We Are in Store for the Greatest Change to Our Health Care System Since the Affordable Care Act. Here’s Why.


The COVID-19 pandemic has been harsher and lasted longer than many of us would have predicted. While our media has been inundated with updates on death tolls and economic depression, there has been little conversation of healthcare beyond the era of COVID-19. The first question that we ask when we hear of deaths: was it COVID? We have grown to expect the primary cause of death to be of coronavirus. But the impact of COVID-19 will extend beyond the individual, effecting fundamental and long-lasting change to our healthcare system.

By this point, it is clear that the public health ramifications are reaching well beyond the physical impacts of the virus. Social isolation, economic depression, soaring unemployment, and mandated closures all contribute to the adversity that we have had to face – notwithstanding the explosive, ever-present sociopolitical climate of a pandemic that is killing Black Americans at a rate almost three times that of whites. This hardship will likely last for months more.

A recent Kaiser Family Foundation publication found that half of the public have skipped or postponed medical care due to the pandemic, with one-fourth reporting worse health as a result. Many of these people do not plan to receive the care they need within the next three months. The public is simultaneously reporting declines in mental health. Furthermore, over 30% say they have had difficulty paying for household expenses, like food, rent, and medications. The figures are disproportionately damning among Black and Hispanic populations.

Taken together, the inaccessibility of medical care, deteriorating mental health, increasing poverty, worsening access to nutrition, and host of other challenges present a dark, impending storm. Cancer, diabetes, and other chronic diseases will all be rearing their untreated heads post-pandemic. Communities and policymakers must therefore act quickly and decisively to heal not only a sick population, but a fraying social fabric.

This storm of chronic health issues will be hitting at a time when the coverage system is exceptionally unstable. The unemployment that has ravaged our labor force leaves many families without health insurance in 2021. In many cases, these folks will enroll in Medicaid, which is jointly funded by states and the federal government.

The issue, though, is the limited capacity of cash-strapped states to absorb this increase in Medicaid enrollees. Masses will enroll in Medicaid in the upcoming year, and budgets will have to adapt to rising expenditures. Because the nature of Medicaid is through reimbursement and not direct allocation, states must set aside funds for Medicaid. To compensate for the anticipated rise in Medicaid costs, states must raise taxes or make prospective cuts to areas like education – both of which are morally unpalatable and politically impossible in the aftermath of a pandemic. With promissory federal aid unlikely to be pledged under the Trump administration, the onus will be on states to balance the books themselves.

States that have expanded their Medicaid coverage will face greater 2021 enrollment and, consequently, greater gross economic burden. In states that have yet to expand Medicaid, low-income groups may be financially crippled if they don’t qualify for Medicaid. Regardless of expansion status, our healthcare system will experience overwhelming stress that will further expose its limitations. Individuals and states alike will struggle to pay for healthcare.

The result? An incensed public demand for a more robust health safety net in the form of Medicaid expansion.

Change in the wake of the pandemic is inevitable. Our current healthcare system is incapable of functioning through a pandemic and is plagued with vast racial and socioeconomic inequality. The COVID-19 pandemic will undoubtedly push our healthcare system toward more government coverage, via a public option or universal coverage. The distance and degree to which the push is maintained will mark the greatest change in the structure of the American healthcare system since the Affordable Care Act. Ultimately, though, we shouldn’t care how precisely it is changed. For now, more than ever, we just need a healthcare institution that can be equitably accessed by all people in all times. 

Logan Cho is a recent graduate of Brown University and incoming medical student at the Icahn School of Medicine at Mount Sinai.

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