What to expect next on the agenda in the 117th Congress and the incoming administration on healthcare.
At A Glance
- Pandemic response will dominate 2021 and may remain the priority healthcare issue long into Biden’s first term.
- The Biden Administration will use the administrative state to expand access.
- Drug pricing and surprise medical billing will continue to receive significant attention.
Lay of the Land
President-elect Biden’s first, second and third priorities in the healthcare space will be responding to the coronavirus pandemic. With two promising vaccines moving through the research, development and approval processes, there is hope that the country will get through the worst of the pandemic sometime in 2021, allowing the Biden Administration to shift its focus to systemic reforms.
Assuming the Affordable Care Act (ACA) is not struck down by the Supreme Court, the incoming administration will work to build on the ACA’s foundation. Biden’s healthcare plan reflects his centrist, pragmatic instincts. However, Democrats’ hopes for an expansion of the Affordable Care Act and introduction of a public option will be on hold if, as seems likely, Republicans maintain control of the Senate. There is bipartisan agreement that healthcare costs in general, and prescription drug costs in particular, should be a priority, but identifying bipartisan policy solutions has been difficult.
Congress
Congress will focus its immediate attention on fighting the coronavirus pandemic. With hopeful signs on vaccine development, ensuring that there is a plan for distribution will be the highest priority. Congress is also certain to react to any administrative efforts to reduce the spread of the virus until a vaccine is produced and distributed, looking to balance economic and health concerns.
- Covid Response. The Biden Administration will look to centralize many aspects of the government’s response to the pandemic more than the Trump Administration has to date, from acquisitions of personal protective equipment (PPE) to testing and contact tracing. The Republican-led Senate will focus its oversight efforts on these efforts while the Democratic-led House will look to support the Administration with funding and making the policy case for increased centralization.
- Surprise Medical Billing. Looking beyond the pandemic, Democrats have had success in recent elections prioritizing healthcare issues. The Trump Administration tried to take some steps to reduce surprise medical billing, but both there continues to be division within both the Republican and Democratic caucuses on the best policy to address the issue. Republicans resistance is likely to be more solidified with a Democrat in the White House, but political pressure could force action as the pandemic heightens concerns over the issue.
- Drug Pricing. As with surprise medical billing, there is general agreement that prescription drug pricing must be dealt with, but no consensus among the parties on the best policy to pursue. Allowing the federal government to negotiate drug prices for Medicare beneficiaries, the Democrats’ preferred approach, is a nonstarter with Senator McConnell and the Republican-led Senate.
The Administration
The incoming administration will focus almost exclusively on its pandemic response. As noted above, President-elect Biden has indicated that he favors a more centralized approach than the current administration. They will also work to rebuild some of the federal infrastructure around the ACA that the Trump Administration defunded and deprioritized. With a divided Congress unlikely to find legislative ways to expand coverage and reduce costs, the Biden Administration will look for administrative ways to accomplish these goals.
- Covid Response. Biden has stated that he wants a more coordinated response to the pandemic, including a federal pandemic testing board, free testing for everyone, mobilizing a cadre of national contact tracers, and possibly further use of the Defense Production Act to ensure a sufficient supply of PPE. Developing a vaccine distribution plan will be the highest priority.
- Healthcare Access. With legislative action on expanding access to healthcare unlikely, the Biden Administration will take a page from its predecessors and seek to use the administrative state to expand access to Medicaid and Medicare. The Trump Administration allowed states to tighten restrictions on Medicaid by implementing work requirements and creating additional restrictions on eligibility and benefits. President-elect Biden will likely use these same authorities to shift policy in the opposite direction, allowing states to expand enrollment in these programs.
- Opioid Addiction. The opioid epidemic has been somewhat forgotten during the pandemic. Expect the issue to return to the forefront when the pandemic subsides. President-elect Biden has emphasized increased access to treatment services, reducing prescriptions, and continuing to put legal pressure on pharmaceutical companies that public health officials agree helped fuel the crisis.
- Racial and Ethnic Health Disparities. The Biden Administration is likely to look at the racial and ethnic health disparities that were laid bare by the pandemic. It is an issue that is timely and speaks to the multiracial coalition that helped elect Biden. Improved distribution and analysis of the data on health outcomes from Covid will be the first step, but identifying policy solutions will be an ongoing discussion.