Andy Slavitt on the Upcoming Election and Ongoing Pandemic

The former acting CMS administrator opines on the Trump administration's response to COVID-19 and what a Biden administration could mean for hospitals.

Andy Slavitt, MBA, says that the choice between President Donald Trump and former Vice President Joe Biden in next month's presidential election centers on who has the right approach to handling the ongoing COVID-19 pandemic.

Slavitt, who served as acting administrator for the Centers for Medicare & Medicaid (CMS) in the Obama administration, said that Biden has a proven track record of leading during a pandemic and could serve as a "unifier for the nation."

In a conversation with HealthLeaders, Slavitt discussed the upcoming election, what each outcome could mean for healthcare executives, and his ongoing involvement with the Medicaid Transformation Project (MTP).

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This transcript has been lightly edited for brevity and clarity.

HealthLeaders: What are the latest or most important developments regarding MTP and your efforts to positively impact healthcare?

Slavitt: COVID has made MTP less optional because we have such massive disparities that have come through. We have large numbers of communities at risk from infection and therefore, need alternative models of care, like being taken care of at home or through virtual models. The people who began the MTP process have an important leg up on how to deal with patients in these troubling times.

HL: Are there any specific goals or benchmarks that you're trying to reach with MTP?

Slavitt: Ultimately, this is a transformational project about reducing the disparities between people with lesser means in the communities having worse health outcomes. The early stage is about adopting these programs, and with more programs adopted, we'll learn which ones work and measure how well they work to reduce disparities.

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HL: If you were speaking directly to our audience of hospital and health system executives, what would you say about the upcoming election and the ongoing pandemic?

Slavitt: While the pandemic is a public health topic and not a political one, it's pretty clear at this point that President Trump is never going to deal with the pandemic successfully. He's known about it, he's refused to do it, and he's had every opportunity. That's becoming clear to most people. He's not fighting for the things that are most needed: contact tracing, enough testing, and mask wearing. 

The truth is that in Africa, where there are 1.3 billion people, there have only been 35,000 [COVID-19] deaths. This is not physically impossible; it's about leadership and focus. The good news is you have two candidates running for president, both of whom have had experience leading a pandemic: Trump with COVID-19 and Biden with Ebola. 

I think it's pretty easy to judge their records on that regard, that's the most important point relative to the election: how do you want this [pandemic] managed? 

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As it relates to other topics of the pandemic, there is important relief for states and hospitals in the House bill, but Republicans have been unwilling to do anything close to that. It's important because otherwise states are going to have significant budget shortfalls and that's going to mean significant Medicaid funding shortfalls, which will create significantly more pressure that will fall onto hospitals.

HL: Two-part question: If we had this conversation a year from now, assuming Trump wins or Biden wins, what does the healthcare industry look like in each scenario? What are the most impactful changes that you think would take place?

Slavitt: It's no secret that Trump is running as a divider; he's running to turn his base out against others while Biden is running as a unifier. Biden's vision, and he articulated it to the Trump supporter protesting him, is 'If I win, I will be your president, too.' That's Joe, that's who he is. I think he finds it much more important to heal the country and bring competence and compassion [back].

He will get things done that, but the things that he wants to [focus on] are the things that will bring the country back together, not radical departures. I think he will shore up confidence and faith in our institutions like the CDC and FDA, get more funding for states, hospitals, and people in need, and push to get paid medical leave passed.

He would pay for contract tracing resources, and I think will work to get Republican votes on everything he does. He also knows how to do vaccine distribution since he did it for H1N1.

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I think Trump would just as soon not focus on healthcare or the pandemic. His playbook on healthcare is to get through the election and then focus on taking away the ACA, cutting Medicaid, and looking at the Medicare trust shortfall and saying, 'Medicare is on fire and it needs to be reformed,' which will mean cutting benefits. Biden would not cut Medicare benefits.

HL: What are your thoughts on the potential impact of a protracted high unemployment rate on the nation's overall payer mix, and what should healthcare executives do to mitigate that damage?

Slavitt: It's time to support equal access to healthcare regardless of employment status. If we're dependent on people being employed to get coverage, then recessions are going to be hard on the healthcare industry.

We need to have modifiers or automatic stabilizers in Medicaid so that when we have recessions, funding increases. Otherwise, it's going to be challenging for rural hospitals, particularly for safety-net hospitals, too. 

There's plenty of evidence that Trump wants funding to go to pharmaceutical companies. There's no evidence that he wants funding to go to take care of some of these issues that are concerns of hospitals.