Health Policy Student Association hosts Election Year Health Policy Outlook Panel
The Michigan Daily 2/19/24
The panel featured Scott L. Greer and Marianne Udow-Phillips, professors in the School of Public Health, and John Z. Ayanian, director of the Institute for Healthcare Policy & Innovation and professor at the Medical School. The discussion was led by Public Health student Jamaal Shaikh, HPSA president.
The first question for the panelists asked about the effectiveness of Democrats’ policy initiatives, such as the Inflation Reduction Act, at tackling high prescription drug prices. The IRA, passed in 2022, placed numerous restrictions on how pharmaceutical companies can price drugs for people on Medicare. Ayanian said the IRA gives the federal government more power in regulating drug prices.
“The IRA is a foot in the door to give the government a greater role in negotiating drug prices,” Ayanian said. “Other countries, like England or Australia, have national agencies that basically set the prices that the government is willing to pay for new and existing drugs. We don’t have that here in the United States. We leave it almost entirely up to the market.”
Udow-Phillips said while she supports the passage of the IRA, she is skeptical of its promises.
“I think the pharmaceutical industry is extremely clever and has always found ways around any efforts to constrain their prices,” Udow-Philips said. “Color me a skeptic that (the IRA) is going to achieve everything that one might hope it would.”
The panel then moved on to reproductive rights, a key policy issue in the 2022 midterm elections. Since the U.S. Supreme Court overturned Roe v. Wade in 2022, many states have passed legislation regarding women’s access to abortions. Though many of these laws contain exceptions for victims of rape or incest, Greer said that in certain states, like Texas, those provisions are ineffective.
“Rape and incest grounds tend to be functionally unenforceable,” Greer said. “It’s practically impossible to find a doctor or hospital that will stick their neck out and perform an abortion when you have the Texas Supreme Court ultimately deciding whether or not you committed a felony.”
Udow-Phillips said in states that have voted on ballot initiatives, including Michigan, there has been bipartisan support for protecting abortion rights. According to Udow-Phillips, some states have been more effective at sending out ballot initiatives than others.
“The problem is that in (conservative states), they can’t get on a ballot initiative,” Udow-Phillips said. “There are lots of groups trying to figure out how to reduce public say in those states because abortion protections will pass in almost every state.”
Ayanian said that new court cases could affect pregnant women, like a recent Texas Supreme Court decision that ruled the federal government cannot enforce the Emergency Medical Treatment and Labor Act in hospitals. EMTALA is a provision requiring hospitals to treat patients who are experiencing medical emergencies, including life-threatening pregnancy complications.
“Pregnancies can lead to crises, from infections to bleeding to miscarriages,” Ayanian said. “The Biden administration has interpreted this as meaning that emergency rooms must treat pregnant women who may be in need of an abortion. States are challenging this and saying, ‘No, under our laws, this is our decision.’ ”
The panel also addressed the issue of institutional public health, with an emphasis on the United States’ response to the COVID-19 pandemic. The panelists discussed how COVID-19 brought to light a number of institutional issues regarding public health, ranging from the federal to local level. Greer said former President Donald Trump’s lack of leadership during COVID-19 contributed to nationwide failure to address the pandemic.
“I think it’s a basic axiom of American emergency response that to be effective, the states require federal leadership, and to be effective, the federal government requires White House leadership,” Greer said. “That was what collapsed so completely in 2020 … What we’ve discovered is that the single point of failure in the entire American federal system during a disaster is the presidency, and we either need to think hard about our institutions or just be very lucky in our presidents.”
Udow-Phillips, in contrast, said the public health issues that arose during the COVID-19 pandemic were due to the breakdown of local institutions in their response to COVID-19.
“The actual implementation of public health is at the local levels,” Udow-Phillips said. “Local public health directors are appointed, at least in Michigan, by the county commissioners. What we saw in many communities across the country is that our public health leaders have no experience and no understanding of political processes. And so our public health leaders were overwhelmed in dealing with uncertain science, changing guidelines and a population that is generally resistant to being told what to do.”
In an interview with The Michigan Daily after the event, Shaikh said he enjoyed all of the events throughout Health Policy Matters Week, but this panel was his favorite.
“This event had to have been the most educational and informative event so far,” Shaikh said. “We had some amazing, extremely well-accomplished panelists.”
