President Joe Biden's farewell address at the Democratic National Convention this week got me thinking about the impact his policies have had on U.S. healthcare facility planning, design, and construction. Here are a few that I think are the most important.
How and Where People Receive Healthcare
Policies that affect how and where people receive healthcare impact the number, size, and location of new or renovated healthcare facilities. And even the design, if you consider things like access to care, equity, and inclusion.
American Rescue Plan Act (ARPA): One of the most significant moves under Biden's administration was the passage of the ARPA March 2021. This legislation included substantial provisions to make health insurance more affordable, especially through the Affordable Care Act (ACA) marketplaces.
It increased subsidies for people buying their own insurance, which made coverage more affordable for millions of Americans. The ARPA also expanded Medicaid coverage in states that chose to participate, allowing more low-income individuals to receive healthcare.
Public Health Infrastructure: The Biden administration has also invested heavily in public health infrastructure. This includes funding to enhance the capacity of healthcare systems to respond to emergencies like the COVID-19 pandemic. The administration supported expanding community health centers, which are crucial for providing healthcare in underserved areas.
Telehealth Expansion: The Biden administration has supported the continued expansion of telehealth services, which increased during the pandemic. This expansion was partly supported by regulatory changes and funding to make telehealth more accessible, especially for Medicare and Medicaid beneficiaries.
Incentives for Energy Efficiency and Sustainability
Inflation Reduction Act (IRA): Passed in August 2022, the IRA provides significant financial incentives for hospitals and health systems to incorporate energy-efficient designs and renewable energy systems in their facilities. This has encouraged increased adoption of sustainable building practices, such as using energy-efficient HVAC systems, solar panels, and advanced insulation materials in new and renovated healthcare facilities.
It also includes funding specifically for building material transparency and labeling to support the specification of low-carbon options. While the Act’s immediate impact will be felt most quickly within the federal government, my bet is that other public and private projects will also prioritize carbon in future specifications.
Health Sector Climate Pledge: U.S. Department of Health and Human Services in partnership with the Biden Administration launched this initiative on Earth Day in 2022, asking hospitals, health systems, and other industry stakeholders to take a voluntary pledge to reduce carbon emissions by half by 2030 and reach zero emissions by 2050.
As of April 2024, a group of 139 organizations representing 943 hospitals have signed the pledge. In addition to hospitals, these stakeholders include health centers, suppliers, insurance companies, group purchasing organizations, pharmaceutical companies, and more. More info on the pledge>>>
Funding for Modernization and Infrastructure
American Rescue Plan Act (ARPA): In addition to expanding coverage, this ARPA has funds for upgrading healthcare infrastructure, particularly in response to the COVID-19 pandemic. This includes improving HVAC systems for better air quality, enhancing infection control measures, and making buildings more resilient to future health crises.
Bipartisan Infrastructure Law: Also provides funding that hospitals and health systems can use to modernize their facilities and become more sustainable. It supports the integration of new technologies that improve energy efficiency and resilience to climate-related impacts.
Biden’s administration has also directed resources to improve healthcare infrastructure in rural and underserved areas. The policies encourage the construction of healthcare facilities that are not only sustainable but also accessible and resilient, ensuring that these communities have reliable access to healthcare.
One More Thing
The Biden administration has continued to support the shift from fee-for-service to value-based care, where Medicare reimbursements are tied to the quality of care provided rather than the volume of services. This is why patient safety and quality, as well as patient satisfaction are still two of the top issues confronting U.S. hospital CEOs.
And the design of the physical environment affects both those issues.
I'm assuming that most of these policies will remain in place if Kamala Harris is elected president in November, and likely some of them expanded to promote sustainability, resiliency, and equity. If Donald Trump takes office, based on his previous administration’s approach to healthcare, infrastructure, and regulatory policies, his administration could potentially affect healthcare facility planning, design, and construction in several ways. I'll break this down more in another post as it gets closer to the election.
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