The Pandemic & The Safety NetsSeptember 12, 2020
In the past two weeks, almost every discussion that I’ve had about planning for future sustainability has, in some form or fashion, involved a discussion about “the safety net.” However, the discussion was really about our two safety nets in the United States—the health care safety net and the social safety net (see Virus Imperils Health Care Safety Net and The Social Safety Net: The Gaps That COVID-19 Spotlights). These are not academic discussions—because whatever happens now and in the near future with our safety nets is going to have a significant impact (either positive or negative) on any organization entering into some type of value-based contract for services.
The pandemic has pointed out the shortfalls in our safety nets. An estimated 5 million people have lost their health insurance coverage since February (see Millions Have Lost Health Insurance In Pandemic-Driven Recession), with the overall uninsured rate expected to increase by about 10%, from 28.6 million before the emergency to 31.5 million (see COVID-19 Job Losses & Recession Projected To Raise Uninsured Rate From 10.4% To 11.4%). And, with the CARES Act funding at an end, income support for the 53 million unemployed people is also at an end. And, no amount of food banks and eviction/foreclosure protections are going to fill the gap. This is happening at time when state and local budgets foretell significant cuts to all budgets (see Estimated City Shortfall Hits Combined $2 Billion For This Year And Next, Florida’s Deficit Grows To $5,400,000,000 Over Next Two Years Thanks To Pandemic, and US budget Deficit Hits Record $3 Trillion Through 11 Months).
In my recent conversations with payer managers—Medicaid directors, county health directors, and health plan managers—there is a recognition that the lack of safety nets is going to “bend the cost curve” negatively in the very near future. As we look to next year, the number of people on Medicaid rolls and the number of people uninsured is almost certain to increase. In addition, the number of consumers inadequately housed, with food insecurity, and in need of transportation assistance will also increase. This will put the pressure on payers to fund programs that address these social factors (in order to reduce unnecessary health care spending) and on provider organizations to develop some innovative approaches to these problems that have a measurable return on investment.
In the year ahead, we’ll be covering these budget issues and their impact on funding health and human services for consumers. And, we’re planning to feature both changes in payer and health plan policies to address social determinants—and the innovative programming in the service delivery system that takes the “whole person” concept to new levels. To get started with this discussion, we’ve compiled the latest findings and activities on addressing SDOH from The OPEN MINDS Circle Library and our online communities.