November 11, 2020
An Early AssessmentWith the election over, the focus now turns to the expected policy changes when the new Congress and President are sworn into office. Since healthcare was a major topic in the race, Joe Biden has given a glimpse into his administration’s expected approach and strategies around the issue of healthcare policy and of course, health coverage. It is unclear how much a Biden administration can achieve with control of the Senate still in flux. If the Democrats win control of the Senate, Biden will have a greater ability to enact his policies. If the Republicans maintain control, changes may be harder to make and would be relegated to executive orders, regulation and enforcement. Based on publicly available information about a Biden administration, below is a summary of some likely actions:
- Expanded Coverage – There will likely be an attempt to enroll significantly more people in coverage with the Affordable Care Act (ACA) markets and Medicaid. Experts believe the Biden administration could create a special enrollment period for the uninsured to sign up for coverage and increase spending on marketplace advertising and outreach to help. The Trump administration reduced such publicity.
- Policy Roll Back – Biden is expected to stop or roll back a wide range of Trump-era policies. Campaign staff suggest that as soon as his first day in office, Biden could direct federal agencies to pause their regulatory pipeline for at least 30 days to give his team time to review ongoing work. He could be looking to rein in short-term limited-duration insurance, Association Health Plan expansion, and other non-ACA coverages.
- Revise Trump ACA Changes – Experts also predict Biden will revise guidance for state innovation ACA waivers, stop approving waivers for Medicaid work requirements and restore Obama-era non-discrimination protections, among other policy changes.
- Cost of Prescription Drugs – Biden has proposed allowing Medicare to negotiate prescription drug prices, regulating the launch prices of drugs without competition, limiting drug-price increases to the rate of inflation, and allowing personal drug importation. Some measure of pharmacy price action is also expected.
- Anti-Trust and M&A – Biden has called for a retroactive review of recent mergers and acquisitions approved by the Trump administration in the healthcare sector. Biden pledged to use antitrust authority to tackle market consolidation in healthcare (i.e., hospitals, provider groups, insurers, etc.) and scrutinize future acquisitions based on impacts on labor markets, low-income communities and racial equity, as well as prices and competition.
- FDA and COVID Management – It is believed that Biden will try to depoliticize federal agencies like the Food and Drug Administration and empower the Centers for Disease Control and Prevention to lead the public health response rather than depend on a COVID-19 czar to lead the effort.
Biden has signaled his intent to revisit a voluntary “public option” under Medicare for Americans. The cost estimates for such a plan vary widely although his plan is to make the option voluntary vs. a single-payer model. To enact this approach, Biden would need Congressional approval, which may not happen if Republicans hold the Senate. There is also an expectation that any lack of ACA enforcement that has happened in the last 4 years will ramp up as will administrative and departmental policy updates and edicts aimed at protecting the ACA. More will become clear as the Senate election is finalized.
In the coming weeks we expect more from the Biden transition team. We will provide updates and commentary as warranted.
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