Almost 11 million Americans are unemployed, according to the latest estimates by the U.S. Bureau of Labor Statistics. The economic turmoil has directly affected many of our patients, who had previously relied on their employer for health insurance coverage. While some have turned to alternative financial assistance to obtain medications without disruption in their medical care, others have had to change physicians due to insurance coverage or opt for less optimal medications, such as coumadin to replace apixaban. Some patients have foregone medical care altogether – an issue that preceded the pandemic, but now exacerbated by the current conditions.

These devastating consequences of the pandemic raise the question of what can be done by the new Biden administration. Larry Levitt, MPP, the executive vice president for health policy at the Kaiser Family Foundation; Journal of the American Medical Association (JAMA) Associate Editor Karen Joynt Maddox, MD, MPH, co-director of the Center for Health Economics and Policy at Washington University School of Medicine; and Lawrence O. Gostin, JD, from the O'Neill Institute for National and Global Health Law at Georgetown University, addressed this question in a JAMA podcast.

The podcast discussed issues in health insurance coverage that stem from the lack of unified insurance system – a problem that is unique to the U.S. compared to other developed western countries. We lack not only federal regulation (such as in the National Health System of the United Kingdom) but also meaningful competition among insurers (such as in Germany with a multi-payer system), leading to suboptimal health insurance coverage in both number of patients insured as well as the degree of coverage provided. These pre-existing issues were further exacerbated in the face of the pandemic's economic impact as well as a set of policy changes meant to weaken the Affordable Care Act.

I was pleasantly surprised, however, to find that all three health policy experts were optimistic in the reforms that could make real impacts for our patients. The health care reforms earlier this year have already improved access to the comprehensive coverage afforded by the ACA eligible plans with real changes, such as increasing the annual enrollment period. The more recent health reforms under consideration could provide a public health insurance option that any individual could opt for if they lost employer-based insurance plans due to unemployment or if their current plan was simply suboptimal. In addition, their reforms would expand the population eligible for Medicare by reducing the age of eligibility from 65 to 60 years of age, as well as provide subsidies to help pay premiums for middle class Americans.

I found it encouraging to hear the perspectives of Maddox with regards to the possibility of Medicaid expansion. Even in states that had previously opposed this in the past, such as Louisiana and Oklahoma, change in popular opinion was an important impetus for Medicaid expansion. Voters in these states came to appreciate that lack of health insurance coverage for the working poor – who are not eligible for Medicare due to the age cutoff, and not eligible for Medicaid and ACA due to their low wages – can affect us all. The panelists agreed that the popular perception of Medicaid across the country is shifting – from an unpopular handout to now an important safety net for us all, a critical prerequisite to change.

These discussions inspired me to better inform myself and my patients, and find ways in my clinical practice to ease the pain that the economic turmoil has afflicted. Here are a few tools and resources I've gathered so far.

Educational resources

1. As mentioned above, JAMA has launched a new series on U.S. health care and health policy that aims to inform health care providers on current policy issues and reforms.
2. The Kaiser Family Foundation website provides updates on today's most relevant policy issues, as well as an exposure to 'policy talk' that is slightly out of my comfort zone.
3. ACC's Advocacy website provides a centralized resource for those looking to stay up to date on health policy issues impacting cardiovascular clinicians and patients. Learn more at ACC.org/Advocacy and don't forget to sign up for The Advocate newsletter every Thursday. Looking for more ways to get involved? The ACC's HeartPAC is a voluntary, non-partisan, non-profit Political Action Committee formed to support the ACC's mission to transform cardiovascular care and improve heart health. Learn more.

Prescription costs

1. There are a number of websites that are now available to patients to help find cheaper alternatives to help reduce high out-of-pocket costs on prescription medications. The most familiar to many of us is "GoodRx." Many other comparative websites are now available including "NeedMeds" and "FamilyWize." These may be invaluable resources for patients who are experiencing insurance instability due to employment insecurity, particularly exacerbated during this pandemic.
2. There are resources also designed for health care clinicians to help speed up the prior authorization process. This is one of these websites I have found most helpful. I took advantage of this resource as a medicine resident, discharging a patient with new-onset atrial fibrillation on a Saturday. I was able to follow the few simple steps to easily submit for and receive prior authorization even on a weekend!
3. There are also State Pharmaceutical Assistance Programs that are searchable based on this Medicare website.

Listen

1. As physicians, one of our fundamental skills and resources is the value of active and effective listening. While I sometimes feel powerless to help patients with their financial turmoil that is directly affecting their access to care, actively listening has created a chance for us to connect in a different way. By creating not only a therapeutic alliance but a financial one, I hope patients can feel more willing to discuss with the health care team optimal solutions to financial and insurance instability rather than foregoing medical care.  
2. It is also worthwhile to look for other patient-centered resources available at your local hospital. Whether they are social workers, patient advocates, or financial advisers, they make up a critical part of our health care team, now more than ever before. I am so grateful for my clinic staff that help me connect with those resources, and to my patients during these challenging times.

This article was authored by Hyeon-Ju Ali, MD, general cardiology fellow in training at Houston Methodist Hospital.

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