Cornell Professors Weigh in on Pandemic’s Impact on America’s Healthcare System

More than 176,000 people have died from COVID-19 and 5.6 million people have contracted the virus in the United States. In Tompkins County, 241 people have tested positive for the coronavirus and there have been two reported deaths. The Sun sat down with Prof. Sean Nicholson, policy analysis and management, and Prof. Colleen Carey, policy analysis and management, to reflect on the impact the COVID-19 pandemic has had on the U.S. healthcare system. According to the professors, the pandemic has served to underscore the problems of relying on employment for health coverage.

Unlike other developed countries, the majority of Americans receive subsidized insurance through their workplace, meaning that a sudden economic downturn can cause millions to scramble for pricey healthcare options. Some people who were temporarily laid off or are on furlough still retain coverage from their employers. But, “the longer the pandemic and the recession persists, the greater the likelihood [those on temporary layoff or furlough] lose their current jobs as employers either close up shop, redirect and transition their efforts or scale down,” Carey pointed out. All told, it is estimated that 40 million people lost their jobs due to the pandemic and the recession — with 10 million Americans expected to lose health insurance as a result. The very nature of healthcare is also transforming: While in-person doctor visits once defined how most individuals received healthcare, the pandemic has drastically accelerated trends towards virtual alternatives. “The silver lining of the pandemic was the quick transition for primary and outpatient care from traditional doctor visits to telehealth-based programs,” Nicholson said. Telemedicine has arisen as an alternative to face-to-face doctor visits, with nearly 9 million people covered under traditional Medicare having used digital services in the early months of the pandemic. In a boon towards virtual healthcare, Medicare and Medicaid announced that it would pay health providers the same amount for telehealth visits as traditional visits. Major health insurance providers waived co-payments for all telehealth services, expanded access to telehealth for mental health and substance use services, and instituted provider payment parity for telehealth, although many of these policies will be discontinued by the end of 2020.

Even so, Nicholson predicted that telehealth is here to stay, mainly because it has emerged as a more efficient and convenient mode to treat patients, potentially saving millions of hours in transportation and waiting. However, telemedicine proves limited when it comes to surgeries and hospitalization, whose availability has become even further reduced as COVID-19 surges have prompted hospitals to cancel voluntary procedures. Facilities outside of hospitals have also encountered new challenges. For nursing homes in particular, it has been “hard to keep the elderly patients safe [and] isolated as they required daily personal care and [were] separated from family, ” Carey said. The Centers for Disease Control guidelines recommend weekly testing at nursing homes, although this goal has not been consistently met. “As it was implemented state-by-state, there was a failure to follow through due to the gap in the levels of required testing,” said Carey, who noted that nursing homes were unequipped and not designed to protect an elderly population vulnerable to viral spread. In response, the Center for Medicare and Medicaid Services coordinated a big intervention — contributing $50 billion in aid to provide testing, treatments and personal protective equipment in nursing homes. The pandemic has not only produced major health concerns for individuals, but financial worries for the health providers charged with caring for them. Despite a dramatic spike in hospitalizations and demand for medical workers, COVID-19 has proved to be a significant damper on the healthcare industry — on average, hospitals receive $3,045 for treating a single coronavirus case, far less than for other patients.

“Elective surgeries are the real engine behind hospital profitability and physician income, and the pandemic has led to the cancellation and postponement of these surgical procedures,” Nicholson said. The American Health Association estimated that hospitals will lose approximately $323 billion during 2020 and physicians will lose nearly 30 percent of their income as a result of the health crisis. “Outpatient care fell by 30 percent in the second quarter of 2020, [a segment that] doesn’t typically fall in recessions,” Carey said, who pointed out that the lack of telehealth infrastructure for many doctor offices has caused “temporary layoffs … like never before.” As a result, approximately 500,000 primary care physicians and health providers were at risk of shutting down. Although hospitals and physicians have suffered losses, health insurance providers largely have avoided a similar fate, as they avoided paying for expensive surgeries and other complicated medical procedures due to reduced care in medical facilities. As a result, insurers, including Humana, Anthem, UnitedHealth Group, and Aetna, reported second-quarter earnings double those compared to last year. Overall, Carey and Nicholson both agreed that the future of U.S. healthcare policy lies in incremental reforms of the Affordable Care Act.

Carey believed that tinkering with the Affordable Care Act and reforming the existing model seems to be the building blocks towards universal coverage. She pointed out that implementing Medicaid for All would be more feasible than Medicare for All because universal insurance through Medicare is more expensive and would lead to large middle class tax increases. “The COVID-19 pandemic has shifted the voter mentality to accept an expansion of Medicare and Medicaid and reminded voters and politicians of the need for health insurance and medical coverage,” Nicholson said.

Despite cuts in service and a steep drop in ridership, the Tompkins Consolidated Area Transit system has worked to overcome pandemic challenges and continue to serve the Ithaca area.

Although it offered free service for six months, TCAT’s ridership has nevertheless remained at about 10 percent of its typical levels since the beginning of the pandemic. According to General Manager Scot Vanderpool, the meager results reflect semi-permanent changes in work patterns and fear of catching the virus.

“The biggest fear is … getting COVID-19 … but the biggest reason people aren’t riding is the fact that people are telecommuting, and employers are allowing folks to work from home,” Vanderpool said. 

TCAT created a number of safety procedures in its fleet of 50 buses, using a portion of the $7.9 million it received in CARES Act funding to purchase electrostatic disinfectant spray and plexiglass shields. The service has implemented a slew of other policies since the pandemic’s beginning in March to keep TCAT afloat amid plummeting ridership and escalating expenses. 

According to Vanderpool, service was cut by 50 percent over the summer, while routes were cancelled, schedules reduced and bus occupancy limited to 20 passengers. Employees were laid off, hiring was frozen for administrative and operational positions and overtime was eliminated.

Scaling back operations in anticipation of low ridership was the key to remaining financially solvent during the early months of coronavirus, Vanderpool said. And six months later, the number of miles driven by the bus service has returned to 90 percent of normal levels, even if use continues to remain low. 

“Our goal is to keep going with our service levels as much as possible,” Vanderpool said. “I don’t want to take anything away from anybody.”

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