With the presidential election three weeks away, healthcare policy experts are weighing how the industry would be affected if the White House were to change hands from President Donald Trump to former Vice President Joe Biden.
While a Trump win would obviously remain on a similar course for the next four years, experts say key issues a Biden administration would likely try to change range from policies on coverage to value-based care and the age for Medicare eligibility.
Here’s a look at three ways healthcare could change after the presidential election:
1. Push for more coverage
No matter who wins, the next president will need to confront mounting job losses due to the COVID-19 pandemic that have had a direct impact on health coverage, experts say.
An analysis from the Commonwealth Fund estimates as many as 14 million Americans could lose their health insurance due to job losses or because they are dependents of someone who holds an employer-sponsored plan.
The lingering financial crisis will prompt a major emphasis on expanding insurance coverage to offset the millions of people who could lose their employer-sponsored insurance, some experts said. “For health industry leaders, providers and payers, coverage has to be on their mind more acutely because of the pandemic,” Ben Isgur, head of PwC’s Health Research Institute, told Fierce Healthcare.
Biden’s campaign has proposed the creation of a public insurance option similar to Medicare for customers on the individual market. But a public option would require an act of Congress.
It remains unclear whether there would be enough support in Congress to get a public option approved, even if Democrats retake the Senate in November. The Obama administration tried to add a public option to the Affordable Care Act (ACA). However, while the House passed a version of the ACA with a public option, it wasn’t able to get enough support in the Senate.
The same scenario could occur this time around if strident Republican opposition to a public option holds firm.
But prospects for a public option could greatly improve if Democrats gain control of the Senate next year and decide to eliminate the legislative filibuster. Some Senate Democrats have threatened the move after Senate Republicans took up the nomination of Judge Amy Coney Barrett six weeks before the election to replace Justice Ruth Bader Ginsburg, who died late last month.
If Biden were to win, it’s also expected he would employ a series of moves to shore up the ACA’s insurance exchanges. The administration could also pursue a change in eligibility for the subsidies to ensure more people qualify for income-based tax credits that lower the cost of premiums, Isgur said. They could also fully fund marketing of the exchanges after cuts from the Trump administration.
The moves would be a stark departure from the Trump administration, which has supported lawsuits and legislation challenging key elements of the ACA. Trump has previously said he’ll release a comprehensive replacement plan but has not unveiled anything as of yet.
In December 2019, a federal district court in Texas ruled the landmark healthcare law’s individual mandate is unconstitutional but punted on the question of whether that mandate can be excised from the remainder of the law.
A collection of blue states appealed the decision to the Supreme Court, which will hold oral arguments on the case on Nov. 10. A decision by the court is expected in June at the earliest.
Early on, the administration cut funding to ACA marketing by 90% when it took office and also cut funding by $26 million to the ACA’s navigators, which assist consumers in picking plans. Enrollment in the ACA’s exchanges has remained relatively stable despite those cuts, and private insurers who retreated from the exchanges a few years ago due to financial losses have started to return and offer plans.
However, enrollment among the population that doesn’t get income-based tax credits has plummeted.
Isgur said a Biden administration could do research into why the unsubsidized population has dropped so steadily.
The administration could look into whether there is a “larger structural issue where there is a gap where people who work for larger employers and people who may be self-employed and trying to understand what kinds of strategic changes to be made,” he said.