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JAMA Forum
July 22, 2021

Evidence-Based Health Policy in the Biden-Harris Administration

Author Affiliations
  • 1Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC
JAMA Health Forum. 2021;2(7):e212598. doi:10.1001/jamahealthforum.2021.2598

In its first 6 months, the Biden-Harris Administration has tackled a range of critical health policy challenges. From the outset, the Administration made clear its commitment to science, issuing a memorandum prioritizing scientific integrity and evidence-based policy making. Within the US Department of Health and Human Services (HHS), the Office of the Assistant Secretary for Planning and Evaluation (ASPE) is at the forefront of the effort to use science, data, and evidence to guide policy. Sometimes called HHS’s think tank, ASPE and its team of policy analysts, economists, public health professionals, clinicians, and more are tasked with supporting the Secretary of the HHS by providing analysis and evidence to guide the Department’s efforts. On a range of policy priorities—including the COVID-19 pandemic and recovery, behavioral health and the drug overdose crisis, health insurance coverage expansion, and the continued reckoning with structural racism and other health care inequities—ASPE has been working to support an evidence-based agenda at the HHS.

Pandemic response has been a top priority since day 1 of the administration, with the HHS playing a central role in coordinating federal health efforts. To support a national vaccination campaign, ASPE has analyzed survey data on COVID-19 vaccine hesitancy, and generated state, county, and local estimates to assist with outreach. This analysis showed a marked reduction in hesitancy rates among young adults and Black people since January 2021, but hesitancy remains a challenge in many regions.1 Reports describing the disproportionate effect of COVID-19 in communities of color have helped highlight the need for targeted efforts to improve health equity in the pandemic response.2 In addition, ASPE has tracked some of the less direct but still sizable effects of the pandemic on health care. Reports examining the large increase in telehealth use in 2020, as well as health spending and utilization during 2020, indicate the degree to which the pandemic created substantial changes in usual patterns of care.3

Another ASPE effort is analyzing evidence on behavioral health and disability during the pandemic and beyond. The office has documented substantially higher rates of COVID-19 and double the mortality rate among Medicare fee-for-service beneficiaries with dementia compared with those without dementia.4 Homebound patients have faced acute challenges during COVID-19, as shown in ASPE’s work on barriers to vaccine access due to living alone or lacking technology, and workforce shortages that intensified because of reimbursement and safety obstacles. COVID-19 has exacerbated the persistent overdose crisis, which now extends beyond opioids to multiple drugs of concern. ASPE work is at the frontier of these trends, identifying promising state and community efforts to address stimulant use and barriers to effective responses, such as limited knowledge about effective therapies and a dearth of funding for social supports.5 And although substance use disorder treatment has increased in recent years, the need for treatment remains high and is growing. ASPE continues to track trends in behavioral health utilization and assess effects of policies such as the HHS buprenorphine prescribing guidelines issued in April 2021, designed to augment the number of prescribers available to deliver opioid use disorder medication treatment.

Another key priority for the Biden-Harris Administration is expanding health insurance coverage. An executive order directed HHS to examine policies related to Medicaid and health insurance Marketplace coverage, and ASPE’s work has provided important data in these areas. Evidence reviews on issues such as health insurance churning and state demonstration programs describe some of the challenges in keeping people enrolled in stable coverage over time. Reports on coverage trends and ASPE public-use datafiles describe uninsured individuals and where they live, to support outreach efforts for enrollment and research.

Most recently, the provisions of the American Rescue Plan Act of 2021 (ARP) took effect, along with increased HHS funding for “navigators” and outreach to help consumers sign up for health care through the Affordable Care Act (ACA). ASPE analyses show that the ARP’s enhanced and expanded subsidies to people obtaining coverage on the Marketplace enable 3 in 5 uninsured consumers and 4 in 5 current enrollees to find a zero-premium plan (after premium tax credits) on HealthCare.gov.6 Overall, the Administration has taken a strong evidence-based approach to coverage expansion—through aggressive outreach to consumers combined with improved affordability, both shown by prior research as keys to increasing coverage rates. Most recently, a report indicated that enrollment in coverage related to the ACA—namely Medicaid expansion and Marketplace insurance—had reached 31 million, an all-time high.7

Yet concerning disparities remain in access to services as well as health outcomes across populations, making equity a central focus for the administration. President Biden issued an executive order to advance racial equity and support for underserved communities through the federal government, as well as an executive order to ensure an equitable response to COVID-19 response and recovery.

The HHS and other federal agencies are implementing these executive orders. Along with the Assistant Secretary of Health, ASPE co-chairs the HHS Health Disparities Council, which is committed to advancing health equity for all—with an emphasis on groups that have historically been marginalized, including people of color, the LGBTQ+ community, religious minorities, and rural populations. As noted above, ASPE has tracked disparities in COVID-19 rates of infections, hospitalizations, deaths, and vaccinations, showing consistently worse outcomes for communities of color. ASPE has also documented racial and ethnic disparities in economic opportunity during COVID-19, showing that women of color have been particularly hard hit in employment losses and experienced a slower recovery than other groups.8 Social determinants of health, including employment and poverty, interrelate to health inequities in important ways; for instance, ASPE has shown that social determinants of health are associated with increased incidence of mental health conditions during COVID-19, and that people with a history of homelessness have greater prevalence of many chronic conditions, such as alcohol and opioid abuse, viral hepatitis, and repeat head injuries.9

Using rigorous science and evaluation to guide decision-making in areas of HHS authority is critical to accomplishing administration priorities. In all of HHS’s work, having high-quality data is the first step—whether conducting analysis to document disparities or more broadly to inform evidence-based decision-making. A co-chair of the HHS Data Council and home to the Secretary’s Patient Centered Outcomes Research Trust Fund, building data capacity and promoting scientific integrity are also key parts of ASPE’s role. In all of these areas, ASPE’s mission is to serve the Secretary of HHS in providing these science and data-driven insights, to advance sound and meaningful policies.

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Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Haffajee RL et al. JAMA Health Forum.

Corresponding Author: Benjamin D. Sommers, MD, PhD, US Department of Health and Human Services, 200 Independence Ave SW, Washington, DC 20201 (benjamin.sommers@hhs.gov).

Conflict of Interest Disclosures: Dr Sommers reported receiving personal fees from the Health Research & Educational Trust, the Massachusetts Medical Society, the Urban Institute, AcademyHealth, the American Economics Journal, and the Illinois Department of Healthcare and Family Services; and receiving grants from Baylor Scott & White, the Commonwealth Fund, and the Robert Wood Johnson Foundation. No other disclosures were reported.

References
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Beleche  T, Ruhter  J, Kolbe  A, Marus  J, Bush  L, Sommers  BD.  COVID-19 Vaccine Hesitancy: Demographic Factors, Geographic Patterns, and Changes Over Time. Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services; 2021.
2.
Simmons  A, Chappel  A, Kolbe  AR, Bush  L, Sommers  BD.  Health Disparities by Race and Ethnicity During the COVID-19 Pandemic: Current Evidence and Policy Approaches. Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services; 2021.
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Tarazi  W, Ruhter  J, Bosworth  A, Sheingold  S, De Lew  N.  The Impact of the COVID-19 Pandemic on Medicare FFS Beneficiary Utilization and Provider Payments: FFS Data for 2020. Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services; 2021.
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Lamont  H, Samson  LW, Zuckerman  R, Dey  J, Oliveira  I, Tarazi  W.  The Impact of COVID-19 on Medicare Beneficiaries with Dementia (Issue Brief). Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services; 2021.
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Haffajee  RL, Heins  S.  State and Community Efforts to Address Stimulant Use. Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services; 2021.
6.
Branham  DK, Conmy  AB, DeLeire  T,  et al.  Access to Marketplace Plans with Low Premiums on the Federal Platform, Part II: Availability Among Uninsured Non-Elderly Adults Under the American Rescue Plan. Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services; 2021.
7.
Office of the Assistant Secretary for Planning and Evaluation.  Issue Brief No. HP-2021-13. Health Coverage Under the Affordable Care Act: Enrollment Trends and State Estimates. Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services; 2021.
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Mead  E.  COVID-19 and Economic Opportunity: Inequities in the Employment Crisis. Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services; 2021.
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Sutherland  H, Ali  MM, Rosenoff  E.  Health Conditions Among Individuals with a History of Homelessness. Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services; 2021.
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