In on Nov. 2, 2020, then-presidential candidate Joe Biden promised, “I’ll not only restore Obamacare; I’ll build on it.”

Two years and counting since then, how is he doing in meeting that promise?

KHN has teamed up with to monitor — including this one — made by Biden during the 2020 presidential campaign. The pledges touch on issues related to improving the economy, responding to calls for racial justice, and combating climate change. On health care, they range from getting covid-19 under control and improving veterans’ health care to codifying Roe v. Wade. KHN has recently done progress checks on the administration’s pledges to and to .

Eight days into his tenure as president, Biden signed an aimed at strengthening Medicaid and the Affordable Care Act, or Obamacare. A couple of months later, he signed his first major piece of legislation, the American Rescue Plan, which included provisions expanding eligibility for subsidies and increasing premium tax credits available to help low- and moderate-income Americans purchase ACA coverage.

That legislation also offered financial incentives to encourage the 12 states that had declined to expand Medicaid eligibility to do so.

The consumer subsidies were originally set to expire this year but were extended by the Inflation Reduction Act, which Biden signed into law Aug. 16, after much debate and without any Republican votes. The expanded eligibility for subsidies was also continued by this measure.

In October, the Biden administration addressed another issue in the ACA, the so-called , which prevented some people with job-based insurance from qualifying for subsidies.

Those items alone prompt “an unequivocal yes,” to the question of whether Biden has met his campaign promise, said , co-director of the Center on Health Insurance Reforms at Georgetown University., a senior fellow at the American Enterprise Institute think tank, offered a different perspective — that the actions taken on the glitch can’t count toward Biden’s promise to “restore” the ACA. Antos said that’s because it wasn’t a glitch at all, but rather an intentional element of the original ACA put there to save the government money, and help win its passage in Congress.

“Biden was vice president when the bill was signed into law, and he supposedly supported it,” Antos said.

Corlette touted other Biden administration changes, including increased funding for consumer assistance programs that help people sign up for ACA coverage and streamlined some of the paperwork required for enrollment.

The White House of other actions taken as a result of the executive order, including extending the annual open enrollment period to bring in more policyholders, and allowing low-income Americans to sign up anytime.

Last year, a record Americans selected an ACA plan. This year’s sign-up period ended Jan. 15 in most states and, based on preliminary numbers, will continue the upward trend.

The boost in enrollment is due, in part, to the enhanced subsidies, which lowered premiums to $10 or less a month for some low-income consumers, and eliminated a cutoff threshold, allowing some higher-income families to qualify for at least some subsidy, said Corlette.

Antos agreed that the administration has made changes that “clearly built on Obamacare and expanded spending and probably did cover more people.”

What happened with the financial incentives meant to get states to expand their Medicaid programs to include more low-income adults, particularly those at or below the poverty level who have no children? Those incentives are still there for the taking, but, so far, no states have done so.

South Dakota expanded after the rescue plan’s passage, but that was because voters approved a ballot measure, not because of the financial incentives.

“That was part of Biden’s goal, to close the coverage gap,” said , executive director of the Center for Children and Families at Georgetown. “We still have 11 states resisting Medicaid expansion, and that leaves a big, gaping hole in coverage in those states. But that’s not for lack of trying by the Biden administration.”

Because enrollment is up, subsidies are more available, more people are helping consumers enroll, and there are additional enticements to get states to expand Medicaid, we rate this as a Promise Kept.

Our sources:

Telephone interview with , co-director of the Center on Health Insurance Reforms at Georgetown University, Dec. 20, 2022

Telephone interview with , senior fellow at the American Enterprise Institute, Jan. 5, 2023

Telephone interview with , executive director of the Center for Children and Families at Georgetown University, Jan. 10, 2023

Archive Today, Pittsburgh, Nov. 2, 2022

KHN, “Inflation Reduction Act Contains Important Cost-Saving Changes for Many Patients — Maybe for You,” Aug. 12, 2022

White House, , April 5, 2022

Â鶹ŮÓÅ, “,” accessed Jan. 5, 2023

Â鶹ŮÓÅ, “,” Aug. 11, 2022

Â鶹ŮÓÅ, “,” Nov. 21, 2022

NPR, “,” Oct. 31, 2022

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President Joe Biden caused a stir in a Ìýon Sept. 18 when he declared that the covid-19 pandemic is over.

“We still have a problem with covid — we’re still doing a lot of work on it,” Biden said. “But the pandemic is over.”

Ìýthat the U.S. is still averaging about 400 deaths daily from the virus, that nearly 30,000 Americans remain hospitalized, and that many others areÌýÌýsymptoms stemming from previous infections.

Two days later, Ìýthat despite the negative reactions by some, the pandemic “basically is not where it was.” White House press secretary Karine Jean-PierreÌý “a lot more manageable.” Past experience means “we know what works,” she said.

PolitiFact has been tracking a campaign promise Biden made in 2020 that is closely related, but distinct, from what Biden told “60 Minutes.” During the presidential campaign, Biden said,Ìý“I’m never going to raise the white flag and surrender. We’re going to beat this virus. We’re going to get it under control, I promise you. “

Biden is on safer linguistic ground with his promise to get covid “under control” than saying “the pandemic is over.”Ìý

There remains some debate among public health experts about whether the pandemic is “over” — or whether it realistically can ever be. There isÌýÌýfor making that decision, and the word “over” suggests a finality that is not well suited for describing a pathogen that will exist in some form indefinitely.

However, we found broad agreement among infectious-disease specialists that the pandemic by now is “under control.”

When Biden was inaugurated, physical distancing was widely enforced, schools were often virtual, public events were rare or tightly controlled, and few Americans had yet received a vaccine. Today, life for many Americans is much closer to the pre-pandemic norm, with virtually all schools open, concerts and restaurants well attended, and travel back to its typical level.

“The nation clearly has made tremendous progress on covid-19 since President Biden’s election,” said Jen Kates, senior vice president and director of global health and HIV policy at Â鶹ŮÓÅ. “I would probably say that we are in a pandemic ‘transition’ phase — that is, moving from the pandemic into a post-pandemic period. But this is a continuum, not a cliff, where it’s a pandemic one day and over the next,” Kates added.

Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, added that the promise to get the pandemic under control “is certainly well on course, or perhaps even met, as far as what the federal government can provide to accomplish that.”Ìý

And Dr. William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University, agreed that the “emergent phase of the pandemic is coming to a close. We’re now moving into the ongoing struggle — call it a truce with the virus.”

Medical experts said pandemics inevitably become “endemic,” meaning that the pathogen is here to stay but does not present a widespread emergency.Ìý

“We will always have to manage covid in the medical system,” said Dr. Monica Gandhi, a professor of medicine at the University of California-San Francisco. “Unfortunately, although we can bring down deaths to very low, I don’t think we will ever get to zero deaths from covid-19.”

The level of U.S. deaths from covid is lower today than it has been during most of the pandemic, and it has been that way since the spring.

Notably, the number of “excess deaths” is also down. That’s a metric that gauges how many more deaths are occurring beyond the long-term average for that time of year. The number of excess deaths nationally per week has been consistently between zero and 5,000 since the spring, after peaking at 20,000 to 25,000 per week during four previous surges since the pandemic began.

Hospitalization Ìýrecently at some of the lowest rates of the pandemic. And even this level may overstate the virus’s impact; routine testing upon admission often detects cases that are asymptomatic and largely coincidental to the reason a patient is admitted.Ìý

Gandhi pointed to data from Massachusetts hospitalsÌýÌýmost hospitalized patients who test positive for covid have only “incidental infections,” with only 1 in 3 being treated primarily for a covid-related illness.

Experts noted that hospitalizations and deaths, even at these reduced levels, remain too high,Ìýand they cautioned that infections could increase as winter forces people indoors. Still, they credit the availability of vaccines and therapeutics, as well as the knowledge gained from living with the virus for more than two years, for the likelihood that the darkest days of the pandemic are behind us.

“I am not worried at all that we will go back to the scale of hospitalizations and deaths of the worst days of the pandemic,” said Brooke Nichols, an infectious-disease mathematical modeler and health economist at the Boston University School of Public Health. “We will likely enter into a seasonal covid vaccine situation, potentially combined alongside the flu into the same vaccine, and these seasonal vaccines will become critical to avoiding hospitalizations and deaths during the flu and covid seasons.”

There has been no major new variant since omicron emerged in late 2021, and even the most recent omicron subvariant to emerge, BA.5, has had aÌýÌýas the dominant strain in the U.S., prevailing since early July.Ìý

This doesn’t mean that a more dangerous new strain couldn’t emerge. However, public health experts take comfort from recent patterns. The trend during most of 2022 suggests that a rapid succession of ever-more-confounding — and vaccine-evading — variants is not inevitable. If a major new variant does emerge, mRNA vaccines like those made by Moderna and Pfizer-BioNTech can beÌýÌýÌýfor it.

Vaccination uptake, though, remains an urgent question. About one-third of Americans are not fully vaccinated, and an even smaller percentage have received boosters. Plescia said “the main deciding factor right now is not going to be the president or the response of the federal government — it’s going to be the response of the public.”Ìý

“I think there’s disease fatigue and vaccine fatigue and wearing-a-mask fatigue,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “People are just tired of covid and trying to wish it away, and it’s unfortunate because it’s not gone. We’re tired of it, but it’s not tired of us yet.”

Some experts caution that a pandemic “under control” doesn’t mean the costs will be minimal.Ìý

“The degree of protection afforded by the current vaccines available, especially to the most vulnerable, is of limited duration, and nonfatal outcomes from covid can still have knock-on consequences to the population health,” said Babak Javid, an associate professor in the division of experimental medicine at UCSF.

These consequences are called “long covid,” and nearly 1 in 5 Americans who have had covid are suffering from it. TheÌýÌýlong covid as symptoms lasting three or more months after contracting the virus that weren’t experienced before.

“Under control” suggests progress on keeping further spread within modest limits. It does not mean that people haven’t lost loved ones or felt continuing effects from the virus; clearly, they have.

What Does Biden Still Need to Do?

Biden and his administration still have work to do, experts said.

Several public health experts urged Congress to pass Biden’sÌýÌýin covid-related funds. The White House has framed this funding as a way to be ready for a resurgence even though case levels are low now. It proposes that the funding support testing, research on new vaccines and therapeutics, preparations for future variants, and global assistance. Biden’s open declaration that the pandemic is “over” could make congressional approval less likely, however.Ìý

Gandhi said the federal government should do a better job targeting boosters and therapeutics at populations most at risk of severe breakthrough infections, notably older Americans and people who are immunocompromised.

And Schaffner urged more effective and unified messaging, with efforts to remove any hints of politics. “I wish the federal government would get together on who the main messenger is, and provide sustained, clear, simple messages,” he said.

Biden may not have used the most appropriate word when he described the pandemic as “over,” but the long-term statistical trends have been trending in the right direction, and the vaccines and treatments should dampen the severity of future waves. For these reasons, experts say it’s fair to declare that the pandemic is “under control.” If circumstances change, we will reassess our rating, but for now, this receives a Promise Kept.

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On the campaign trail last year, Joe Biden promised that, if elected president, he would get covid-19 under control. Since assuming office in January, Biden has continued to pledge that his administration would do its best to get Americans vaccinated against covid and allow life to return to some semblance of normal.

Both signs of progress and setbacks have cropped up along the way.

Initially, as covid vaccines became available early this year, demand exceeded supply, frustrating many. Eventually, all those who wanted to were able to become fully vaccinated.

In May and June, new covid cases, hospitalizations and deaths dramatically fell, prompting the Biden administration to ease mask requirements and guidance for fully vaccinated people. But many states and localities responded by dropping mask mandates altogether, even for people who were not inoculated.

The summer also ushered in the highly contagious delta variant, causing another pandemic wave. By Labor Day, were at their highest point since last winter..

On Sept. 9, to combat the delta variant and step up efforts to get control of covid. The plan includes vaccine mandates for federal workers, government contractors and those working at private companies with 100 or more employees; requirements that employers offer paid time off for those getting a shot; increased distribution and lower costs for covid tests, including rapid at-home tests; and stronger covid safety protocols in schools and on interstate transportation.

The vaccine mandate for private employers includes an option for workers to be tested weekly instead of getting the shot. Federal workers won’t have that option.

KHN teamed up with our partners at to analyze Biden’s promises during the 2020 presidential campaign. We asked the experts for their take on whether this list of action items will help make — to beat the virus — a reality.

Limitations and Benefits of Biden’s Plan

While the plan is a “big step in the right direction,” according to , a visiting professor of health policy and management at George Washington University, it should have been released two months ago. That would have slowed the delta variant from gaining such a strong foothold in the U.S.

“Had they acted much earlier, we would be in a different position,” she said.

And the current plan doesn’t go far enough, said Wen, who urged the Biden administration to give companies and jurisdictions incentives to require proof of vaccination for entry into restaurants and other businesses, as New York City and San Francisco did.

“That would send the message of ‘You don’t get to enjoy the privileges of pre-pandemic life unless you’re vaccinated,’” said Wen. “Right now, the vaccinated are being held hostage by the unvaccinated. The vaccinated are having breakthrough infections and the unvaccinated are endangering those who cannot get vaccinated, like kids.”

, chief medical officer at the Association of State and Territorial Health Officials, is optimistic that Biden’s plan will move the needle, “but it’s hard to know how much.”

The vaccination mandates for employers, for example, will definitely be helpful in states where similar measures, such as requirements that state workers get vaccinated or test regularly, have already started, he said. It “will reinforce what the state is trying to do.”

But it’s less clear what will happen in states with strong political opposition to mandates. “There will be partisan disagreement on this,” Plescia predicted.

Biden’s proposal has elicited broad opposition from many Republican governors, with some pledging to fight it. Others issued more tempered statements. Ohio Gov. Mike DeWine, a Republican, the plan may hamper efforts to educate people on the importance of vaccines, because “we’re going to now be talking about a federal mandate, which no one likes, instead of talking about ‘Look, here’s the science.’”

But Plescia is pleased the vaccination mandate broadly extends the requirement for health care workers to get vaccinated. It now goes beyond an earlier announcement affecting only nursing home workers to include staffers at nearly all health facilities that receive federal funding, such as Medicare or Medicaid.

An August announcement that targeted mainly nursing home workers raised concern that some employees would simply quit and find work in health care settings where vaccines were not required, further exacerbating a shortage of nursing home workers.

With the president’s new move, “this levels the playing field,” Plescia said. The same goes for other industries.

And the mandate might prove less objectionable for some unvaccinated adults, said executive director of the American Public Health Association, because the employer becomes the enforcer.

“The person telling them what to do is their boss at their job,” he said. “That’s a different leverage point than the government.”

However, , director of global health and HIV policy at Â鶹ŮÓÅ, said the testing option for companies with 100 or more workers could slow any positive impact of the vaccine push.

It will also take time to see how the mandates and requirements are implemented. Possible legal challenges could delay results, as could the regulatory steps involved in the enforcement of the employer vaccination requirement, which will rely on the Occupational Safety and Health Administration for enforcement.

The goal to get more testing kits to health centers and to make home test kits available through major retailers for a lower price could also be helpful, Plescia said.

Benjamin gives Biden a “healthy B-plus” on progress in getting covid under control, citing the more than 200 million Americans who have had at least one shot, even as he acknowledges that, “as a nation, we haven’t achieved critical vaccination levels in enough of the country.” Currently, age 12 and over is fully vaccinated.

But, in many pockets of the country, not even half the population is vaccinated, far short of the levels many public health experts believe necessary to tamp down the virus.

“It’s pretty clear the carrot has not worked,” said Benjamin, referring to the . “We have enormous forces pushing back, both the usual anti-vaccine community plus the politicization at the most senior levels.”

Disparities remain in vaccination rates among people of color compared with that of white people, though the gap has been shrinking recently. Still, the share of doses is disproportionately smaller than their share of covid cases in most states.

Continuing to reach out to these populations will be an important tool to boost the vaccination rate across the U.S. — and to slow the delta variant surge.

When Will We (If Ever) Get Covid Under Control?

Despite all this, , a professor of medicine in the Division of Infectious Diseases at Vanderbilt University in Nashville, Tennessee, is hopeful.

If things move forward expeditiously, “by sometime this winter we could have covid under control,” he said. By that, he does not mean the virus will be vanquished. Instead, Schaffner said, “we would be on the same track as before delta, entering a new normal.”

Kates envisions covid becoming manageable if the U.S. can achieve a much higher rate of vaccination coverage. But she also thinks it’s likely the virus will continue to circulate and covid will become an endemic disease.

“The likelihood of it not being an issue is diminishing since vaccine coverage is so poor in other countries. Containing covid depends on what we do globally, too,” said Kates. “The likely scenario of the U.S. is we’ll be living with it for a while and containment will be dependent on vaccination rates.” We continue to rate this promise In the Works.

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These issues were key to candidate Biden’s 2020 health care platform, which stated he would “stand up to abuse of power” by drugmakers. Biden promised on his that he would allow consumers to buy prescription drugs from other countries, as long as the Department of Health and Human Services deemed it safe. In speeches, candidate Biden also pledged to bring down drug costs by 60%.

Nearly six months into his term, Biden issued an on promoting economic competition, which included moves toward fulfilling these promises.

KHN has teamed up with our partners at PolitiFact to during the 2020 presidential campaign — and, so far, experts generally say the jury is still out on how meaningful these efforts will be.

Drug Importation

Promise: “To create more competition for U.S. drug corporations, Biden will allow consumers to from other countries, as long as the U.S. Department of Health and Human Services has certified that those drugs are safe.”

The July 9 executive order directed the Food and Drug Administration commissioner to work with states to develop a program allowing prescription medications to be brought in from other countries, particularly Canada.

However, several drug pricing experts told us that, of all the policy ideas aimed at reducing the cost of drugs, importation seems the least likely to happen.

“Other countries are not interested in facilitating this,” said , a senior fellow in economic policy studies at the American Enterprise Institute.

, a fellow with the USC-Brookings Schaeffer Initiative for Health Policy, agreed.

“This policy is unlikely to ever work as intended because Canada is unlikely to allow the export of drugs to the United States,” Fiedler wrote in an email.

That’s because drug manufacturers would then probably demand higher prices in Canada, since those would become the de facto U.S. prices, he said. “That would cause a big increase in prices in Canada that Canada likely wishes to avoid.”

This is not the first time a president has suggested importing drugs, notably from Canada. President Donald Trump put forward the same idea during his time in office. Democrats and Republicans alike have supported similar proposals.

During the Trump administration, a rule was finalized allowing states to seek the FDA’s permission to import drugs. Several states then passed laws to that end, but Florida is the only state to have formally applied to the FDA. The agency has yet to make a decision on the request.

The Pharmaceutical Research and Manufacturers of America, the trade industry group representing major pharmaceutical companies, sued HHS in 2020 in an attempt to get this drug importation rule overturned. The litigation is ongoing, though the Biden administration has asked for the case to be dismissed.

In a May court filing, the administration argued the case was pointless because it’s unclear whether any state importation plan would be approved anytime soon.

its concern that exporting drugs to the U.S. could trigger shortages within its borders, and after the Trump-era rule was finalized, the country moved to block bulk exports of medications in short supply.

Still, , a law professor and drug pricing expert at Washington University in St. Louis, said Biden’s “rehabbed” policy isn’t a bad thing.

“Drug pricing has been a big problem for several years now, and there are many policy ideas on the table. We don’t lack for policy ideas — we lack for actual implementation of those ideas,” Sachs wrote in an email. “So I don’t think it’s concerning at all if the administration chooses to advance existing policy ideas rather than developing new ones from scratch.”

It’s also important to remember that Biden has just released an executive order directing that these things happen. It is just a first step in a long line of steps, including issuing rules and allowing time for public comment.

That means details of how this importation policy would work are not yet available. The executive order calls for a report to be issued 45 days afterward with a plan outlining specific efforts to reduce prescription drug prices.

“I assume we’ll know more then,” Sachs said.

The High Cost of Drugs

Promise: “I’m going to lower prescription drugs by 60%, and that’s the truth.”

On this pledge, the recent executive order outlined the president’s vision for how to proceed.

The order included an initiative designed to shore up the approval framework for generic drugs and biosimilars, working with the Federal Trade Commission to address efforts to impede competition for these types of drugs and help Medicare and Medicaid incorporate new payment models to cover them.

Experts so far have offered measured reactions.

The administrative actions outlined in this executive order do have the potential to reduce prescription drug prices, said Fiedler of the USC-Brookings Schaeffer Initiative. But it depends on more than just what the order says.

“In each of these areas, whether prices actually fall will depend on the details of the proposals the administration ultimately puts forward,” Fiedler wrote in an email. “However, these are all areas where there are opportunities to make changes that would have a meaningful impact.”

Again, more will be known in 45 days, the deadline for the release of the plan to reduce prescription drug prices.

It’s important to note that the FTC is an independent agency, so Biden’s principal means of influencing drug policy comes from his appointments to the agency, said Fiedler. It does seem likely, though, he added, that the newly appointed FTC chair would be sympathetic to cracking down on market conduct that delays the entry of generic drugs or biosimilars.

Still, reducing drug prices by 60% would require legislation, said the AEI’s Ippolito.

“And the most disruptive drug pricing reforms — those that could even sniff that kind of price reduction — are also the most unlikely to pass,” Ippolito wrote in an email. “In short, I suspect that this executive order isn’t going to make much headway.”

Trump also promised last year on the campaign trail that he would lower drug prices by 60%, after repeatedly promising to reduce medication costs during his four years in office. However, little progress was made toward that goal despite several related executive orders in 2020.

While Biden’s executive order has a different focus than most of the Trump-era drug pricing orders, the Biden administration has signaled it may still be open to embracing some of those policies.

Trump’s directives focused on rebates paid to pharmacy benefit managers being rerouted to beneficiaries, reducing the cost of insulin by compelling federally qualified health centers to make the drugs available at low prices to low-income people, importing drugs from Canada and tying drug prices to the prices paid in other countries.

Three proposed rules that resulted from Trump’s orders are being kept around by the Biden administration — at least for the time being. One is the “Most Favored Nation Model.” This rule is supposed to match U.S. prices for certain classes of drugs with the lower amounts paid in countries that negotiate drug prices.

According to , the Biden administration’s regulatory office received the rule this month, which means there may be a new public comment period before the rule is finalized — though it’s likely this would take some time.

And, of course, there’s the pending Trump administration rule on drug importation, currently tied up in court.

Trump’s rebate rule, meanwhile, has also been delayed. The Biden administration pushed back its effective date to January 2023. Freezing the rule was part of the Biden administration’s policy to review any rules finalized in the final months of Trump’s term.

No other Trump drug pricing efforts made much headway. Instead, they drew a fair amount of industry pushback.

And it remains to be seen whether Biden’s directives will fare any better.

Experts agreed that most likely congressional action would be needed to achieve a 60% reduction in prices. With over three years left in Biden’s term, who knows what could still happen?

For now, we rate these promises “In the Works.”

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Before vaccinations were widely available, covid-19 tests were considered one of the few tools to help control the spread of the coronavirus.

That’s why then-candidate Joe Biden promised during the 2020 presidential campaign to boost the United States’ testing capacity as one way he would “beat covid-19.”

Specifically, that, if elected, he would “double the number of drive-through testing sites” and “invest in next-generation testing, including at-home tests and instant tests, so we can scale up our testing capacity by orders of magnitude.”

KHN has teamed up with our partners at PolitiFact to analyze Biden’s promises during the 2020 presidential campaign. Now that Biden has been president almost five months, we checked how he has done on this one. Experts say testing capacity has improved. At the same time, testing demand has decreased and part of Biden’s promise — doubling the number of drive-thru testing sites — is harder to pin down.

In February, about a month after Biden took office, his administration announced that it would invest more than $1.6 billion in covid testing. These funds would, among other things, expand testing in schools and other congregate settings, increase domestic manufacturing of testing supplies, and help track covid variants via genetic sequencing.

Then, Biden’s American Rescue Plan, which successfully passed through both chambers of Congress in March, also allocated funds specifically to expand testing.

On March 17, the Department of Health and Human Services that $10 billion from that legislation would be devoted to screening and testing so schools could reopen, and $2.25 billion to scaling up testing in underserved populations as well as providing new guidance. An additional was allotted in May to reimburse health care providers for testing uninsured people for the coronavirus.

, chief medical officer of the Association of State and Territorial Health Officials, the organization representing state public health agencies, said states have begun to receive their American Rescue Plan funds and are starting to plan how testing will be implemented to help schools conduct classes in person in the fall.

But whether Biden was successful in doubling the number of drive-thru testing sites is unclear. KHN and PolitiFact asked various testing experts for their take, and they generally said they weren’t aware of any data that showed the number of sites had doubled. Some hypothesized, though, that this may have been because many public health resources were shifted away from testing sites to staff and to set up vaccination sites once covid vaccines became available to the public.

“I think states did shift their efforts to vaccination, because that was the move in the spring,” said Plescia. But as more people were vaccinated, demand dropped, and “if we had those drive-thru testing sites we ended up closing them,” he added. “It was a promise we ended up not needing to keep.”

Indeed, there have been reports of shuttered testing sites across the U.S. In Florida all 27 state-run testing sites . a mass testing site once demand fell to fewer than 50 tests a day and, in late May, the state’s first outdoor testing site.

The shows that testing demand in the U.S. has significantly dropped. In January, about 2 million tests were conducted in a day. In May, that number dropped to about 850,000. This reduction has occurred at the same time the number of Americans getting vaccinated is rising and covid cases and deaths are dropping.

The Centers for Disease Control and Prevention also recently that vaccinated people who have been exposed to someone with covid no longer need to be tested if asymptomatic, and that vaccinated people can be excluded from workplace testing in most instances.

Still, Plescia thinks that if future outbreaks occur in certain areas and more tests are required, states would be able to scale up to meet the need. Especially because of the increased availability of at-home tests — another Biden focus.

So far, the administration has contracted with several private companies to ensure the production and distribution of both rapid and at-home covid tests.

Ellume, an Australian diagnostics company, was the first to receive an emergency use authorization from the Food and Drug Administration for an at-home test. In February, the Department of Defense it had awarded Ellume almost $232 million to build a U.S. factory and increase home-test production. The contract also includes the allocation of 8.5 million home tests to the federal government, which must be provided by the end of 2021.

Abbott, another diagnostics company, received significant funds from the federal government for tests during both the Biden and Trump administrations. In March, that Abbott had received a contract to deliver 50 million of its rapid point-of-care tests to long-term care facilities.

Currently, five over-the-counter at-home tests have been by the FDA. In addition to the Ellume and Abbott tests, which provide results at home in 15 minutes, a Labcorp test is also available over the counter, but its results take one or two days to return.

The increase in supply and decrease in demand could mean some testing efforts originally envisioned by the Biden administration might not be rolled out and the U.S. might never get to “orders-of-magnitude” increases in testing, , associate director of global health policy at Â鶹ŮÓÅ, wrote in an email.

Overall, though, despite the number of drive-thru or mass-testing sites closed down, there is now a greater availability of covid tests. The Biden administration has also provided significant funding toward testing, even if some of it has been .

“In general, I think testing is much better,” , director of the Columbia University National Center for Disaster Preparedness, wrote in an email. “There are easier-to-access options, and the wait times seem to be much faster for results. … There are also more resources available to state and local health departments to perform testing. So I would qualify this as a promise kept.”

So would we. We rate this a “Promise Kept.”

Source List

The Associated Press, May 27, 2021

Bradenton Herald, May 12, 2021

Centers for Disease Control and Prevention, “,” May 28, 2021

CNBC, Feb. 17, 2021

CVS Health, April 19, 2021

Department of Defense, “,” Feb. 1, 2021

Department of Health and Human Services, “” Feb. 17, 2021

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President Biden now faces major challenges in accomplishing his health care agenda; among the biggest will be bridging partisan divides in both Congress and the nation at large.

Even with the Democrats’ newfound majority in the Senate — the result of victories by the Rev. Raphael Warnock and Jon Ossoff in Georgia’s runoff elections — differences in health policy between the party’s moderate and progressive wings will persist.

“With razor-thin Democratic majorities in both the House and the Senate and many other priorities in addition to health care, Biden is unlikely to succeed in accomplishing all of his health agenda,” said, executive vice president for health policy at the Â鶹ŮÓÅ. (KHN is an editorially independent program of Â鶹ŮÓÅ.)

Still, Democratic control of the Senate will allow Biden to pursue some of his health care priorities “using a two-pronged strategy of legislation and executive actions,” Levitt said.

PolitiFact and KHN teamed up to analyze Biden’s promises during the 2020 presidential campaign and will monitor his policies over the next four years to see which ones materialize. But, for now, as Biden settles into the West Wing, what are his chances of making progress on health care?

The Covid Pandemic

In his first 100 days in office, Biden has promised to get 100 million doses of covid vaccine in the arms of Americans and — if Congress provides the funds to do so — get all kids back into schools safely. He asked people to wear face masks in public for those 100 days. He also has repeatedly promised he would get the covid pandemic under control.

Other covid promises include a pledge to double the number of drive-thru testing sites and create a national pandemic testing board. He said he wants to invest $25 billion in covid vaccine distribution and to ensure that every American has access to the vaccine at no cost. He’s also promised to use the Defense Production Act to ramp up personal protective equipment supplies and restore national stockpiles.

During his first two days in office, Biden took steps to accomplish these goals, using to put in place masking mandates regarding federal buildings and interstate — for example, in airports and on commercial aircraft, trains, ferries and intercity bus services — and re-engaging the United States with the World Health Organization. He also issued orders to create a covid response coordinator who will lead the federal government’s efforts for providing vaccination, testing and supplies, set up a national pandemic testing board, establish international travel protocols, use the Defense Production Act to provide necessary supplies and ensure minority communities are provided resources to combat the disease. The White House released a 200-page on Thursday that outlines the Biden administration’s strategy to address the covid-19 pandemic.

Some members of his covid leadership team — such as Jeff Zients, tapped to coordinate the White House’s covid response, and Dr. Rochelle Walensky, who will lead the Centers for Disease Control and Prevention — don’t require Senate confirmation, meaning they can get to work right away. But Biden’s pick for Health and Human Services secretary, Xavier Becerra, will need approval by the Senate, a step that will likely be eased because of Democrats’ Georgia victories. Still, how his nomination plays out — as well as Biden’s other selections for posts that require confirmation — could be an early sign of whether the new administration will face strong partisan resistance.

While the executive orders are strong signals of what Biden hopes to accomplish, he will need Congress to fund his plans to expand testing and vaccine distribution. Biden outlined the week before his inauguration in a proposal to address covid and the economy. However, the president could face difficulty in getting bipartisan agreement on this plan, with some Republicans criticizing it as too expensive.Ìý It took Congress seven months to pass a second covid relief bill in December.

Other limiting factors include whether the supply of vaccine is adequate to reach 100 million doses and whether organized efforts are put in place to increase testing and ramp up production, said, executive director of the American Public Health Association.

One area in which Biden could face pushback: mask-wearing. Even though he has already issued executive orders regarding mask use in federal buildings, for instance, broader mask mandates fall under individual governors’ authority, and some Republican state executives remain resistant.

Even if Biden makes inroads on that front, Americans will have to accept this step as part of their daily lives. A showed that while most Americans, regardless of party, wear a mask whenever they leave their house, there is still a lag among Republicans.

“I think Biden’s biggest challenges in fulfilling his covid goals are in bringing a divided country together with the bully pulpit of the presidency,” said Levitt. “If testing and the vaccine and mask-wearing are successful in only blue America, then it will be hard to succeed overall.”

Health Insurance

As Barack Obama’s vice president, Biden was instrumental in the enactment of the Affordable Care Act, which expanded health insurance coverage to millions of people but has drawn fierce Republican opposition.

Biden’s health agenda promises to expand the ACA and undo many of the steps taken by President Donald Trump to dismantle it.

“I’ll not only restore Obamacare, I’ll build on it. You can keep your private insurance. If you like it, you can choose a Medicare-like public option,” Biden in Pittsburgh on Nov. 2.

Adding a government-run public option to other ACA health care plans is one of Biden’s most ambitious pledges. It’s a controversial idea even within the Democratic caucus, where some members want instead to move to a single-payer health plan like “Medicare for All.” Remember the debates during the Democratic presidential primary?

Health policy experts we consulted said implementing a public option seems extremely unlikely in the current environment. So does lowering the Medicare eligibility age from 65 to 60, another divisive idea among Democrats. But both moderates and progressives — even lawmakers across the aisle — might be able to come together on initiatives that could shore up the ACA and make coverage more affordable, such as expanding eligibility for premium subsidies.

Biden doesn’t need Congress to restore parts of the ACA that were changed via regulations issued by the Trump administration. He can instruct agencies to issue new rules that would reverse such Trump initiatives as allowing states to implement work requirements for some adults who gained Medicaid coverage in the ACA expansion of that program. Still, regulatory changes take time. And, in some cases, altering them can be complicated.

Take, for instance, the Trump administration’s rules promoting short-term or association health plans. That metaphorical cat is already out of the bag, said , a health care scholar at the .

“There are a lot of people insured through those plans and so [changing that policy is] a very tricky thing,” said Antos. “I don’t think it would be wise for him to do anything to reverse that [rule] even though there has been a lot of noise from the left.”

In Antos’ view, the main advantage in gaining Senate control will be helping speed confirmation for key nominations, “which opens the door to new thinking on regulations.”

Drug Prices

On the campaign trail, Biden made clear his intent to bring down prescription drug prices. He promised to lower costs by 60%. Among the related policy ideas he floated: repealing the law that bars Medicare from negotiating lower drug prices and allowing the importation of prescription drugs from other countries.

But details of these proposals aren’t yet available, leaving some experts to question their feasibility.

Of course, the pharmaceutical lobby won’t be enthusiastic about any drug pricing legislation and would likely mount an aggressive campaign to defeat it. And just as with any other proposal, there will be the hurdle of getting Congress to agree on what to include in a drug pricing bill. Plus, given the rapid development of covid vaccines, Capitol Hill may be more sympathetic to the drug industry.

But, an associate professor of health policy at Vanderbilt University, said it’s possible Biden could succeed in lowering drug prices by limiting drug price increases to the rate of inflation and capping out-of-pocket spending for seniors covered by Medicare.

Both the House and Senate included similar proposals in past drug pricing bills, she said, and “those are both things I think could legitimately move forward, if anything moves forward.”

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Esa promesa se cumplió, pero , como la de Bill Clinton de lograr una atención médica universal o la George H.W. Bush de no generar nuevos impuestos.

Ahora, durante una pandemia que ocurre una vez en un siglo, Joe Biden ha prometido proporcionar 100 millones de dosis de vacunas contra covid-19 en sus primeros 100 días de mandato.

“Este equipo ayudará a que 100 millones de dosis lleguen a los brazos de los estadounidenses en los primeros 100 días”, dijo Biden en la del 8 de diciembre en la que presentó a su equipo de salud.

Luego de esa afirmación, la campaña de Biden aclaró que se había referido a que 50 millones de personas recibirían sus dos dosis. Más tarde aclararon que distribuirían las dosis a medida que , en vez de retener suministros para las segundas dosis.

De cualquier manera, la meta de Biden parece difícil de alcanzar.

“Creo que es un objetivo posible. Pero también un gran desafío”, dijo , directora ejecutiva de la Association of Immunization Managers.

“Mientras que el ritmo de 1 millón de dosis al día es en alguna medida un aumento con respecto a lo que estamos haciendo ahora, será necesaria una tasa mucho más alta de vacunación para frenar la pandemia”, dijo , vicepresidente ejecutivo para políticas de salud de la Kaiser Family Foundation (Â鶹ŮÓÅ).

“La administración Biden planea racionalizar la distribución de vacunas, pero aumentar el suministro rápidamente podría ser una tarea difícil”, agregó.

Bajo la administración Trump, el despliegue de vacunas ha sido mucho más lento que el plan de Biden. El lanzamiento comenzó el 14 de diciembre. Desde entonces, se han administrado 12 millones de dosis y se han distribuido 31 millones, según el de los Centros para el Control y Prevención de Enfermedades (CDC).

Esta lentitud se ha atribuido a la falta de comunicación entre el gobierno federal y los departamentos de salud estatales y locales. También a la falta de fondos para una vacunación a gran escala, y a la confusa orientación del gobierno federal sobre la distribución.

La administración Biden podría tener los mismos problemas, según expertos. Los estados aun no están seguros de cuántas vacunas recibirán y si habrá un suministro suficiente, dijo el , director médico de la Association of State and Territorial Health Officials, que representa a las agencias de salud pública estatales.

“Se nos ha proporcionado poca información sobre la cantidad de vacunas que recibirán los estados en el futuro cercano y puede que no haya un millón de dosis disponibles cada día en los primeros 100 días de la administración”, dijo Plescia.

Otro problema ha sido la falta de dinero: los estados han tenido que iniciar campañas de vacunación con presupuestos esqueléticos a causa de la pandemia. “Los estados deben pagar por crear los sistemas, identificar al personal y capacitarlos, el rastreo de contactos, las campañas de información, todo lo que necesitan para terminar vacunando a una persona”, explicó , directora de política global y VIH de Â鶹ŮÓÅ. “Tienen que crear un programa de vacunación masiva si precedentes sobre una base inestable”, observó.

El último estímulo para covid, promulgado en diciembre, asignó $9 mil millones en fondos a los CDC para esfuerzos de vacunación. Se supone que la mitad, unos $45 mil millones se destinarán a estados, territorios y reservas indígenas.

Pero cuando la vacunación se amplíe a más grupos, no está claro si las campañas se puedan sostener con ese nivel de financiamiento.

La semana del 11 de enero, Biden lanzó un plan de para abordar los problemas de la economía y covid. Incluye dinero para crear programas nacionales de vacunación y pruebas, pero también para asistencia financiera a individuos, ayuda a gobiernos locales,Ìý extensión del seguro de desempleo y dinero para que las escuelas reabran de manera segura.

Aunque el Congreso tardó casi ocho meses en aprobar el último proyecto de ley de ayuda tras las objeciones republicanas, Biden parece optimista de que logrará que algunos republicanos se unan a su plan. Pero aún no está claro que funcione. También está la cuestión de si el juicio político del presidente saliente Donald Trump se interpondrá en el camino de las prioridades legislativas de Biden.

Además, los estados se han quejado de la falta de orientación e instrucciones confusas sobre a qué grupos se les debe dar prioridad para la vacunación, un tema que la administración Biden deberá abordar.

El 3 de diciembre, los que el personal de atención médica, los residentes de centros de atención a largo plazo, las personas de 75 años o más y los trabajadores esenciales de primera línea se vacunaran primero.

Pero el 12 de enero, los CDC cambiaron de rumbo y recomendaron que todas las personas mayores de 65 años debían vacunarse. Biden dijo que .

El secretario saliente de Salud y Servicios Humanos, Alex Azar, también que los estados que muevan su suministro de vacunas más rápido tendrán prioridad para recibir más envíos.

Aún no se sabe si los CDC de la administración de Biden se apegarán a esta guía. Los críticos han dicho que podría hacer que la distribución de vacunas sea menos equitativa. En general, asumir el control con una visión sólida y una comunicación clara será clave para aumentar la distribución de vacunas, dijo Hannan.

“Todos deben comprender cuál es el objetivo y cómo va a funcionar”, agregó.

Un desafío para Biden será frenar las expectativas de que la vacuna es todo lo que se necesita para poner fin a la pandemia. En todo el país, hay más casos de covid que nunca y en muchos lugares los funcionarios no pueden controlar la propagación.

Los expertos en salud pública dijeron que Biden debe intensificar los esfuerzos para aumentar las pruebas en todo el país, como ha sugerido que hará al prometer establecer una junta nacional de pruebas de pandemias.

Con el fuerte enfoque en la distribución de vacunas, es importante que esta parte de la ecuación no se pierda.

En este momento, “está en todo el mapa”, dijo Kates de Â鶹ŮÓÅ, y agregó que el gobierno federal necesitará tener un claro sentido de las áreas del país en donde se están haciendo las pruebas y en las que no, para “arreglar” esa capacidad de salud pública.

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Now, during a once-in-a-century pandemic, incoming President Joe Biden has promised to provide 100 million covid-19 vaccinations in his first 100 days in office.

“This team will help get … at least 100 million covid vaccine shots into the arms of the American people in the first 100 days,” Biden during a Dec. 8 news conference introducing key members of his health team.

When first asked about his pledge, the Biden team said the president-elect meant 50 million people would get their two-dose regimen. The incoming administration has since updated this plan, saying it will release instead of holding back some of that supply for second doses.

Either way, Biden may run into difficulty meeting that 100 million mark.

“I think it’s an attainable goal. I think it’s going to be extremely challenging,” said , executive director of the Association of Immunization Managers.

While a pace of 1 million doses a day is “somewhat of an increase over what we’re already doing,” a much higher rate of vaccinations will be necessary to stem the pandemic, said , executive vice president for health policy at Â鶹ŮÓÅ. (KHN is an editorially independent program of Â鶹ŮÓÅ.) “The Biden administration has plans to rationalize vaccine distribution, but increasing the supply quickly” could be a difficult task.

Under the Trump administration, vaccine deployment has been much slower than Biden’s plan. The rollout began more than a month ago, on Dec. 14. Since then, 12 million shots have been given and 31 million doses have been shipped out, according to the .

This sluggishness has been attributed to a lack of communication between the federal government and state and local health departments, not enough funding for large-scale vaccination efforts, and confusing federal guidance on distribution of the vaccines.

The same problems could plague the Biden administration, said experts.

States still aren’t sure how much vaccine they’ll get and whether there will be a sufficient supply, said , chief medical officer for the Association of State and Territorial Health Officials, which represents state public health agencies.

“We have been given little information about the amount of vaccine the states will receive in the near future and are of the impression that there may not be 1 million doses available per day in the first 100 days of the Biden administration,” said Plescia. “Or at least not in the early stages of the 100 days.”

Another challenge has been a lack of funding. Public health departments have had to start vaccination campaigns while also operating testing centers and conducting contact tracing efforts with budgets that have been critically underfunded for years.

“States have to pay for creating the systems, identifying the personnel, training, staffing, tracking people, information campaigns — all the things that go into getting a shot in someone’s arm,” said , director of global health & HIV policy at Â鶹ŮÓÅ. “They’re having to create an unprecedented mass vaccination program on a shaky foundation.”

The latest covid stimulus bill, signed into law in December, allocates almost $9 billion in funding to the CDC for vaccination efforts. About $4.5 billion is supposed to go to states, territories and tribal organizations, and $3 billion of that is slated to arrive soon.

But it’s not clear that level of funding can sustain mass vaccination campaigns as more groups become eligible for the vaccine.

Biden released a last week to address covid and the struggling economy. It includes $160 billion to create national vaccination and testing programs, but also earmarks funds for $1,400 stimulus payments to individuals, state and local government aid, extension of unemployment insurance, and financial assistance for schools to reopen safely.

Though it took Congress almost eight months to pass the last covid relief bill after Republican objections to the cost, Biden seems optimistic he’ll get some Republicans on board for his plan. But it’s not yet clear that will work.

There’s also the question of whether outgoing President Donald Trump’s impeachment trial will get in the way of Biden’s legislative priorities.

In addition, states have complained about a lack of guidance and confusing instructions on which groups should be given priority status for vaccination, an issue the Biden administration will need to address.

On Dec. 3, the health care personnel, residents of long-term care facilities, those 75 and older, and front-line essential workers should be immunized first. But on Jan. 12, the CDC shifted course and recommended that everyone over age 65 should be immunized. In a speech detailing his vaccination plan, he said he would stick to the CDC’s recommendation to prioritize those over 65.

Outgoing Health and Human Services Secretary Alex Azar also that states that moved their vaccine supply fastest would be prioritized in getting more shipments. It’s not known yet whether the Biden administration’s CDC will stick to this guidance. Critics have said it could make vaccine distribution less equitable.

In general, taking over with a strong vision and clear communication will be key to ramping up vaccine distribution, said Hannan.

“Everyone needs to understand what the goal is and how it’s going to work,” she said.

A challenge for Biden will be tamping expectations that the vaccine is all that is needed to end the pandemic. Across the country, covid cases are higher than ever, and in many locations officials cannot control the spread.

Public health experts said Biden must amp up efforts to increase testing across the country, as he has suggested he will do by promising to establish a national pandemic testing board.

With so much focus on vaccine distribution, it’s important that this part of the equation not be lost. Right now, “it’s completely all over the map,” said Â鶹ŮÓÅ’s Kates, adding that the federal government will need a “good sense” of who is and is not being tested in different areas in order to “fix” public health capacity.

Today marks the launch ofÌý, which monitors the 100 most important campaign promises of President Joseph R. Biden. Biden listedÌýtheÌýcoronavirus and a variety of other health-related issues among his top priorities. You can see the entire list – including improving the economy, responding to calls for racial justice and combating climate change –Ìý. As part of KHN’s partnership with PolitiFact, we will follow the health-related issues and then rate them on whether the promise was achieved: Promise Kept, Promise Broken, Compromise, Stalled, In the Works or Not Yet Rated. We rate the promise not on the president’s intentions or effort, but on verifiable outcomes. PolitiFact previously tracked the promises ofÌýÌýandÌý.Ìý

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