During the 2020 election season, healthcare was a major topic of discussion, with focuses on the Affordable Care Act and COVID-19. Now that President Joe Biden has been voted into office, we’re starting to heavily consider what the next four years of American health care legislation may look like. Here’s some of what we’re expecting to see, and when we’re expecting to see it take place.
COVID-19 Response and Research
Top of mind for most Americans right now where healthcare is concerned is how the government is handling the COVID-19 pandemic. The Trump Administration began efforts to fund research and vaccine development, although many leaders in the healthcare industry independent of any political party believe more could be done. President Biden’s plan involves expanding regulations and government assistance in many ways. His tentative seven-point plan includes:
- Access to regular, reliable, and free COVID-19 testing
- Increases in the supply of personal protective equipment
- Evidence-based guidance on how communities could navigate the pandemic
- Equitable distribution of treatments and vaccines
- Increased protections for older and high-risk Americans
- New defenses for predicting, preventing, and mitigating pandemic threats
- Mask mandates nationwide
These seven points were designed to reduce COVID-19 through scientific, evidence-based procedures. Additionally, he plans to fund more research to continually develop new strategies, and bolster federal aid and assistance to relief efforts as soon as he is inaugurated.
The Affordable Care Act and Health Care Accessibility
Over the past four years, the Republican Party and former President Trump have worked to modify, repeal or replace the Affordable Care Act, oftentimes through lawsuits. These cases have reached the Supreme Court multiple times. Currently, the piece of legislation that is being challenged by case California v. Texas is the individual mandate, or the requirement that Americans without insurance plans purchase them. As the case currently stands, the fate of the ACA is unclear, as the Supreme Court is not expected to hear the case or make a ruling until the middle of 2021. However, one of the legal challenges the Supreme Court will consider in conjunction with the individual mandate is the overall constitutionality of the massive government health care law.
In the past several years, the ACA has already made significant changes to how Americans access insurance by drastically lowering the uninsured rate. Additionally, the ACA Marketplace offers new enrollment options to many people who were not insured due to cost or lack of employer-sponsored options, and were also ineligible for Medicaid or Medicare. The debate over how to expand the ACA is still ongoing in many states, but that’s likely to change after the inauguration of President Biden and Vice President Kamala Harris.
While he was Vice President under the Obama Administration, Biden was involved throughout the entire process of developing the ACA and pushing it through Congress, and his close proximity to its creation will be reflected in his health care plans. He plans to defend it to the best of his ability, and eventually expand it.
One of the first things the Biden Administration plans to do to expand the ACA is to increase the value of the tax credits people receive for the private insurance plans they purchase through the Marketplace, and expand upon who can receive them. This in turn will decrease the cost that people have to pay out of pocket, and should attract more people to the options that the Marketplace offers.
A New Public Option
In addition to these federal government subsidies and tax credit changes, Biden and the Democratic Party plan to develop a new public option for health care that anyone can benefit from. Current options are limited based on income, disability status and age as required by Medicaid and Medicare. This plan will likely pursue the idea of universal health care that many politicians and pundits have been vying for in recent years, and will drastically increase government spending in this area. To start, Biden plans to remove the eligibility cap (currently 400 percent of the FPL) from Marketplace plans and lower coverage limits. This will create a system of health care that resembles Medicare, though it’s unclear how exactly this idea will move forward as the battle over universal health care continues in the Senate and House of Representatives. By working to pass these measures over the course of the next few years, Biden also hopes to provide health insurance for over 97 percent of Americans.
Updates: The American Rescue Plan Act of 2021
In March 2021, President Biden signed the American Rescue Plan Act into law. Besides providing financial stimulus to families struggling through the effects of the COVID-19 pandemic, this legislation has also ushered in the first step of Biden’s Affordable Care Act expansion. Some of the most significant changes to federal healthcare regulations that this law implements include:
- Deadline for the special open enrollment period for Marketplace plans extended to August 15, 2021.
- Out-of-pocket costs have been lowered for people covered by the ACA who make between 100-400 percent of the federal poverty line.
- People who earn 100-150 percent of the FPL will no longer have to pay a monthly premium for their health insurance
- ACA plan premiums are capped at 8.5 percent of income for those who make more than 400 percent of the FPL (where previously plan costs would have gone up dramatically)
Reducing Healthcare Costs
The Trump Administration worked through a series of executive orders to bring down healthcare costs by reducing or eliminating surprise medical billing, lowering drug costs, mandating price transparency and reducing the out-of-pocket cost of care for seniors. Biden will inherit many of these regulations, although many of his goals are more expansionist, such as lowering the Medicare minimum age to 60 and expanding Medicaid and ACA regulations. Again, much of this will depend on the result of the Supreme Court Affordable Care Act case, California v. Texas, that will be heard later this year. However, despite previous opposition to ideas like price transparency, it’s likely that the Biden Administration will continue to pursue these regulations.
Additionally, Biden has said that part of his health plan is to crack down on surprise billing and market concentration, attempting to reduce the amount of pricing power that many large pharmaceutical companies currently possess (which often drive up prescription drug prices). He also wants to create education and income incentives that will help bring more health care workers into the industry.
Value-Based Care is an emerging alternative health care model that has gained bipartisan support. The Biden Administration will likely continue pursuing ways that this model could work, although it will also explore other alternatives to push the universal health care agenda forward , such as offering reimbursement incentives for preventive health care goals.
We’re Here to Help
Healthcare change can be difficult to understand, especially as healthcare organizations work daily to maintain a healthy revenue cycle no matter what current regulations are. At DECO, we stay up-to-date on the latest health care information so we can help our clients work through health care issues and reimbursement on a day-to-day basis. As a new President takes over the White House and new legislators arrive on Capitol Hill, we will do our best to help you take all of the upcoming changes to regulations in stride. Contact us today for more information.