On inauguration day, Joe Biden will become the 46th President of the United States. He likely will move fast to implement the plans he articulated during his campaign. Much of that campaign focused on improving healthcare for Americans, so today we’ll examine Biden’s plan for healthcare, how the new administration can accomplish these priorities, and their likelihood of moving forward.
Expand Health Insurance Coverage
Unlike many of his Democratic rivals who promoted Medicare-for-All or single-payer health care plans, Biden focused on continuing to improve the framework that the Affordable Care Act (ACA) implemented. Biden aims to improve the uninsured rate – which in 2019 stood at 9.2% – by expanding access to ACA marketplace plans.
One way he plans to expand access is by increasing the number of individuals eligible for subsidies in state and federal health insurance exchanges as well as increasing the subsidies available. To improve access to ACA marketplaces, Biden’s plan for healthcare proposes changing how to calculate subsidies. Today, those with household incomes above 400% of the federal poverty level are ineligible for subsidies. Biden’s plan would tie subsidies to income so that coverage would cost no more than 8.5% of household income. Plus, those subsidies would be based on the more costly gold plans rather than today’s subsidies, which are based on silver plans. See our blog post about health insurance exchange terminology for more information about gold and silver plans.
Biden can also expand insurance marketplace enrollment by enabling employees who could otherwise access employer-sponsored coverage to enroll in plans through the exchange and earn a subsidy. Today, employees with access to employer-sponsored plans are not eligible to enroll in a subsidized marketplace plan.
Biden’s health care plan also includes a public option offered through the ACA marketplaces. In his plan, Biden’s public option would negotiate prices from providers to deliver lower costs to everyone. Biden also proposed lowering the Medicare eligibility age from 65 to 60.
How to Accomplish: Most of these policy goals would need to be achieved through legislation.
Likelihood of Getting Done: The results of the Georgia run-off election delivered a slim majority to the Senate for the Democrats, which increases the likelihood of the items listed above gaining traction. However, Democrats still have to contend with filibusters – assuming they don’t remove them – to get bills to a vote.
Limit the Impact of COVID-19
Biden largely won the election because of the federal government’s poor response to the pandemic. It also continues to drag down the economy, so is a priority for Biden’s first 90 days.
With a stimulus package recently passed, Biden will likely focus on implementing his campaign plan. That plan included a more coordinated federal testing and contact tracing plan as well as a federal distribution of vaccines.
When it comes to health insurance coverage during the pandemic, Biden released a plan that would enable the federal government to cover 100% of the cost of COBRA coverage for workers who lost their employer-based coverage.
Telehealth use and availability increased during the pandemic. As a result, Congress and the Trump administration introduced various bills and regulatory guidance to employers, plans, and employees to enable telehealth usage. Much of this short-term guidance and regulation requires an extension by the Biden administration.
COVID-19 also highlighted the importance of paid leave. Many expect that the Biden administration will view paid leave legislation as a priority. The Biden plan specifically calls for 14 days of paid leave for the sick, exposed, or individuals subject to quarantines. Biden plans to pay for this leave through a federal fund that covers 100% of weekly salaries capped at $1440 a week.
How to Accomplish: Again, most of these plans require legislation to become law, though executive actions can lead to more coordinated testing, tracing, and vaccine distribution.
Likelihood of Getting Done: Biden may be able to garner Republican support for some short-term, emergency legislation – like paid leave. And he can leverage regulatory guidance – especially around items like telehealth – to affect some change. But other items may be prone to filibuster.
Make Prescription Drugs More Affordable
Biden’s health care plan – and the Biden-Sanders Unity Platform – would leverage the Medicare program to lower the cost of prescriptions. The administration would enable Medicare to negotiate prescription drug prices for all public and private purchasers regardless of where they get their coverage. They also propose tying the price of brand-name and outlier generic drugs to the inflation rate. Finally, they plan to cap out-of-pocket drug costs for seniors.
The Biden administration also supports importing drugs from other countries as long as they are certified as safe. Biden would also create an independent review board to recommend price parameters for expensive drugs with no competition.
How to Accomplish: Again, most of Biden’s plans require legislation to become law.
Likelihood of Getting Done: Lowering prescription drug prices earned the support of the Trump administration, though the administration accomplished little. That said, limiting drug prices for those prescriptions with little competition and limiting price increases could garner moderate bipartisan support.
Other Regulatory Actions
When the power shifts in Washington D.C., generally regulatory actions and activities follow suit. As a result, the Biden administration will modify some healthcare-related regulations. Regulations the administration will likely examine include healthcare nondiscrimination rules which prohibit discrimination based on race, color, sex, national origin, age, or disability. The Trump administration chose to curtail non-discrimination rules.
Association Health Plans – which enable small employers to band together to purchase health insurance – could also be tossed aside by the Biden administration. Short-term insurance expanded under the Trump Administration and the Biden administration can narrow their scope with regulatory actions. See our comparison of qualified health plans vs. short-term health plans for more information.
The Biden administration likely won’t modify price transparency and individual coverage health reimbursement accounts (ICHRAs). Read our short guide to ICHRA plans for more information. The ACA included some price transparency elements and the Biden administration likely won’t prioritize any changes. ICHRAs, as designed, positively impact the individual market, and the Biden administration likely won’t act to change them, either.
How To Accomplish: In most cases, these are regulatory in nature.
Likelihood of Getting Done: The Biden administration can implement the changes they desire.
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