In approximately two months, Joe Biden will be sworn in as the 46th President of the United States. In what was deemed one of the most pivotal elections in our country’s history, healthcare was on center stage for many voters. As the final votes are tallied, the focus now shifts to President-elect Biden’s plan for our country moving forward. He will be entering his term as the country continues to break somber records, tallying more than 150,000 new COVID-19 cases on a daily basis. Hospitals are overflowing and understaffed. Clinicians are being pushed harder than they ever have been before. Nurses are being stretched to the point of mental exhaustion. Hospital administrators are seeing their facilities sinking. Albeit large, this is only a piece of the pie that is healthcare in the United States. In looking ahead to a Joe Biden presidency, these are some of the issues we will see discussed.
COVID-19 Pandemic Response and Relief
Early in November, the U.S. passed a grim statistic – 10 million total COVID-19 cases. Cases are currently surging with no visualized end in sight. Many healthcare professionals saw a slight respite after state lockdowns were forced, but we are once again facing the harsh reality of case numbers outweighing facilities, supplies and staff. Hospitals and care groups are looking for additional federal funding, particularly as many are being faced with the possibility of suspending elective and low-priority surgeries for a second time this calendar year.
There is potential to see another round of stimulus relief before President Trump completes his term, but this is unlikely. Since March, the federal government has provided close to $200 billion to hospitals and providers. A portion of this allocated money has come in the form of Medicare loans, which will need to be repaid barring loan extension or forgiveness. Hospital systems and care groups also will need clarification from the Biden administration on payback and ongoing relief rules through the Coronavirus Aid, Relief and Economic Security (CARES) Act.
Many voters and healthcare officials were encouraged by President-elect Biden’s choice to name a COVID-19 task force – made up of multiple physicians, commissioners, agency officials and researchers – to help smooth the transition between administrations, but are still uncertain of future mask mandates, vaccine production schedule/efficacy, therapeutic medications and future prevention of similar outbreaks.
Healthcare Insurance Coverage and Promotion of the ACA
As a result of the COVID-19 pandemic, millions of Americans were either furloughed or terminated from positions they held entering 2020. Although unemployment rates are dropping into the end of the year, many are questioning what their health insurance futures are going be, come 2021. For the vast majority of insured Americans, their health insurance is connected to their employment. Without this coverage, patients may avoid needed preventative care and could be faced with major medical expenses were an emergency to occur.
Assuming the ACA passes the Supreme Court review, President-elect Biden has vowed to build on what was put forth by the Obama administration. He will likely address premium subsidies and their cost, pushing for expansion. The current writing provides subsidies for households that make up to 400% of the current federal poverty level. We will also see the Biden administration move to change ways the Trump administration has challenged the insurance exchanges. However, the biggest component of the ACA that will undoubtedly draw opposition from GOP House and Senate members will be inclusion of a Medicare-like program that would be offered as a public option to people of any age and would compete with private insurance carriers and plans. If Republicans hold control of the Senate, a public option will likely be dead on arrival.
Medicare and Medicaid Expansion
Combined, Medicare and Medicaid provide coverage for over 100 million people. The Biden administration will likely move to expand eligibility for both. President-elect Biden has said, on multiple accounts, he would prefer to lower the age of Medicare eligibility to 60 while including dental, optical and hearing coverage as standard components. With current Medicare guidelines, patients need a supplemental insurance plan to cover these latter components.
Historically, Medicare spending has not been entertained on the right side of the aisle. Like the possibility of a Medicare-like public option, this issue might not go far. Regarding Medicaid, the Biden administration may need to get creative to change the program. There will likely be proposed rollbacks of Trump administration actions, specifically in terms of reporting requirements and payment limitations. The Biden administration will also likely push for an increased federal match rate for Medicaid.
Prescription and Health Care Costs
This is the biggest area where President Trump and President-elect Biden have similarities. Under a Biden presidency, we will continue to see a push to end “surprise” medical bills and lower prescription drug prices. This will likely come through the government negotiating drug prices on behalf of Medicare beneficiaries. This has received pushback from the Senate over the past two years and may not see the light of day in a Republican-held Senate. “Surprise billing”, however, will likely get a bipartisan consideration. This refers to a situation where a patient receives hospital care in-network but is treated by an out-of-network provider. The patient is then billed directly by said provider, often at a much higher rate.
Telehealth Capabilities and Coverage
The capability of connecting with patients through telephone and video services has provided benefits for both the patient and the care group. In some settings, telehealth, more than any other service, has saved hospital systems and care groups from massive layoffs, facility closure or complete elimination of services. Telehealth has allowed providers to connect with patients who may have elected to avoid a clinic setting due to COVID-19 concerns. Many providers have received overwhelming approval from patients and have bolstered trust and continuity of care thanks to Telehealth services. The Biden administration will be tasked with extending or making permanent telehealth waivers that were established in response to COVID-19.
Expect President-elect Biden to reverse the restrictions placed by President Trump on federal funding for agencies providing abortion counseling, such as Planned Parenthood. President-elect Biden and Vice President-elect Harris have been vocal on their stance concerning Roe v. Wade. We will likely see this administration push to maintain this position and increase federal funding to protecting a woman’s liberty to abortion without excessive government restriction and access to low and no-cost contraception coverage.
Although this is not an exclusive list, it likely encompasses what the Biden administration will try and tackle over the next four years. As in previous administrations, there will be assumed pushback from both the House and Senate, but regardless of political stance, these are issues are country is facing and will have to address together.
Predicting the Impact on Patient Experience
With these topics being at center stage in the healthcare plan of the Biden administration, patients will need open channels of communication between their providers more than ever. Providers will be tasked to clarify patient concerns and confusion about care costs, national/global recommendations concerning ongoing COVID response, vaccine administration, and drug prices.
We will see an encouragement of healthcare shopping, and patients will continue to pursue telehealth options, due to their lower cost, convenience and safety. In the coming four years, and beyond, providers should offer increased and personalized communication to their patients, remap the traditional patient journey, fine-tune internal processes to promote the desire for patients to return, invest in telehealth communications and continue to acknowledge patient fears and concerns.