Healthcare was a major campaign issue when Donald Trump first ran for president in 2016. Joe Biden made it an issue during the 2020 race. As we prepare for a new administration – at the time of this writing, the inauguration was just six days away – all eyes are on Washington and its future plans for healthcare. What can we expect under a Biden administration?
For the time being, campaign promises are all we have to work with. The new president is unlikely to get everything he wants, but even passage of his most important priorities will redefine healthcare delivery and health insurance, at least for the next four years. Below are some of the potential changes we could be looking at.
Public Health Insurance Option
Though it seems likely the Supreme Court will uphold the constitutionality of the Affordable Care Act (ACA) when it renders its latest decision in June, it is also likely that the court will permanently strike the individual mandate from the law. In response, the incoming administration has hinted at a public health insurance option.
The public option would essentially be low-cost health insurance for people who are either inadequately covered by an employer plan or have no coverage at all. It is a compromise between Medicare for all and subsidized insurance through federal exchanges.
Increased Federal Subsidies
The Biden campaign has also talked about increasing federal subsidies in support of ACA exchanges. It is unclear why such subsidies would be required with a public health insurance option. So we could be looking at a one-or-the-other scenario. Biden campaigned on subsidies that would guarantee no one pays more than 8.5% of their income on health insurance.
Open Enrollment Expansion
Under the Trump administration, open enrollment was reduced to 45 days. The Biden administration is likely to roll that back to the previous standard. In addition, incoming administration seeks to establish a special enrollment period to accommodate people who need health insurance as a result of the coronavirus crisis.
Qualifying Health Insurance Plans
One of the biggest changes the Biden administration might pursue is how the federal government assesses qualifying health insurance plans under the ACA. Biden has talked about reversing a Trump administration rule that allowed for the sale of short-term health insurance policies.
Biden has also talked about reversing the Trump administration's associated health plan regulation. If the regulation is overturned, associated health plans would return to the previous rules in place under the Obama administration.
One final note regarding health insurance plans: the Biden administration could modify or reverse 2018 rules that gave insurers greater flexibility in providing Essential Health Benefits (EHBs). Modifications could reduce that flexibility and end the practice of substituting benefits within EHB categories.
Medicare and Medicaid Expansion
Regardless of action taken on any of the other items discussed in this post, the incoming administration is almost guaranteed to work on Medicare and Medicaid expansion. Lawmakers are already expecting to deal with proposals to reduce the Medicare eligibility age to sixty.
In terms of Medicaid, Biden has discussed the need to expand the program by increasing eligibility verification requirements so that more people qualify. It is possible the incoming administration will resend previous limits on Medicaid spending and revise regulations to make it harder for states to recoup Medicaid costs.
Bear in mind that all of this is speculation. We will not know for sure what the incoming administration will do until they get to work. The only thing that we can say for certain is that changes are coming. Such is the nature of healthcare in this country.