Health Policy in a Biden Administration

Coming out of a nail-biting start to November, all indications point to Joe Biden taking the oath of office come Jan. 20.

The 2020 election has significant implications for healthcare, ranging from the pandemic response to coverage expansion and drug pricing ─ just to name a few.

With Senate control uncertain until after the New Year due to the run-off of two senate seats in Georgia, the party in power will further shape the Biden administration agenda and outlook. With Republicans’ history of winning special elections in Georgia, it is most likely that the Republicans will win both seats, but this will be a massive electoral fight. Should the Democrats win both seats, they will have greater control over the legislative agenda, but will still be constrained by narrow majorities in the House and Senate.

Let’s dig deeper into what Biden administration health policy might look like as well as likely implications for U.S. healthcare providers.

Pandemic Response

As U.S. COVID-19 cases continue to skyrocket, the Biden administration has announced confronting the pandemic as first priority. Biden recently named 13 leading scientists and health experts to the Transition COVID-19 Advisory Board and tasked them with developing a COVID-19 action blueprint to be put into place on Inauguration Day.

Under a Biden administration, we can expect a very different COVID-19 management approach. We anticipate that the current setup of state and local municipalities responding independently to the pandemic will be upended, with the assertion of far greater federal control and management of the response. Much of this can be accomplished administratively ─ or in other words, under the authority of the President.

Biden’s approach would include:

• Investing $25 billion in COVID-19 vaccine manufacturing and free vaccines to Americans.
• Implementing a national surveillance program for COVID-19 and future pandemics.
• Working with state and local officials to increase use of masks including via mandates; federal guidelines on social distancing and business and school closures/re-openings based on risk level and degree of virus spread.
• Doubling the number of drive-thru testing sites and investing in next-generation testing.
• Leveraging the Defense Production Act to ramp up production of personal protective equipment (PPE).

Passing the next COVID-19 relief package is a Congressional priority with bipartisan support, though negotiations on the details will continue. Senate Majority Leader Mitch McConnell indicated that COVID-19 relief is a major priority in the lame duck period, and he spoke in support of additional provider relief payments. While COVID-19 relief may be closer in size to the Senate $500 billion version than the $2.2 trillion House version, we are unlikely to hear any details on the bill unless and until they actually can reach agreement. Barring that, a COVID-19 relief package is likely to be an early order of business in the first 100 days for Biden.

Biden Administration Healthcare Priorities

With either a divided Congress or with small Democrat majorities, it will be a tough environment for the Democrats through 2022, and for the Biden administration, in advancing big-ticket healthcare reform items.

It is unlikely we will see Medicare for All, a public option or Medicare negotiation on high-cost medicines. We expect the ACA to survive the latest U.S. Supreme Court test, although any major reforms in the near-term will elude Congress. A couple other actions that will be out of reach will include the age 60 Medicare buy-in and empowering Medicare to negotiate prescription drug prices.

Biden has also previously relayed a Plan to Rebuild the U.S. Supply Chain, which includes several key elements that align with Premier recommendations, from expanding strategic stockpiles and incenting domestic manufacturing to ensuring greater diversification and transparency.

Regulatory Scorecard

As president, Biden would wield significant regulatory power to advance his healthcare priorities, and he will rewrite or rescind many of the regulations put in place by the Trump administration. Look to see an aggressive healthcare regulatory agenda related to Medicare alternative payment models, Medicare Advantage, interoperability, pricing transparency, surprise billing, drug pricing, 340B and provider consolidation, Medicaid waivers and expansion encouragement and more.

Below is a list of healthcare-related Trump-era regulations as well as our projections as to whether the regulation stays (green), is stopped (red) or is changed (yellow).

Back to Bipartisan?

If there’s one key takeaway from the 2020 election, it’s that areas likely to advance will do so via bipartisan support. The healthcare-related areas where we anticipate movement include:

• Shifting public risk to private entities (i.e., Medicaid managed care organizations, Medicare Advantage plans).
• Continuing movement from fee-for-service to value.
• Increasing consumer access to cost and quality insights – ensuring good measures are in place and making them transparent.
• Increasing access to electronic health record (EHR) and claims data – driving interoperability.
• Addressing social determinants of health.
• Letting the private sector innovate and compete.

Over the next few years, the private sector will be aggressive in trying to innovate around interoperability, new payment models, the movement to risk/accountability and consumerism. Every healthcare provider needs to be tightly focused on strategy to prepare.

With the elections behind us, it’s imperative we get back to the task of advancing bipartisan policies to transform healthcare.

• Watch our on-demand webinar on this topic to go even deeper into Premier's post-election update, the likely legislative outlook, potential administration leaders and the new administration’s regulatory agenda.
• Stay up to date on our policy statements and perspectives from D.C.

Further reading.

• Top Things We’re Watching on Election Day
• On-Demand Webinar: Healthcare in an Age of (COVID-19) Disruption: Election Implications
• Premier, Health Groups Urge Congress to Maintain Value-based Care Incentives Beyond COVID-19