In the United States, the ongoing evolution of the healthcare landscape posits numerous complex and critical matters for policymakers and experts. Highlighted by the Association of State and Territorial Health Officials (ASTHO) as the prime ten public health policy concerns for 2023, these issues encompass a broad scope. The gamut runs from the challenges encountered by the public health workforce, the nuances of legal authority, and the imperatives of immunization. It extends to cover the vitality of reproductive health and the dimensions of mental health. These facets represent a mere fraction of the sweeping myriad of health care policy topics and public health policy issues currently occupying the focal point of national dialogue, engaging decision-makers and stakeholders nationwide.
Healthcare Costs and Affordability
The preeminence of health care policy within the national discourse manifests as a multifaceted predicament engrossing the American populace. Such entanglements include surging insurance premiums, escalated out-of-pocket expenditures, the spiraling expenses tied to long-term care, and accessibility to avant-garde anti-obesity pharmacotherapies. Emblematic of this is the anticipated 5% amplification in health expenditures within the United States from 2023 to 2024, culminating in an exceptionally elevated $4.9 trillion tally. This projection poignantly delineates the exigency for holistic strategies to surmount the mounting challenge of healthcare afforadability.
Rising Insurance Premiums and Out-of-Pocket Expenses
The escalating figures in family health insurance premiums, soaring to nearly $24,000 for employer-subsidized benefits in 2022, are rendering them inaccessible to a substantial contingent employed at minor enterprises. This narrative resonates within the broader discourse of healthcare availability, where over 100 million individuals in the nation, representing a formidable 41% among the adult demographic, grapple with inassimilable medical obligations. The burgeoning expenses associated with premiums, as well as the obligatory out-of-pocket disbursements, significantly encumber familial economic dynamics. Consequently, manifold are coerced into either differring imperative healthcare or traversing toward ostensibly inferior alternatives.
Long-Term Care Costs and “Dying Broke”
The financial encumbrance appertaining to long-term care has precipitated a critical inflection point within healthcare policy discussions, exemplifying a scenario where depletion of fiscal resources is synonymous with “dying broke”. Owing to the collective aging of the populace and the correlating augmentation in requisites for extended care, policymakers are confronted with the imperative to proffer strategic interventions that both mitigate this economic quandary and ensure unfettered access to essential care.
Coverage and Access to New Anti-Obesity Drugs
The advent of novel anti-obesity pharmaceutical formulations, typified by semaglutide and tirzepatide, spotlights an additional angle of the healthcare affordability saga, particularly concerning accessibility. Despite boasting efficacious weight management modalities, these innovate drugs are plagued by exorbitant pricing paradigms and a concomitant dearth in inclusion across Medicare’s coverage schema. Hence, geriatric cohorts, standing to accrue substantial benefits, find their ingress pertinaciously restricted. Resolving these coverage and accessibility discrepancies delineates a milestone in the collective endeavor to afford every American the privilege to elevate their health and overall welfare.
Access to Reproductive Healthcare
The Supreme Court’s ruling, which overturned Roe v. Wade in the year 2022, has significantly altered the landscape of reproductive healthcare availability in the United States. This momentous decision has propelled a proliferation of legislative actions and subsequent legal disputes. These activities are either fortifying or obstructing the pathways to abortion and contraception. At the vanguard of this tumultuous advocacy, the American Public Health Association (APHA) stands firm in asserting that comprehensive reproductive health services, inclusive of abortion, constitute an indispensable right essential to the broad spectrum of public health.
State Abortion Policies and Litigation
The aftermath of the Dobbs ruling manifests as a tapestry of divergent legislative efforts. Some states have ushered in rigorous abortion bans or onerous restrictions, juxtaposed with others that have endeavored to safeguard established access. Concurrently, the highest echelon of juridical authority in the nation has been engaged in deliberations. These include the pivotal appraisal of whether religious entities merit exemption from the contraceptive mandate delineated in the Affordable Care Act. Throughout these legal forays, APHA has been resolute in its support, lending its influence through meticulously crafted amicus briefs and supportive correspondence.
Looking ahead to the year 2024 reveals a prospective electoral climate wherein as many as 15 states within the U.S. might have significant abortion-related propositions. This emergent scenario underscores the persistent political and legal flux characterizing the field of reproductive healthcare. The KFF’s Policy Tracker serves as an invaluable resource, meticulously chronicling the evolving status of exceptions to abortion prohibitions and constraints across a spectrum of 20 states, providing a portrait of the current ethical and legal terrain.
Contraception Access and Rights
The discourse on reproductive freedoms extends beyond the issue of abortion. Encompassed within this vital conversation is the imperative of contraception access and rights. Here, the APHA staunchly supports the universal availability of contraception, deploring any modifications to Title X that may impede access to crucial reproductive and sexual health services. A notable milestone in the journey towards enhanced contraception availability is the milestone reached with the launch of Perrigo’s Opill. This revolutionary product, the FDA’s inaugural over-the-counter daily oral contraceptive, marks a historic leap forward in this crucial area of healthcare provision.
At the crux of the policy and data frameworks surrounding reproductive healthcare in the U.S. is a flux, bearing profound implications for public welfare. As the discourse among policymakers and advocates continues to navigate these multifaceted dimensions, a strategy informed by rigorous evidence, fortified through collaborative efforts, and steadfast in the preservation of the reproductive rights and health of every individual emerges as paramount. This ethos remains critical as the nation navigates the complexities of this pivotal issue.
Medicaid Enrollment and Expansion
In the United States, the dynamic evolution of healthcare underscores the salience of Medicaid programs’ enrollment and expansion, emblematic of pivotal policy considerations. The cessation of pandemic-induced continuous enrollment safeguards has precipitated a reduction in Medicaid beneficiaries, raising apprehensions regarding coverage accessibility for those most in need. Concurrently, an augmenting number of states, exemplified by North Carolina, have enacted policies broadening Medicaid eligibility, thereby enabling essential healthcare provisions to underprivileged adults.
Unwinding Pandemic-Related Continuous Enrollment Protections
The exigencies of the COVID-19 pandemic necessitated extraordinary actions, notably including uninterrupted Medicaid enrollment. Subsequently, however, with the erosion of these protection mechanisms, states have commenced reassessing eligibility, heralding a marked diminution in Medicaid recipients. Cumulative figures suggest over 12 million individuals have disjoined from Medicaid due to this deregulation, as per December 2022 metrics.
North Carolina’s Medicaid Expansion for Low-Income Adults
Contrary to the prevailing national trajectory, North Carolina has lately sanctioned Medicaid expansion, underwriting healthcare coverage for low-income adults. This measure is prophesied to afford access to healthcare for approximately 600,000 individuals state-wide, who heretofore languished in the coverage void. The expansion marks a substantial stride in mitigating healthcare inequality and augmenting North Carolinians’ general welfare.
The status quo of Medicaid enrollment and expansion underscores enduring challenges and possibilities in health policy. With continuing navigations of these multifaceted predicaments, decision-makers and invested parties are compelled to meticulously deliberate the repercussions entailing care access, health dividends, and the comprehensive welfare of their cohorts.
Medicare Drug Price Negotiations
The Medicare drug price negotiations, under the aegis of the Inflation Reduction Act, were initiated in 2022 amidst robust disputation from the pharmaceutical sector. Their overarching objective is to mitigate the exorbitant prices of prescription medicines for beneficiaries of Medicare, thereby curbing the federal outlays on prescription medications within Medicare Part D.
Quantitatively assisting this objective, projections from the Congressional Budget Office indicate that the resultant negotiated prices might lower Medicare’s expenditure on negotiable drugs by close to $100 billion, spanning the timeline of 2026 to 2031. In the span of a year, Medicare’s disbursements towards the premier ten Part D drugs earmarked for price negotiation exceeded $50 billion.
Propelled by bipartisan favor, in accordance with KFF polls, there echoes a prevailing consensus among the populace towards granting Medicare the ability to haggle over drug prices. Regrettably, a substantial percentage, inclusive of a significant fraction of elderly Medicare recipients, remains oblivious to the legislative mandate for these negotiations. Furthermore, awareness pertaining to supplementary mandates within the Inflation Reduction Act, such as the imposition of an insulin copayment limitation and a ceiling on out-of-pocket expenditures for prescription medications among Medicare beneficiaries, remains distressingly scant.
As attested by the Centers for Medicare & Medicaid Services for the fiscal year 2026, ten Part D drugs have been earmarked for negotiation with the manufacturers. This tally is anticipated to escalate in successive years, with 15 and 20 drugs under Part D or Part B expected to be included in the negotiations for the fiscal years 2027 and 2028, respectively, whilst the number increases to 20 in the subsequent years.
| Year | Number of Drugs Subject to Price Negotiation |
|---|---|
| 2026 | 10 Part D drugs |
| 2027 | 15 Part D drugs |
| 2028 | 15 Part D or Part B drugs |
| 2029 and later | 20 Part D or Part B drugs |
The selection of the ten Part D drugs, targeted for negotiation in 2026, was executed based on empirical data. From the cohort of top 50 negotiation-eligible drugs, these were chosen, given criteria encompassing the absence of therapeutically equivalent generics or biosimilars for single-sourced brand name products or biologicals. The Inflation Reduction Act, in its granular detail, also places an embargo on the eligibility of so-termed “small biotech” drugs for negotiation from 2026 to 2028.
“The Congressional Budget Office suggests that simply giving the Secretary authority to negotiate drug prices in Medicare may not significantly lower prices due to the need to cover various drugs.”
The genesis of the Medicare Part D program in 2003 brought with it a prohibition against governmental intervention in drug price negotiations. Consequently, Medicare Part D and Medicare Advantage plans partake in autonomous negotiations, devoid of governmental oversight, which significantly attenuates their negotiating prowess vis-à-vis entities like the Department of Veterans Affairs. Moreover, there exist six drug classes within Medicare Part D that are considered sacrosanct, mandating their inclusion and thereby diminishing the room for negotiation by these plans.
Contrastingly, Medicaid leverages federal statutes to regulate drug prices, ensuring capped price augmentations and garnering rebates from pharmaceutical manufacturers. The counterexample of the Department of Veterans Affairs and associates, which centrally negotiate drug prices with the panoply of federal programs, underscores the effectiveness of this approach. The VA, benefiting from a unified formulary and strategic control over prescribing practices, routinely secures more favorable drug prices than the Medicare Part D regime.
The disparities in drug prices are discernible; comparative to Medicare Part D, instances such as the federal supply schedule, Medicaid’s rebate structure, and federal entities like the VA and DOD exhibit superior efficacy in securing reduced costs for brand name medications.
COVID-19 Pandemic Response and Vaccination
Amidst the persistent COVID-19 pandemic, there was a discernible shift in the American public’s concern regarding their susceptibility to the virus. This trend, discerned from KFF’s COVID-19 Vaccine Monitor, indicated a diminishing fear. Concurrently, a reduction in zeal for procuring the latest booster immunizations was observed. The convoluted nature of identifying and financing these booster doses, post the revocation of the public health emergency, further exacerbated the situation.
Public Perception and Vaccine Hesitancy
The intricacies of public attitudes towards COVID-19 vaccines, delineated through various studies, have unearthed a labyrinth of hesitancy and resistance. An Indian study, for instance, illuminated a hesitancy incidence rate of 1,048 per 10,000 individuals. In the UK, a survey emphasized the role of misinformation in fostering vaccine hesitancy among its populace. Notably, analyses posit that the proliferation of anti-vaccine narratives might be contributing to an upsurge in vaccine resistance globally, echoing similar concerns in Australia where significant percentages of its citizens have exhibited signs of reluctance towards COVID-19 immunization.
Booster Access and Cost Confusion
The advent of the Omicron variant, a formidable strain of the SARS-CoV-2, elicited grave concerns over a potential surge in infection rates. This atus quo, contrasted with a diminishing interest amongst the general populace to obtain the latest booster shots. The lassitude towards adherence and the ambiguity surrounding the procurement and financial aspects of these vaccinations were further compounded by the post-emergency era. The shift in vaccination access and subsidization mechanisms, consequent to the emergency declaration’s abrogation, refashioned the landscape of COVID-19 booster dose attainment, accentuating public disorientation.
| Country | Vaccine Hesitancy Rate |
|---|---|
| India | 1,048 out of 10,000 individuals |
| United Kingdom | Survey participants displayed hesitancy due to COVID-19 misinformation |
| Australia | 43% of the population showed vaccine hesitancy and resistance |
| Australia | 34% of individuals in a nationally representative survey displayed COVID-19 vaccine hesitancy and resistance |
Combating Health Misinformation
The dissemination of health misinformation represents a profound challenge to public health, exacerbated by the COVID-19 pandemic’s widespread ramifications. In response, a multi-level strategy was engineered, spearheaded by renowned experts within various communities, targeting the primary sources of COVID-19 misinformation. Simultaneously, media entities augmented their fact-checking mechanisms to unveil and discredit erroneous assertions. This strategy was further bolstered by technological platforms, which, through nuanced algorithms, suppressed false narratives and funneled users toward vetted health information resources. Concurrently, governmental bodies, in synergy with respected health authorities and professions, played a pivotal role in promulgating clear, accurate public health guidelines.
Prevalence of False Health Claims
The Kaiser Family Foundation’s investigations divulge that a substantial segment of the population has encountered a plethora of debunked health claims, with a significant subset refraining from outright dismissal, a testament to the informational warping effect. However, their receptivity to verifiable information presents a bridge for engagement by authorities and educators. Utilizing this opening, these individuals should mount initiatives focused on developing critical information appraisal skills, spanning domains such as media, science, and health literacies. Moreover, it stresses the imperative for healthcare practitioners to actively address and rectify misconceptions endemic within their patient base, reflecting on the urgency of clear, accessible communication.
Trusted Sources for Reliable Information
To navigate the complex landscape of misinformation dissemination, an integrated approach is essential, requiring the concerted efforts of a diverse array of stakeholders. Instructional bodies are enjoined to fortify their curricula with robust, evidence-based learning modules dedicated to nurturing misinformation resilience across all education strata. The medical fraternity, on the other hand, must leverage its authoritative position to counter falsehoods, employing an approach that prioritizes empathetic understanding alongside the dissemination of simplified, yet accurate, information. Not to be outdone, journalistic entities are reminded of their professional mandate to combat misinformation, commencing with internal knowledge enhancement initiatives that bolster their capacity to differentiate truth from falsehood before communicating the same to the general populace.
The strategic dissemination of unalloyed health information from verified sources constitutes a cornerstone in this multi-pronged battle. Through cohesive, exhaustive strategies embracing a wide spectrum of initiatives, stakeholders stand to significantly enhance the public’s capacity for informed decision-making, thereby fostering a resilient trust in the veracity of the healthcare domain.
Advancing Health Equity
Health equity is now a central concern in healthcare policy discussions. Research by the Kaiser Family Foundation (KFF) uncovers marked disparities in health experiences and outcomes among vulnerable populations across the U.S.
Addressing Racial and Ethnic Disparities in Healthcare
According to KFF, 60% of Black adults, nearly half of American Indian, Alaska Native, and Hispanic adults, and 40% of Asian adults report anticipating insults or feeling the need to overly focus on their appearance for fair treatment during healthcare engagements. These disheartening statistics highlight the profound difficulties and discriminatory encounters that individuals of color encounter in the healthcare system.
Preparing for Potential Discrimination and Insults
To surmount these entrenched disparities, policy makers and healthcare officials must focalize on strategies that foster health equity, ensuring equitable access to top-tier, culturally sensitive care for all patients. This initiative involves enacting stringent anti-discrimination measures, offering comprehensive cultural competency training to healthcare professionals, and incorporating the marginalized community’s perspectives in healthcare service development and deployment plans.
The Future of the Affordable Care Act
The Affordable Care Act (ACA), colloquially known as Obamacare, has signified vast strides in the realm of healthcare since its enactment over a decade ago. Plumbing the depths of its provisions, the national uninsured metric plummeted from 15.5% to 8.6%, thus ensuring coverage for over 30 million denizens within the nation. It has been bolstered by a prevailing reservoir of favor, typified by KFF’s polling which unearthed an overwhelming preference for its discussion amongst Democratic constituents, with a skew towards 70%, juxtaposed against a significantly lower 32% amongst Republicans.
Public Support and Record Enrollment
This legislative milestone has garnered unequivocal public acclamation, reflected in a momentous upsurge of enrollments in the ACA marketplace throughout the incumbent year. The pivotal year of 2024 glittered with a choice by 21.4 million participants to opt for an ACA marketplace scheme. Concurrently, an amalgamation of over 40 million individuals was enveloped within the realms of coverage set forth by the ACA marketplaces, coterminous with its Medicaid expansion counterpart. Such an assertive display is underscored by the staggering reduction in the cohort of uninsured, waning from 45.2 million in the year preceding its implementation to 26.4 million in its ensuing span, attesting to the ACA’s poignant efficacy.
Proposals for Replacement or Alteration
Conversations have been vigorously ongoing regarding the ACA’s prospective metamorphosis or substitution. These dialogues pivot around paradigm shifts in financial responsibilities, advocating for public payers to undertake the full berth of care expenditure, as well as the requisite for the obfuscating barriers imposed upon non-traditional healthcare participants to be dismantled. Echoed by the stout endorsement of the ACA by the American Hospital Association (AHA), these endeavors have catalyzed a transformative ripple effect within the healthcare matrix. This metamorphosis heralds a new epoch of enhanced delivery and value augmentation, emblematic of the ACA’s catalytic role in the sector’s evolvement.
health care policy topics
Public Health Workforce and Legal Authority
With an aging U.S. population elevating healthcare service demands, policymakers meticulously scrutinize both the public health workforce and the legal prerogatives afforded to public health entities. The Association of State and Territorial Health Officials (ASTHO) underscores the imperative for state and territorial legislatures to delve into these crucial issues. This includes discussions on maintaining recent public health workforce investments, potential professional licensure mandates, as well as elucidating the applicability and execution of public health orders aimed at disease containment.
Facilitating the augmentation of the public health workforce and the refinement of legal powers is pivotal for the effective navigation of burgeoning health policy challenges. Such efforts are indispensable for the protection of community well-being within the nation at large.
Immunization Policies and Childhood Vaccination Requirements
Upholding robust childhood vaccination rates stands as a paramount objective for state and territorial public health authorities. ASTHO envisions a persistent prioritization of immunization protocols, encompassing regulations stipulating vaccination prerequisites for educational and childcare enrollments. There is also a concerted drive to tackle vaccine hesitancy and streamline access to recommended immunization services.
Consequently, it is anticipated that policymakers will strategize on bolstering immunization schemes. Their focus will likely be on the endorsement of empirically validated methodologies to fortify children’s and communities’ resilience against maladies that are preventable through vaccines.
Overdose Prevention and Harm Reduction Strategies
The prevalent addiction issue in the U.S. perpetually devastates its communities, demanding heightened attention towards efficacious overdose prevention alongside harm reduction protocols. Legislatures at state and territorial levels are poised to discuss strategies that broaden the reach of naloxone and facilitate access to syringe services, among other evidence-based interventions. A comprehensive strategy is imperative, one that accentuates public health interests, shuns societal stigmas, and in the process, preserves lives.
Emerging Health Policy Issues
The dynamics of the American healthcare arena are undergoing significant shifts, directing the collective gaze of policymakers as well as health officials towards several key areas. These enclaves, pivotal for the enhancement of individual and communal well-being, encompass the accessibility of mental healthcare and the sustenance of youth health. They also extend to the enhancement of data security and the modernization of public health data, alongside a focus on environmental health in the face of climate shift, regulatory measures on tobacco, and the imperative of curbing the spread of HIV whilst endeavoring to diminish its associated social stigma.
Mental Health Access and Youth Well-Being
The advent of the COVID-19 pandemic wrought a formidable impact on mental health dynamics, particularly within the cohort of young individuals. Recent statistics illuminate that one-fifth of the American populace grapples with mental health conditions, while nearly fifty percent of high school students contend with enduring feelings of despondency and hopelessness. Legislative bodies across states and territories now ponder over enactments designed to broaden mental health services through the adoption of telemedicine and the endorsement of specialized youth mental health efforts.
Data Privacy and Public Health Data Modernization
Accruing and leveraging comprehensive datasets for informed policy-making in the public health sector finds itself marred by an escalating concern for data privacy. Policymakers are currently entrenched in a dialectic over the necessity of timely and extensive health data against the backdrop of safeguarding individual privacy and maintaining data integrity.
Environmental Health and Climate Adaptation
The encroaching peril of climatic alterations portends substantial public health repercussions, ranging from the proliferation of infectious maladies to the exacerbation of weather-derived adversities. At the legislative frontier, a medley of policy measures is being deliberated with the aim to ameliorate environmental health threats and bolster community resilience against the vicissitudes of a dynamic climate.
Tobacco and Nicotine Product Regulation
Tobacco consumption holds its position as the primary instigator of disease, incapacitation, and mortality within the U.S.; however, the framework is in flux, delineated by diminishing rates of tobacco consumption juxtaposed against a steady upsurge in nicotine product utilization, prominently among the youth. Policymakers are entranced in a strategic quagmire, devising effective strategies to regulate this transmuting market vis-à-vis public health protection.
HIV Prevention and Reducing Stigma
In spite of momentous advancements in the arena of HIV treatment and prevention, the U.S. is beset by the specter of unabated new infections. A swathe of legislative measures is presently underway at the state and territorial levels, echoing national aspirations to curtail new HIV occurrences by ninety percent before 2030. Concurrently, initiatives seeking to erode the social stigma conjoined with HIV are being championed, acknowledging its pivotal role as a barrier to the tripartite of testing, treatment, and prevention.
Conclusion
The health policy landscape, as outlined by ASTHO and KFF, is vast and complex, directly affecting the public’s health, access to healthcare, and the financial and holistic well-being of individuals and communities nationwide. It encompasses a broad spectrum of issues such as the affordability of healthcare, reproductive health access, Medicaid expansion, negotiations on Medicare drug prices, as well as themes pertinent to the ongoing pandemic, health equity, and the fate of the Affordable Care Act. Each of these is recognized as pivotal in the discourse surrounding public health policy and constitutes a varied array of national health policy priorities.
In the endeavor to address these multifaceted concerns, state and federal policymakers must focus on solutions that are deeply rooted in evidence and are forged through collaboration with health policy experts. Their efforts should be directed towards enhancing and refining current healthcare policies, health policy matters, prevalent health policy issues, and public health concerns. By adopting this multifaceted strategy, they stand to make significant headway in tackling the critical issues prevalent in public and national health policies.
Policymakers possess a unique opportunity to instigate change through an approach that is underpinned by empirical analysis, engenders collaboration with health experts, and remains steadfast in its dedication to rectifying health disparities’ root causes. Weaving these elements together, they can strive to fashion a healthcare system that not only ensures equitable access but also meaningfully serves the diverse populace of the nation. Such a concerted effort would play a fundamental role in advancing the health and overall well-being of the population, ensuring a brighter future for every American.
