The presidential election victory for Joe Biden, who surpassed the 270 electoral votes needed to snag the win after voting continued over the weekend, could have significant ramifications within the health care delivery system, and for medical groups specifically.
From fresh support for the Affordable Care Act (ACA), which became law during former Vice President Biden’s tenure in the White House, to an expansion of COVID-19 stimulus dollars, the trajectory of a Biden presidency could expand coverage to patients and add funds to weary health care providers.
What’s at stake for the ACA
That ACA will face an immediate test from the newly filled Supreme Court, set to begin hearings on California v. Texas on Nov. 20, just two and a half weeks after the election.
While some experts think the ACA still has a good chance of surviving, the odds of a full repeal seem higher than ever. If all or part of it falls, even many of your non-exchange patients will have to rely on lawmakers to restore its protections to the extent they can.
Biden, who has explicitly run on protecting the ACA, can be expected as president to move to reinstate as much of the law as possible if it’s overturned. A key question will center around the subsidies that the ACA provides to cover the cost of coverage.
People in exchange plans, which are subsidized by the ACA, will find those dollars gone — and, most likely, their insurers unwilling to pick up the slack.
“If the law is struck down, there are no more subsidy dollars,” says Ruth Tabak, associate director at Berkeley Research Group (BRG) in Washington, D.C. “There’ll be no more money to pay the plans for enrolling people.”
This is where state governments would have to step up. Experts believe insurance commissioners and other officials will move to defend in some way those parts of the law that remain popular. If their current regulatory authority is insufficient, states might rush to pass new laws, requiring insurers who want to do business in the state to maintain ACA coverage terms.
“We would likely see the insurance commissioners move very, very quickly to make sure that people don’t lose coverage immediately,” says Heather Meade, principal with Washington Council Ernst & Young in Washington, D.C. There may also be a rush in Congress to “put a stay on any action” until arrangements can be made for beneficiaries who might lose coverage, she adds.
“Health insurers and providers will want quick answers as to how Biden’s administration plans to compensate them for this expanded coverage while avoiding a return to high-risk pools for patients with pre-existing conditions,” Schmeltzer says. “Insurance companies are not going to want to take huge losses on insuring this population without government assistance.”
Mike Strazzella, head of the Washington, D.C., office of law firm Buchanan, Ingersoll & Rooney and practice group leader for federal government relations, thinks insurers will step up to try and retain their beneficiaries, though not necessarily on the same generous terms as before. Insurers will ask, “Is there a way to transition patients to other plans?” he says. “Or create other opportunities for them to maintain some type of coverage? I don’t think insurance companies want to see people uninsured.”
But if coverage and price supports are removed by the decision, Strazzella admits, that might lead to fewer covered Americans.
“[If coverage is affected] in times of economic distress, such as under COVID-19, people will make a decision economically about whether to spend any more money on insurance,” Strazzella says. “Without incentives, without [rules about] affordability, it has the potential to lead to hard decisions.”
What else is at stake
Under a Biden presidency, the likely next steps from a new Democratic administration would center on COVID-19 and a potential stimulus rather than a health care reform package, Meade told HealthLeaders, a sibling publication of Part B News. She added that the Biden administration would likely focus on a legislative package that provides funding for both potential vaccine distribution and coronavirus testing.
Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA), told HealthLeaders that the Biden healthcare platform is “ambitious” but also “doesn't have a lot of details.”
Gilberg said that if Biden is elected he has the potential to “create a little bit more stability” in the system by strengthening the ACA, establishing a public option and lowering the age to enroll in Medicare to 60.
Additionally, Gilberg said there is likely to be a difference between the approach to regulatory reform under a Biden administration.
“On some of these issues, such as value-based care, price transparency, and surprise billing, I could see a Biden administration potentially going a step farther than what Trump has proposed,” Gilberg said. “What you're likely to see under a Biden administration that is different [from the Trump administration] is spending more time issuing regulations. The Trump administration has talked about a lot of things but they haven't really implemented much nor have they rolled back much, like through their Patients Over Paperwork initiative. It's difficult to tell a group of executives who run medical practices that they have less paperwork and red tape than they did four years ago.”
Ted Kennedy Jr. works as a member of Epstein Becker Green's health care and life sciences practice. Kennedy, son of former Sen. Ted Kennedy, D-Mass., served as a member of the Connecticut Senate from 2015 to 2019.
Kennedy said he is focused on four main areas of health care policy distinction between Trump and Biden: coronavirus regulatory relief, surprise billing, drug pricing and health coverage expansion.
He said that it is unlikely that a Biden administration would pursue a 'Medicare-for-All' style proposal and would instead focus on lowering the age of Medicare eligibility to 60, as Democratic vice presidential nominee Sen. Kamala Harris, D-Calif., discussed at the sole vice presidential debate last month.
“[Harris] specifically mentioned allowing Americans to buy in to Medicare at 60, and I think the reason why that idea has legs now is because of the 'job lock.' In order to make room for newcomers in the marketplace as we try to emerge from the pandemic, allowing people to buy in is just a good idea so that [consumers] can have job flexibility,” Kennedy said, according to HealthLeaders. “I also think the overall cost of commercial plans will go down because you are taking these individuals who are probably more high utilizers, people between the age of 60 and 65, out of the risk pool. This means that the cost for regular commercial health insurance below 60 is likely to go down because of that.”
Part of this story originally appeared on HealthLeaders, a sibling publication of Part B News.