And yet the dawn is ours
before we knew it
Somehow we do it
Somehow we’ve weathered and witnessed
a nation that isn’t broken
but simply unfinished

(Amanda Gorman, National Youth Poet Laureate)

For the last four years, America has been running a high fever — a response to prejudice and gross negligence at the highest levels of government. Now it feels like the fever has broken, and I am finally allowing myself to indulge in cautious hope.

Our nation has endured traumatic depredations — the unfathomable celebration of hatred, open attacks on truth and democracy, and the shocking lack of interest in safeguarding the public’s health. It will take time for these traumas to heal, and they certainly will leave scars.

And yet, there are many reasons to be optimistic. Here are the ones that give me the most hope at this moment.

The Restoration of Competency and Sound Science

The virus that causes COVID-19 has many remarkable characteristics, and none more impressive than the ability to spread fast. Leave the door open, and it will walk through every time. The logistics of our nation’s response to this have to be airtight. Policy decisions must be based on the best available science. I have great confidence in the new task force that has taken charge of the federal COVID-19 response. They are rigorous and experienced, and they have been empowered. I am especially encouraged by the new team’s focus on culturally competent care and outreach. They see central roles for community health centers and community health workers in critically important initiatives to provide testing, vaccinations, and contact tracing.

The Renewed Commitment to Count Every Person

The US Census has always been an essential feature of the nation’s operating system. Our founders intended to distribute power and resources based on an accurate count of every resident. From the outset, the previous administration made no secret of its intent to sabotage the 2020 Census to undercount Latinx immigrants. In 2018, the US Supreme Court blocked the Census Bureau from asking about citizenship in its questionnaire. Political appointees at the bureau had sought to tally the number of undocumented immigrants and subtract them from the final census count, thereby reducing the numbers of congressional seats and Electoral College votes in diverse states like California. Their ineptitude in changing that protocol and a last-minute court ruling prevented the agency from implementing that policy. Now the new administration has the power to shut down that effort and preserve the integrity of the census.

An Opportunity to Build on the ACA’s Historic Success

As vice president, Joe Biden was in the picture in 2010 when President Barack Obama signed into law the Affordable Care Act (ACA). Now in charge, President Biden has signaled his intention to strengthen the law. He is committed to reversing the previous administration’s policies aimed at sabotaging the ACA, including the Medicaid expansion. In his first executive orders, he has begun making good on his promise. Biden reopened enrollment on healthcare.gov, the federal health insurance marketplace that serves 36 states, from February 15 to May 15. Covered California, our state-run marketplace, promptly followed suit.* Biden has also voiced strong support for fully funding ACA enrollment outreach and expanding coverage subsidies for Americans with low and middle incomes. And the new president has expressed a desire to work with states to innovate in ways that would further expand coverage and improve the delivery of care. The ACA is the most important and far-reaching US health care policy in a half-century. Now it has a strong chance of becoming even more effective. That’s a big deal.

The Unequivocal Commitment to Equity

The unequal burden of suffering during COVID-19 and the shocking racial injustice bared by the brazen murder of George Floyd have galvanized a new generation of Americans to confront structural racism head-on. The new administration has begun to act with appropriate urgency on the issue. On his first day in office, President Biden signed an executive order to “advanc[e] equity for all, including people of color and others who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality.” He directed agencies to review key programs and resource allocations to determine “whether underserved communities and their members face systemic barriers in accessing benefits and opportunities available pursuant to those policies and programs.” He gave agencies one year to produce plans to remove those barriers and instructed them to prioritize equity when formulating their budgets. Recognizing the importance of being able to measure and track whether these policies are working, President Biden established the Interagency Working Group on Equitable Data. On day two of his administration, President Biden created a COVID-19 Health Equity Task Force to reduce racial and ethnic disparities in pandemic care and outcomes, and on February 10 he named its members. Together these actions will harness federal power to create a more just nation.

To be sure, the road ahead is an uphill climb. Recovering from the woeful last chapter of our nation’s history will take a long time, and we won’t get there without hope. From that perspective, we are off to a strong start.

* I serve on Covered California’s board of directors.

Sandra R. Hernández

Sandra R. Hernández, MD, is president and CEO of the California Health Care Foundation. Prior to joining CHCF, Sandra was CEO of The San Francisco Foundation. She previously served as director of public health for the City and County of San Francisco. Read More

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