Responding to Fundamental Challenges Exposed and Exacerbated by COVID-19

I write this message as we enter the third year of the COVID-19 pandemic. In 2020, we were battered by the devastation wrought by this new disease—not only the number of deaths in that first year, but how it completely upended all our lives. Entire cities closed, we plunged into an economic recession, and a virus we knew very little about fueled our fear and anxiety. We got through that first year, and 2021 brought lots of hope: effective vaccines became broadly available, and treatments improved. Many schools and businesses opened, unemployment fell, and for many of us—if only for brief periods—it felt that COVID-19 didn’t completely control our lives. But then we were hit with the Delta variant over the summer, and the death toll continued to climb; this, of course, was followed by the much more contagious Omicron variant as we approached the end of 2021. 

The future of the COVID-19 pandemic is unclear. A likely scenario is that rather than being eradicated, COVID-19 will become endemic in the U.S.—another respiratory virus that circulates across the country every year. However, even as the acute crisis resolves, the fundamental challenges that COVID-19 exposed and exacerbated within the health care system over the past two years will not go away. These include the three core areas that United Hospital Fund has continued to address throughout the pandemic: health insurance coverage and access to care; improving the quality of care; and addressing health disparities through clinical-community partnerships. 

In the United States, most working families obtain their health insurance through their employer. This means when jobs are lost, families lose their health insurance. The existence of a robust health insurance safety net is therefore critically important. In New York State, our Medicaid program is the linchpin of that safety net system. Indeed, in response to the economic shock of the pandemic, the Medicaid program has grown by over 1 million beneficiaries in New York State, and now covers over 7 million people—over one-third of the population. This is why UHF’s work as a trusted partner with the state to strengthen the Medicaid program is so important. It includes conducting independent research and analysis, providing technical assistance to develop new programs, and hosting both small workgroups and large conferences to bring together stakeholders and spread innovations within the program. 

I am deeply proud of the health care workers and institutions here in New York State, and UHF was privileged to be able to recognize the million-plus health care heroes at our annual Gala last October. Day in and day out, they give it their all, yet they also recognize the imperative to relentlessly pursue improvements in the quality of health care delivery. At UHF, we support these efforts on three fronts: training the next generation of quality improvement leaders in New York through our Clinical Quality Fellowship Program; convening the Quality Leaders Forum to strengthen quality improvement networks across institutions; and working directly with providers where most needed, such as in our nursing home learning collaborative.

Beyond highlighting issues of health care coverage and quality, the pandemic exacerbated the long-standing and wide disparities in health care and health outcomes by race. And the social justice movement reminded us to pay attention not only to the proximate causes, such as poverty, housing instability, and food insecurity, but also the deeper roots in structural racism. Health disparities cannot be solved by the health care delivery system alone, making our work in clinical-community partnerships ever more important. I am particularly proud of our statewide Pediatrics for an Equitable Developmental Start (PEDS) Learning Network, which aims to reduce inequities in childhood by working with pediatric practices across the state. The clinicians that participated with us play a key role in advancing health equity by actively working to reduce the impacts of systemic discrimination, addressing parental stress, and providing interventions that promote optimal child development for lifelong health and well-being. And our continued partnership with Boston Consulting Group is highlighting the importance of food in our overall health and well-being.

Of course, as we work toward an equitable health care system in New York, it is also critically important that we look inward to create a more diverse, equitable, and inclusive culture at UHF itself. Our Diversity, Equity, and Inclusion (DEI) efforts started in 2019, but the pandemic and social justice movement have accelerated our work. It has been both difficult and rewarding, cutting across our entire organization, from staff to the board. Although we have made significant progress, I also recognize that there is much more that we can do.

During another challenging year, we have once again been resilient. I’m proud of our team at UHF and their enduring commitment to our mission. Thank you to all our friends and partners, and I look forward to continuing working together on our shared goal of building an effective and equitable health care system for all New Yorkers.

This commentary appears in UHF's 2021 Annual Report.