What The New Biden Administration May Mean For The Future Of Health Care

And, its impact on employers

When the Biden administration takes office in January, health care—or the lack thereof—will be front and center. Whether we see substantive changes in health care access, delivery and costs will depend in part on the level of bipartisan cooperation in Congress and President Biden’s willingness to embrace the Executive Order.

Not surprisingly, the immediate focus will be on managing the Covid-19 pandemic. The steps taken by President-elect Biden’s Coronavirus Task Force to establish a coordinated, national protocol for “flattening the curve;” ensuring the successful, widespread delivery and public acceptance of a vaccine; eliminating cost sharing for treatment; and providing economic support to employers and individuals will be critical to moving the country forward, and will lay the groundwork for future local, state and federal governments facing similar issues.

Concurrently, the Biden team must be ready to address the outcome of the SCOTUS ruling on the ACA. If the mandate is deemed severable or the court decides the parties in Texas v. California have no standing to sue, the Administration can focus on rebuilding those aspects of the ACA that were scaled back or eliminated—for example, by restoring funding to Obamacare promotional efforts and navigators as well as the original 12-week enrollment period. More broad-reaching changes, such as increasing subsidies, will likely be more difficult to push through, at least in the early stages of the administration. 
 

If all or part of the ACA struck down, the new administration will likely work with Congress to re-enact provisions with bipartisan support (e.g., protections for those with pre-existing conditions, coverage of preventive care at 100% and coverage of adult children to 26, etc.) until a new plan can be developed. It’s worth noting that it will be massively difficult to unwind the ACA, as it is now embedded in every aspect of health care industry and delivery systems. Further, employers, providers and insurers alike would not be happy about the “waste” of the billions of dollars they’ve invested to comply with ACA plan design, delivery and reporting requirements, and will undoubtedly express that opinion to their representatives.

Given the likely makeup of the Senate, the incoming administration’s more sweeping health care proposals may be back-burnered until President Biden is able to garner more bipartisan support. Medicare for all, a new public option and lowering the age for Medicare (whether automatically or through a buy-in option) will be a harder sell to Congress and the public, so we will probably see a focus on expanding Obamacare subsidies (if the ACA stands), a federal surprise billing law, continued support of telemedicine and reducing prescription drug prices. Many of these proposals were already top of mind for Congress and have wide industry and employer support.

President Biden will also likely follow the Trump precedent of using Executive Orders to unwind certain policies that appear to undermine the ACA and associated regulations--such as President Trump’s expansion of short-term plans, waivers permitting states to require Medicaid recipients to work in order to receive benefits, removal of the regulation prohibiting discrimination in health care against transgender patients who are transgender and multiple barriers to abortions.

Most employers will be taking a “wait and see” attitude before making any substantive changes to their health plans for 2022—if then. With the fate of the ACA up in the air until just before employers typically begin planning their benefits strategies, it’s not too early to begin developing contingency plans for the possible outcomes. 

Because government efforts to reduce the cost of prescription drugs are largely focused on federal programs such as Medicare, it’s unlikely that employers will see much relief on that front due to government efforts. 

For now, employers should concentrate on reviewing and revising their communication plans for 2021. Whether it’s explainers about how to use the hospital transparency data to save money once elective procedures can be rescheduled, a discussion of the company’s plans to adjust its benefits offerings in light of the SCOTUS ruling (or not), reminders of telemedicine coverage and the company’s approach to surprise billing—any efforts to improve employee health literacy have the potential to pay off in lower costs down the road and to prepare the workforce for changes to come.

In addition, the coming months offer a prime opportunity for employers to provide input to the new administration regarding proposed and pending legislation and ongoing challenges.

Kim Buckey is Vice President of Client Services at DirectPath, LLC, headquartered in Burlington, Massachusetts. Buckey is DirectPath’s key advisor and senior subject matter expert on new and evolving compliance issues that affect employers as a result of the Affordable Care Act. Buckey, who founded and directs the compliance communications team, works closely with sales, marketing, and product development to explore the potential impact on customer segments and develop new products and services to support current and anticipated needs. Buckey has some 40 years of communications experience, 35 of which focus on the delivery of compliance communications for health/welfare and qualified (savings/pensions) plans. Buckey’s team provides strategy, review and analysis, content development, and management services, giving guidance on mandates like the required Summary of Benefits and Coverage (SBC). Visit www.directpathhealth.com Connect Kim Buckey Follow @SPDkim