Looking Past the Election: What to Expect in 2021

October 30, 2020

In a pre-election webinar, public health experts from Columbia University Mailman School of Public Health explored the potential implications of Tuesday’s outcome, starting with how the federal government will respond to a pandemic that continues to infect record numbers of Americans. (Watch the video below.)

Terry McGovern, chair of Population and Family Health, Michael Sparer, chair of Health Policy and Management, and Monette Zard, director of the Program on Forced Migration and Health, reviewed Trump Administration policies on reproductive health, immigration, environmental policy, health insurance access, and more. Across the board, they said Trump policies have been harmful—most glaringly with COVID-19. “It’s clear that the current administration has done an extraordinarily poor job,” said Sparer about the federal pandemic response. If elected, Joe Biden would take a very different approach.

Sparer explained that a Democrat in the White House would use federal authority to orchestrate a national pandemic response, from testing and vaccine distribution to, potentially, a mask mandate (although the constitutionality of the latter is uncertain). A Biden Administration could improve access to health insurance, beginning with those who lost coverage during the pandemic and create a public health job corps to help with contact tracing and public education. They would also reestablish ties with the World Health Organization and coordinate with the world community. “Big picture, there would be an effort to say, ‘we can’t do this alone here in the United States.’ We are part of a global response to a global pandemic,” Sparer said.

Zard said the next president could begin by rescinding a March 20 order from the Centers for Disease Control and Prevention that denies people refugee and torture protection on the pretext of preventing the spread of the pandemic. The asylum process doesn’t have to be on hold; there are evidence-based ways to ensure it can continue with relative safety, as other countries are doing. Moreover, a Biden Administration could use the pandemic as an opportunity to look at alternatives to detention for migrants and advance comprehensive immigration reform. “It’s been absolutely clear that immigrant communities have been at the forefront of essential workforces, whether in agriculture or the medical professions and everything in between,” she said.

According to McGovern, the Biden Administration could also immediately undo the Global Gag Rule, which was expanded under Trump to deny billions in funding to NGOs that provide abortion counseling or advocate for abortion services, even if family planning isn’t a core part of their mission. Impacted areas have included nutrition, sanitation, gender-based violence, and infectious disease response, she said. (Read McGovern’s CNN op-ed on the Global Gag Rule.) On the domestic front, she said a new administration could pass federal laws to make it harder for states to restrict the right to abortion.

Not Like Flipping a Switch

All three speakers cautioned that Americans shouldn’t expect everything to change overnight with a Democrat in the highest office, even if the party also controls both houses of Congress. Over the past four years, the Trump Administration has made more than 200 lifetime federal judicial appointments, including three Supreme Court justices, and implemented hundreds of policy changes, many difficult to reverse.

While the Muslim ban and family separation made headlines, the Trump Administration carried out large parts of its immigration policy under the radar, implementing more than 400 separate actions, adding to restrictions put in place under previous administrations. Many of the new rules have overlapping policy objectives—a deliberate strategy according to Zard. If one rule is struck down—for instance, directing asylum-seekers to remain in Mexico—its twin would uphold the policy. “Undoing what has been done is going to be a Herculean task,” she said.

On environmental policy, the Biden Administration could rejoin the Paris Climate Agreement, but undoing scores of policies that eased pollution regulations would be delayed by public comment periods and litigation. “It’s like taking a jigsaw puzzle and throwing the pieces around,” said Sparer. “It’s not going to be easy to put every piece back in place.” A new administration also might not be as forceful in its environmental policy as many would like. As one example, Biden says he is not against hydrofracking despite ample evidence of its health risks, although his administration would likely do more to regulate the industry.

As much as Trump and Biden differ on policy, perhaps their most stark difference is tone. If elected, Biden would mark a total departure from Trump’s divisive and racist rhetoric and “America first” ideology, hopefully helping to reverse a global trend toward nationalism. Restoring the country’s standing will take time, however, since the United States has isolated itself and lost so much credibility, especially as the pandemic has laid bare its vulnerabilities. Yet, no matter what happens at the polls, public health will play a key role to “build back better” in months and years ahead.

“Those of us who have not fallen prey to politicization and are science-based have a really important job to do to fix a broken system,” said McGovern. “I don’t think there’s a better sector to be in, in terms of fixing this country.”

Watch the video: