2020: Finding inspiration in hindsight

The morning after the first coronavirus case was confirmed in Arkansas in March, I took to social media, as many did, writing: “For America to withstand the threat from COVID-19, we must place the interests of the community above our own individual self-interest to protect the public health. It is time that we rediscover (or discover for the first time) our neighbors both locally and globally and how connected we remain.”

Few, if any, would have guessed the pandemic would extend into 2021. We were hopeful that Americans would commit to personal sacrifice, and that clear messaging and decisive leadership could inspire collective action to prevent viral spread.

We’ve all had enough sugar over the holidays, so I won’t sugarcoat this: In the face of a once-in-a-lifetime public health emergency, we were gut-punched by leadership disorder of cosmic proportions, widespread disregard of science, and flouting of the most basic and merely inconvenient safety precautions by people in our own communities. As with any crisis, though, there were and will continue to be moments of extraordinary humanity, grace, and perseverance — teachers simultaneously instructing students remotely and in person, singers raising their voices online through virtual choirs, and families holding socially distant gatherings on the front lawn.

As we continue to endure the worst infectious disease outbreak of our time, I suspect that we all are reflecting on the past year of our lives with a bit more scrutiny than in previous years. The year 2020 brought many hardships and scores of lives lost due to COVID-19. It resulted in mere disruption for the privileged few, but for the vulnerable and historically marginalized, it meant devastation. This is why in 2021 we must recommit (or commit for the first time) to ensuring that our healthcare system is sufficient and responsive to those most in need and that all Arkansans have a fair and just opportunity to be as healthy as possible. Here are several things that our state can do to advance those efforts as we enter a new year.

Out of necessity, the public health crisis has ignited rapid implementation of virtual healthcare. How rapid, you ask? Monthly expenditures for virtual care within the Arkansas state and public school employees plan increased by nearly 400% — from about $350,000 to more than $1.7 million — from March to April of this year. If virtual health is to become a more natural and integral part of care delivery as we transition out of the public health emergency, policymakers will need to reexamine the types of procedures that can be safely and effectively delivered and the associated reimbursement for such virtual services compared to in-person procedures. Policymakers must also ensure that access to technology for care delivery is not limited due to poverty, historic under-resourcing of health systems and broadband in rural areas, cultural barriers, and other factors that could compound health inequities.

The state’s Medicaid program, including Arkansas Works, has performed in 2020 as designed: as a safety-net healthcare coverage program catching thousands of Arkansans impacted by income and healthcare coverage loss due to COVID-19. Arkansas Works now covers approximately 300,000 adult Arkansans, a tenth of the state’s total population. The program is set to terminate at the end of 2021 unless it is reauthorized by the Arkansas General Assembly during the legislative session beginning Jan. 11. Reauthorization of Arkansas Works is critical as the state continues to battle the pandemic and seeks to ensure that access to healthcare providers remains available and affordable in rural areas.

The year-end federal budget and pandemic relief deal included a welcome surprise — the restoration of access to Medicaid benefits for Marshall Islanders, including the more than 10,000 who reside in Arkansas. The legislation represents the long-overdue reinstatement of a promise by the federal government, after having excluded Marshall Islanders from Medicaid for more than two decades. With coverage now available, it will be incumbent upon the state to ensure culturally sensitive outreach and education in order to optimize Medicaid enrollment among the Marshallese.

While we are reflecting, let’s extend our gratitude to the dedicated, resilient, and innovative front-line healthcare workers who have shepherded us through this crisis. America’s healthcare system has its problems, but the courage and compassion of its workers is not one of them. Mere gratitude, however, is not enough. In 2021, let’s commit to healthcare workforce policies that acknowledge the humanity of clinicians, make them safer, protect them from burnout, and ensure that their successors in the pipeline keep us as inspired as they did in 2020.

Editor’s note: Craig Wilson, JD, MPA, is the director of health policy for the Arkansas Center for Health Improvement, an independent, nonpartisan health policy center in Little Rock. The opinions expressed are those of the author.