Hard to believe it's only 46 days until the 2020 U.S. Presidential election.

So it's time to offer are some thoughts on which candidate's healthcare proposals and Covid-19 responses moving forward will stimulate new and/or renovation healthcare facility design and construction projects.

After reviewing an excellent slideshow by the Kaiser Family Foundation on where the candidates stand on healthcare, there are several policy changes in Donald Trump's record and proposals by Joe Biden that have the potential to impact healthcare facility design and construction projects.

Joe Biden's Proposals

• Retain and strengthen Affordable Care Act (ACA) and create a new public option, and increase the number of people eligible for subsidies and enhance subsidies
• Enhance funding for long-term care and improve nursing home staffing and quality standards
• Expand federal Covid-19 emergency relief; put federal government in charge of the Covid-19 response
• Expand funding for mental health

What this means for healthcare facility design and construction:  Keeping the good parts of the ACA and increasing the number of insured people means providers will keep focusing on expanding outpatient care in their communities. Improving nursing home quality standards bodes well for design, if providers recognize the relationship between design and outcomes.

Putting the federal government in charge of Covid-19 response could have many implications for design, especially if funding or incentives are provided for facility improvements to enhance safety or expand telehealth services. More funding for mental health may lead to construction of new facilities.

Donald Trump's Record

• Supports repealing and replacing ACA, which would reduce coverage for mental health services and limit funding for long-term care
• Delegated primary responsibility for Covid-19 to states
• Proposed changes to nursing home regulations for quality assurance and performance improvement programs
• Supports expansion of VA mental health services

What this means for healthcare facility design and construction: The threatened demise of the ACA hasn't happened yet, but if it does, it may not change the focus on outpatient care facilities. But reduced coverage for mental health and limited long-term care funding could impact the design and construction facilities that serve those patient populations.

Also, if the ACA is repealed and replaced, it will create renewed chaos and uncertainty in the healthcare industry, which could affect spending on capital projects.

Keeping responsibility for Covid-19 with the states would reduce the change of any federal funding for facility improvements to enhance safety or expand telehealth services. Changing nursing home regulations could be positive for facility design -- again only if providers recognize the relationship between design and outcomes.

Expanding VA mental health services might result in new or renovation projects.

Response to Covid-19 Moving Forward

Another key healthcare issue in the 2020 election is how each candidate plans to respond to Covid-19. According to a survey of registered voters by the Pew Research Center, it's the fourth most important issue behind Supreme Court appointments, healthcare, and the economy.

Here's what Biden pledges to do:

• Restore trust, credibility, and common purpose
• Mount an effective national emergency response that saves lives, protects frontline workers, and minimizes the spread of COVID-19
• Eliminate cost barriers for prevention of and care for COVID-19
• Pursue decisive economic measures to help hard-hit workers, families, and small businesses and to stabilize the American economy
• Rally the world to confront this crisis while laying the foundation for the future

Here's what Trump pledges to do:

• Develop a vaccine by the end of 2020
• Return to normal in 2021
• Make all critical medicines and supplies for healthcare workers in the United States
• Refill stockpiles and prepare for future pandemics

Without the details of how each candidate proposes to do all this stuff, it's hard to say what the impact will be on healthcare facility design and construction. But a national emergency response will surely affect how healthcare providers plan for surge capacity and enhance safety.

Want To Know More?

Check out these articles:

• Healthcare and the 2020 Presidential Election. Kaiser Family Foundation, September 15, 2020.
• Understanding the U.S. Failure on Coronavirus — An Essay by Drew Altman. The BMJ, September 14, 2020.
• Comparing Trump and Biden on Covid-19. Kaiser Family Foundation, September 11, 2020.
• Important Issues in the 2020 Election. Pew Research Center, August 13, 2020.

Please Vote

Finally, a personal request. This election is probably more significant than any other in our country's history. We need strong, honest, selfless leadership to get us through this difficult time.

So, if you're an American citizen and are eligible to vote (in-person or by mail), please do so!

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