The healthcare agendas of Donald Trump and Joe Biden were top voter considerations in the 2020 election. The popular importance of the issue all but assures that we’ll see continued legislative impacts.
October 2020 polling indicated that 64% of men and 83% of women rated healthcare as “very important.” This averages out to three in four voters.
We can expect the Joe Biden healthcare agenda to center around updating the Obama Administration’s Affordable Care Act (ACA). We can also expect to see a more hands-on approach to controlling the pandemic.
We’re unlikely to see Biden pursue a more ambitious healthcare agenda, such as Medicare-For-All. Biden famously never embraced Medicare-For-All during the primaries or general election, and regardless would be unlikely to get such a bill passed in the Senate.
Instead, it’s likely that Joe Biden’s healthcare influence will likely touch four main issues.
Many voters and healthcare experts alike see the COVID-19 crisis as a healthcare issue. As a result, we can expect that Biden will prioritize health and science as the top concern for this COVID-19 response.
An early effect has been the re-empowerment of top vaccine expert Dr. Anthony Fauci. New support for the U.S. Centers for Disease Control and Prevention has also been an outcome.
The voice of public health has received new strength in the response to the pandemic. We now see consistent messages coming from the executive branch, stronger messaging from the CDC, and more support for epidemiologists.
This response has also been backed up by executive action. On day two of his administration, the president signed 10 executive orders related to his pandemic response. The goals of the orders included expanding testing and administering 100 million vaccine doses by the end of April. Biden additionally invoked the Defense Production Act to compel companies to manufacture supplies needed for the nation’s pandemic response.
Push for More Coverage and Lower Costs
One sobering Commonwealth Fund study found that 7.7 million Americans lost access to employee health insurance due to the pandemic. On top of that, nearly 7 million dependents could also lose their coverage.
Increasingly, Americans are beginning to more deeply examine the marriage of employment and health insurance. In response, the Biden Administration has signaled its plans to strengthen the ACA. One immediate response was Biden’s January 28th order to re-open the ACA enrollment period for three months.
Biden has also proposed redefining affordable health care to be no more than 8.5% of a family’s income for a benchmark gold plan. Currently, the ACA caps enrollees’ contributions toward the benchmark silver plan at just under 10% of their income.
Additional moves to sure up ACA could include changes in eligibility for subsidies. Biden plans to eliminate the income limit on premium subsidies, meaning that the new 8.5% premium cap would be available to higher-income enrollees. This eliminates what’s currently called the “subsidy cliff” that exists in the ACA currently.
Additionally, Biden plans to allow workers that qualify for job-based coverage to enroll in Marketplace plans. Workers would now be free to purchase subsidized plans from the market if the plans are a better deal.
Finally, we may even see a public option available to all Marketplace participants. Those who live in a state that hasn’t adopted the ACA Medicaid expansion and make under 138% of the poverty line would be automatically enrolled with no premium. If enacted, this final step in ACA expansion could bring the national uninsured rate down to 3%.
Improved funding for healthcare navigators is another possible change on the horizon. Healthcare navigators are exchange employees tasked with personally helping users find the best and most affordable coverage. This could bring major user experience improvements.
Lowering the Medicare Age
Perhaps one of the most ambitious Joe Biden healthcare legislative goals is lowering the Medicare eligibility age from 65 to 60. Most adults over 55 support the goal. Many fear age discrimination will prevent them from finding suitable employment if they are displaced during this pandemic.
However, increased eligibility will encounter fierce resistance from some healthcare institutions. This will be a result of the lower reimbursement rates of Medicare relative to private insurance. Though, the full impact on healthcare providers will likely depend on their payer mix.
Those seeing significant numbers of privately insured patients between the ages of 60 to 65 could see notable losses. In contrast, the move could actually help providers that serve high numbers of uninsured patients.
Newly eligible sexagenarian decisions to join Medicare will likely hinge on the financial attractiveness of their private insurance options, if available.
Improvements in Patient Experience and Equity
A transition from Medicare fee-for-service to value-based care has bipartisan support. Both the outgoing Trump administration and Biden administration supported such plans. President Biden’s election is likely to speed its implementation.
The Joe Biden healthcare platform also includes several proposals aimed at closing gaps in healthcare among racial groups. One such proposal includes boosting funding to community health centers.
The Biden campaign site quotes a study finding that 59% of patients at community health centers were people of color. Additionally, one quarter were uninsured. As a result, they call for doubling the federal government’s investment in these centers. They also want to see expanded access to “high-quality health care for the populations that need it most.”
Other potential changes include possible provider incentives for taking active roles in addressing racial disparities. Additionally, we could see more provider accountability and appeal mechanisms in Medicare Advantage. These mechanisms would give people more chances to appeal coverage decisions.
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