November 2024 – Health Advocate Insights
November, 2024
Health Advocate Insights
The week leading up to the presidential election can only be described as chaotic. As both candidates make final pushes in the swing states, healthcare and education issues have fallen by the wayside; however, two big issues have managed to gain steam throughout the commotion that may have significant impacts on the ability of patients to receive care and the capacity of the health workforce to serve a broad swath of the population. Enhanced Affordable Care Act (ACA) subsidies and Medication Abortion.
The subsidies ensure that ACA marketplaces are able to expand insurance from only those who make 400% of the federal poverty line to all Americans regardless of income. While they are set to expire at the end of 2025, Vice President Harris wants to make them permanent while Former President Trump has so far failed to take a stance on the issue. That hasn’t stopped his previous advisors from referring to the program as “fraud” and other prominent republicans from lambasting the program. The battle lines are a bit more cut and dry on the issue of Medication Abortion. While the Supreme Court failed to strike down the FDA’s approval of the two drugs commonly used in the procedure, Former President Trump has gone back-and-forth in terms of how he would handle the issue while Vice President Harris has shown support for the drug and while under her watch, the Biden-Harris FDA has allowed the drug to be prescribed via telehealth.
The White House, Public domain, via Wikimedia Commons
What's going on in Washington, DC?
Much has happened in the work of student loan debt relief over the past month. Last Friday saw the release of President Biden’s student loan debt relief proposal. The plan, which would benefit eight million individuals, is the result of legal challenges to his initial effort which would have given relief to 43 million borrowers until it was struck down by the Supreme Court last year. The initial revised plan would have provided relief to borrowers who currently owe more than they initially borrowed or those who have been paying down their debt for 20 years or more; however, it is currently upheld in the courts. The revised final rule has yet to be released; however, according to the draft rule, the proposal would allow the Department of Education to waive the balance of outstanding loans to a borrower who experiences an income shock such as chronic illness, childcare costs, or medical bills, among others.
The ongoing battle to increase accountability over higher education has made a surprising move to the state policy arena. The National Council on State Legislatures’ Higher Education Task Force, which includes members from 32 states, recently released a report advocating for major changes to the role of the federal government in higher education. Arguing that there has been a lack of coordination between the work of state and federal governments, the report focused on two key issues. First, the report implied that the trend towards student loan forgiveness will place a harmful burden on taxpayers and that the federal government should instead focus on expanding Pell Grant programs as a means to promote higher education access. The report further suggested that the increasing political interest in transparency and accountability should be left to the states given their direct and constitutional relationship to higher education institutions. Concerned that there is a lack of federal consensus on what accountability is and what measures should be taken, the authors note that, “unclear or mixed intentions can make for clunky or ineffectual implementation. If Congress contemplates a bipartisan consensus on federal accountability policies, the task force would advise it to: Use accountability measures carefully, thoughtfully and on a limited basis; recognize and support state efforts whenever possible; and seek alternative approaches to accountability when seeking to improve outcomes.” It is unclear how much traction this report will get in Congress given the deeply politicized nature of the issue which has centered college campuses within debates over culture wars in the US.
California State University Chancellor Mildred García with U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra and Assistant Secretary for Administration Cheryl R. Campbell to sign a memorandum of understanding to encourage students to join the health workforce. Image from Cal State University news.
What's going on in the states?
Following the overturning of affirmative action last year, there has been renewed interest in the role of legacy admissions in higher education. Last month, California Governor Gavin Newsom signed a bill banning the practice in the state among both private and public institutions, becoming only the second state to ban the practice at all institutions. This decision has the potential to have a major impact on some of the state’s most competitive institutions. Approximately 14% of Stanford Class of 2026 was admitted via legacy or donor connections, 14.5% were admitted through the same process at USC. Although data is not publicly available on legacy admissions for health professions graduate institutions, it would likely have an impact on at least some of the 16 medical and seven dental schools in the state.
The Department of Health and Human Services (HHS) recently signed a memorandum of understanding with the California State University (CSU) Chancellor’s Office to collaborate to find ways to encourage students to join roles in the federal health workforce. “The memorandum of understanding we sign and celebrate today represents a vital alliance that will serve as a national model for preparing a new generation of dynamically diverse health care professionals to meet our country’s significant and growing workforce needs, particularly in critical areas such as nursing, public health and behavioral health,” CSU Chancellor Mildred Garcia noted. The CSU-HHS partnership will expand career development, mentorship, and training opportunities in the health workforce with the “shared core values of diversity and equity” As the largest regional college system in the state of California, such a partnership has the potential to expand health career opportunities to some of the state’s areas that are typically underserved by the health workforce.
What else are we reading?
- Project 2025’s Labor And Reproductive Health Policies: Implications For The Health Workforce
- House Republicans Vote to Overturn Biden Title lX Rule
- Tribal Colleges are Underfunded with Severe Maintenance Backlogs
- Medical Training in a Time of Political Divide: From the Summer of ‘Racial Awakening’ to DEI Bans
- A partnership between a health system and community college to grow their local health care workforce
- Honoring our ancestors to advance health justice
What can you act on today?
- Vot-ER’s nonpartisan phone banks run through Election Day. Through these virtual phone banks, you can reach invisible voters who likely will not hear from campaigns. You’ll help people vote, whether by mail, early, or on election day.
- Webinar: Saving Primary Care in the United States: An Interdisciplinary Dialogue. Join the Social Mission Alliance on Tuesday, November 12 from 8-9pm (Eastern) for an interdisciplinary panel featuring the work of groups taking different approaches to resuscitate primary care and primary care access in the United States. During the webinar, representatives of Primary Care for All Americans, the People’s Non Violent Medicaid Army, health services researchers, as well as primary care clinicians will discuss the obstacles to realizing robust primary care access in this country. Register to attend.
- Join us November 21 at 3:00pm (Eastern) for the next National Health Equity Grand Rounds event, “Rewrite the Script: Narrative Transformation for Equity in Health,” as we explore collective stories and better understand our role as health care professionals in shaping health in our communities.
As we navigate the ever-evolving landscape of state and federal policies, it’s clear our mission is more important than ever. We look forward to your continued support and involvement in our journey to build a more equitable and inclusive health workforce. Together we can drive meaningful change for our communities and the future of healthcare.
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