After vowing and failing to repeal or replace the Affordable Care Act, President Donald J. Trump will leave office with a mostly dismal record on health care, a point underscored by his denials and diminutions of COVID-19 in the face of a pandemic that as of today has reached more than 20 million cases and killed more than 350,000 people in the United States. Beginning Jan. 20, President-elect Joe Biden will have the opportunity to make his mark on the well funded and lobbyist-heavy health industry, a behemoth that has proven allergic to change under several administrations.
While it's uncertain how effective a Biden-Harris health care agenda will be if it faces a divided Congress, industry leaders and experts nevertheless are preparing for a radical departure from the Trump years. Here are five ways in which the Biden administration will seek to break quickly with the policies of the past four years.
Enhancement and expansion of Obamacare
Biden, who helped guide the ACA to passage during the Obama administration, doubled down on its importance during the 2020 campaign. His platform invokes a plan to ultimately insure more than 97% of Americans by, among other things, increasing the value of tax credits to help lower the cost of premiums. Biden also will push for a Medicare-like public option, with the government negotiating prices directly with hospitals and other health care providers and thus driving down costs. Just after the November election, the Supreme Court heard arguments on what was at least the seventh challenge to the legality of the ACA to come before it. Assuming the law again survives, Biden will immediately begin trying to enhance it.
An "urgent" response to COVID-19
The Biden-Harris plan for attacking the pandemic bears almost no resemblance to Trump's shambolic approach to a once a century phenomenon. The president-elect says he will more aggressively use the Defense Production Act to rapidly increase the supply of personal protective equipment needed by those on the health care front lines, as well as by the public at large, and will build up a U.S.-manufactured stockpile to hedge against future emergencies. Biden also said he is aiming to get 100 million COVID vaccinations distributed in his first 100 days in office, and to have "the majority" of schools open by the end of that three-plus month period. Further, Biden said his administration will ensure that "public health decisions [will be] informed by public health professionals," which sounds self-evident until the Trump record is examined.
Lowering the Medicare age From 65 to 60
This idea, which Biden has repeatedly championed, may be the most fiercely resisted of all – but not simply because the GOP opposes it. Any move toward a lower threshold for signing up for Medicare will face massive pushback and intense lobbying by hospitals and health care facilities, who stand to lose billions in revenue. (Speaking broadly, Medicare reimbursement rates for patients admitted to hospitals are only about half of what private or employer-sponsored plans pay.) But the notion of lowering the Medicare age has overwhelming and bipartisan public support; in fact, on an allied topic, 85% of Democrats and 69% of Republicans favor allowing people between ages 50 and 64 to buy insurance through Medicare, according to 2019 polling data by the Kaiser Family Foundation.
A turn toward value-based care
Put simply, value-based care means that hospitals and doctors get paid, in part, based upon the quality of care they provide, and how efficiently they do it. Thus, providers under this model would be rewarded for things like lowering hospital readmissions and improving preventative care. This stands in stark contrast to the fee-for-service system most often used currently, in which reimbursements are made according to a preset menu of prices, and doctors and hospitals make more money by scheduling more tests and procedures. Both the Obama and Trump administrations made strides toward installing value-based care as the first option, but Biden has signaled a willingness to put that process into hyperdrive.
Reversing Trump on Medicaid
The Trump administration undercut the expansion of Medicaid by approving waiver requests by individual states that allowed them to deny coverage to those who did not work a set number of hours, or to slap premiums and extra costs on those who did use the system. The idea, for several states, was to discourage increasing enrollment in the program, which uses federal and state money to provide health coverage to poor Americans. Health care analysts have predicted that Biden will either withdraw federal approval of those "discouragement waivers" or eliminate them when they come up for renewal. They also expect him to offer financial inducements to the 12 states that haven't yet expanded their Medicaid coverage as allowed under the ACA, part of Biden's goal of extending health care to the millions of Americans who don't have it.
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