States have made heroic efforts to fight COVID-19 over the past 20 months, but one thing the pandemic has proven, according to Dr. Nirav Shah, is that we are only as strong as our weakest neighbor.
“No matter what one county might do, if one county has another county next door with cases out of control, their hospital is going to be overwhelmed and we know that COVID doesn’t respect our official political borders,” the senior scholar at Stanford University’s School of Medicine and chief medical officer of Sharecare, said during a session titled “Pushing Through the Pandemic—and Prepping for the Next” at the NCSL Legislative Summit.
But it doesn’t have to be this way, he said.
Breaking Down Barriers
“Once the lockdowns began in April 2020, for example, we saw that internet traffic jumped literally 20% overnight as people worked from home and moved their lives onto Zoom,” he said. “Despite this 20% increase in traffic, the internet didn’t break. In fact, it worked precisely because it was organized as a network, an ecosystem.”
Shah said that while he knows how hard it is to change things in government, especially in the areas of health care and public health, it’s time to foster innovation.
One place to start: breaking down some of the artificial barriers between states.
“During the height of the pandemic, over two-thirds of the states waived the state-based licensing rules for doctors,” Shah said. “In California, I could do a telehealth visit. I could go to New York and help them out in a crisis. Georgia authorized EMTs to administer COVID vaccines. Wisconsin and Indiana allowed dentists to give COVID vaccines. So why are there anticompetitive barriers in place in the first place? … If a rule doesn’t make sense some of the time, maybe it might not make sense all of the time.”
He added that innovation also comes from looking for new opportunities.
“For example, you’d be surprised at what Medicaid will pay for,” he said. “When I was commissioner of health in New York state, we made many public health investments using Medicaid waivers. … There are a lot of opportunities where you can go upstream—prevention—with Medicaid dollars, rather than downstream—band-aids—that are too late.”
Addressing Health Disparities
Chiquita Brooks-LaSure, the administrator of the Centers for Medicare and Medicaid Services, who joined the meeting remotely, said her agency is focused on designing, implementing and operationalizing policies and programs that promote health equity for the more than 144 million people enrolled in Medicare, Medicaid, CHIP and marketplace programs.
“The reality is that racial and ethnic minority groups are at a greater risk of getting sick and dying from COVID-19,” she said. “The CDC attributes discrimination, health care access and utilization, general health status, occupation, housing, education, income and wealth gaps as factors that contribute to the increased risks of severe illness.”
Addressing those health disparities and inequities; building on the Affordable Care Act and expanding access to quality, affordable health coverage and care; and engaging partners and communities the CMS serves throughout the policymaking and implementation process are the three pillars of the agency’s strategic vision.
To develop a stronger consensus on the pandemic response, LaSure said, it’s important to have discussions and try to understand each other’s perspectives, approaches and experiences.
“These are not instantaneous things, but I think continuing to strengthen our dialogue is key to being ready for the next pandemic that we might face,” she said.
As for what to expect from COVID-19 going forward, Shah said we can learn to live with the virus in a different way, and that we need to remember that basic evidence-based public health behavior works.
“If you’re going to be in a crowded room, it might make sense to put on a mask, and hygiene doesn’t hurt,” he said. “I don’t know about you guys, but I didn’t get any colds, flus or anything these past two years. You know what? Washing your hands works. Wearing masks keeps you protected from everyone else. And so I think we can reach that new normal in the near future. We just all have to get behind that vaccination message because it works and protects.”
Lesley Kennedy is a director in NCSL’s Communications Division.