By Jeffrey Meyers and Benjamin Pollack, Guidehouse
The nation has officially elected Joe Biden as the next president of the United States and the Democratic Party has assumed a majority in both chambers of Congress.
President Biden has signaled that he will focus his immediate attention on the dual crises in healthcare and the economy, as well as the ongoing fight for racial justice and against the divisions that have torn our country apart.
As the pandemic continues, the challenges surrounding vaccine distribution and administration will keep healthcare at the top of the new president’s agenda. Additionally, the shift in leadership in the Senate may now provide Biden and his nominee to lead the Department of Health and Human Services (HHS), Xavier Becerra, new latitude in advancing a post-COVID-19 healthcare agenda that more closely mirrors the Biden Healthcare Plan.
During his campaign, Biden signaled his intent to bolster and build on the successes of the Affordable Care Act. The Biden Plan aims to insure 97% of Americans using policies that emphasize access, quality, prescription drug reform, and preserving healthcare as a right.“Instead of starting from scratch and getting rid of private insurance, he has a plan to build on the Affordable Care Act by giving Americans more choice, reducing healthcare costs, and making our healthcare system less complex to navigate.” - Biden’s Healthcare Plan
Five Pillars Underlying the Biden Healthcare Plan
The Biden Plan would enable Medicare to negotiate pharmaceutical prices, limit launch prices and price increases for certain brands and biotech pharmaceuticals, allow Americans to purchase pharmaceuticals from other countries, remove pharmaceutical corporations’ tax breaks for advertisements, and accelerate the development of generics.
Other priorities in Biden’s plan are to address healthcare market concentration; increase wages for low-wage healthcare workers, including home-care workers; expand access to reproductive healthcare and mental healthcare; and reduce disparities in the provision of care and its outcomes.
While the shift in Senate control may breathe new life into the Biden agenda, significant changes will be hard to achieve.
This is especially true if the filibuster rule remains intact, which may require 60 votes to move legislation such as the public option forward. For that reason, the new president is likely to use regulatory levers and executive orders, as well as demonstration and waiver authority at the Centers for Medicare & Medicaid Services (CMS), to further his healthcare agenda.
In its final weeks, the Trump administration moved aggressively to issue new healthcare regulations, guidance, and Medicaid waivers. It has issued final regulations on insurer price transparency to mirror last year’s final rule governing hospital price transparency, adopted a new market-based approach to set hospital reimbursements, and issued a first-in-the-nation waiver authorizing use of a block grant to fund a state’s Medicaid program.
How the new administration responds to some or all these initiatives may not be fully addressed until Biden rounds out his healthcare team at CMS.
Beyond responding to the COVID-19 pandemic, there are six key healthcare challenges the new administration will confront.
Reimagining the role of public health in healthcare was brought to the forefront by the COVID-19 pandemic, but it also offers the next administration an opportunity to revisit the structure of federal healthcare agencies, especially the role and function of CMS. Some healthcare commentators have suggested that CMS be elevated to a Cabinet-level department and its scope broadened to continue to drive the transformation of healthcare—an idea worthy of early action by Congress.
Importantly, the inauguration of a new administration can both bring opportunities and risks in healthcare.
Industry organizations—payers, providers, and states alike—all need to be prepared to manage impending change.
Every election brings change. The impact of the latest election cycle, occurring amidst a pandemic that itself will remake healthcare, could be profound.
Strategies for Payers/Insurers
While commercial insurer earnings may have been stable through the early months of the COVID-19 pandemic, there are several trends that should impact both their thinking and planning.
Strategies for Providers
Still reeling from the impacts of the COVID-19 pandemic, hospitals, health systems, and other providers continue to face regulatory challenges on the immediate horizon—the final price transparency rule, the interoperability and patient access rule, and significant new reporting requirements under the 2021 Inpatient Prospective Payment System. Scenario planning to take account of several changes will be key.
Strategies for States
Decreased tax revenues and increased demand for services such as Medicaid are already driving state budget deficits. There are several actions states should consider to address current challenges and plan for future needs.
With the “changing of the guard” and accompanying political developments, now is the time for public and private industry organizations to come together and strategically position themselves to mitigate risk and capitalize on these opportunities.