After a year marked by an extraordinary public health crisis, an economic recession, and heightened awareness of widespread social injustice, the new Congress and presidential administration face a lengthy list of complex challenges. In developing strategies to promote Americans’ health, safety, and overall well-being, new members of the 117th Congress must have access to the best information about what makes policies and practices most effective. Fortunately, policymakers recognized this need two years ago, when they passed the Foundations for Evidence-Based Policymaking Act—commonly known as the Evidence Act.
The Evidence Act paved the way for a broader national data strategy, requiring federal agencies to submit plans for coordinating evidence-building activities across government. The nation faces urgent challenges, and the Evidence Act can help ensure that evidence informs federal policy and program decisions, particularly in health, education, and human services.
As the incoming administration and Congress build their legislative agendas, policymakers across the federal government should consider the following recommendations:
- When considering changes to the Affordable Care Act (ACA), review and evaluate the research on improving care and reducing costs.
The ACA heightened the focus on primary care as a critical lever to improve health care delivery, lower costs, and advance the quality of care. Mathematica evaluated the primary care delivery system reform models developed and tested over the past decade by the Center for Medicare & Medicaid Innovation, an organization created under the ACA. As part of this effort, we assessed the potential benefit of continuing cost-saving measures like improved telehealth standards after COVID-19. We also examined how new requirements for price transparency might change the dynamics between health plans, employers, hospitals, other providers, and patients, and whether those changes could lead to lower health care costs.
Our 10-year evaluation of primary care reform concluded that streamlining processes and implementation improved care delivery but had little effect on quality outcomes. When Congress and the incoming administration consider expanding the ACA and health care policy in general, we urge them use the existing evidence to design meaningful legislation.
- Long-term care facilities need more evaluation and guidance from the federal government.
When the coronavirus was first detected in the United States, one of the earliest outbreaks was at a long-term care facility in King County, WA. As we know now, such facilities would become hot spots for spreading the virus. To better understand why the virus had such a severe impact on infections and deaths in those settings, Mathematica launched an in-depth study into COVID-19 spread and response at nursing homes and assisted-living facilities in Connecticut and nationwide. Our findings showed that certified nursing assistants were leaving at peak infection times because of low pay, lack of personal protective equipment (PPE), and overall poor working conditions, indicating that the United States needed a national staffing protocol and a national stockpile of PPE. Further, our research uncovered the need to monitor the mental health of individuals in long-term care. Extended isolation resulted in weight loss and a 15 percent increase in symptoms of depression among this population, highlighting the need for socialization through dedicated staff or family visitation. More data-driven recommendations are available in our Connecticut final report. Using existing evidence from organizations like Mathematica and recommendations from federal agencies like the Centers for Medicare & Medicaid Services, policymakers can help make an impact federally, statewide, and locally to protect the nation’s elderly population.
- Evidence-based reopening and education strategies are critical to preventing learning loss.
Congress and the incoming administration have an opportunity to guide and support schools, to help them educate students without imposing undue risks. COVID-19 elevated the need for evidence on reopening strategies and learning-loss prevention. Mathematica created an agent-based model to run more than 400,000 simulations that showed smaller class sizes with part-time attendance would enable schools to open without substantially increasing the risk of large-scale outbreaks; the model showed this reopening strategy would result in a similar spread rate to fully remote learning. In addition, a hybrid structure would provide an option for high-risk students and staff to remain at home.
Despite educators’ heroic efforts to teach students remotely, the perils of keeping schools closed have had consequences. Learning losses are only beginning to come into focus but are likely to be substantial. We already have evidence that school closures are exacerbating achievement gaps and inequities in schooling. Beyond academics, children’s mental health has also declined in the wake of pandemic closures. Mathematica’s evidence-based recommendations are a guide to preventing further learning loss and bringing students back into the classroom.
- Manage the substance abuse epidemic to better prepare for future public health crises.
The ongoing opioid epidemic has continuously worsened over the past decade. More than 76,000 people died of a drug overdose between April 2019 and April 2020, the most ever recorded in a 12-month period. Federal health officials say months of social isolation, high unemployment, and the diversion of resources to combat the virus have only amplified the drug crisis.
Our research recently unveiled the importance of effective partnerships with behavioral health organizations, sector and industry groups, and training providers to prevent, treat, and support recovery from opioid use disorder. More can be done to research and effectively implement processes and partnerships to decrease the opioid epidemic. In addition, early detection of community drug use can help uncover where to direct intervention strategies. Through our analysis of wastewater and sewage testing, Mathematica helped Montana State University assess rural areas impacted by opioids and methamphetamines. Wastewater testing is a cost-effective and accurate tool to help policymakers use their allocated funds in areas of need.
- When legislating and funding climate change policy, leverage the data and resources already exist.
Climate change is a defining policy challenge of the 21st century. The need for innovative, sustainable solutions that help meet ambitious targets to reduce emissions and make vulnerable communities more resilient is more significant than ever. Mathematica’s research dives into effectively improving financing for climate change endeavors, which could help during a busy appropriations season. We also prioritize existing tools and methods to shape how we approach climate change policy from behavioral and equity perspectives.
As policymakers craft legislation to address the range of current and emerging challenges in 2021, it helps to have a guide who knows data and evidence will lead to the most effective solutions. From using evidence to solidify congressional policy endeavors, to rethinking how to implement health care policy, Mathematica is ready to be that guide.