis as well. So I'm not being dismissive of that part. It's very, very important just because we've seen an increase in reported mental health concerns, so I think all of that would have to be taken into consideration in order to make a decision about a lockdown or no lockdown. 

VN: Which of the two candidates do you see as being better for underserved communities, especially those hardest hit by the pandemic?

AH: Going back to what the data has showed us, in the past four years, especially in the past year or two, we have seen an increase in health inequities, we are seeing more people losing their jobs, losing access to employer-sponsored coverage, so whichever administration comes in, those things need to be top of mind. It does not seem like we’re on a positive trajectory under the current administration.

We're still waiting on the Senate to act; we've had record numbers of some people dying from COVID-19, so how many more people have to die? The trajectory that we are on is very concerning, so whichever administration comes in really needs to center equity and make sure that our policies will be beneficial to everyone, and not just us a select few, and making sure that we're removing barriers to accessing high quality and affordable health and healthcare.

(Image source: tcf.org)