President Biden and Vice President Harris take office with immense tasks ahead of them. The ongoing COVID-19 pandemic poses both significant challenges and significant opportunities to advance their health care agenda. During their campaign, they pledged to tackle the mounting economic and health care crises, as well as make progress on expanding access to quality, equitable, and affordable health care.
So, where can we expect to see the new Biden-Harris administration focus their efforts to improve the health of the nation and increase access to needed care?
Tackling the COVID-19 pandemic is a top priority for the new administration. Already, they are taking a distinct approach from the previous administration as they attempt to ramp up testing, vaccinations, and other public health mitigation strategies.
The administration has already indicated they plan to continue the Public Health Emergency (PHE) declaration through at least the end of 2021. This will allow many key Medicaid provisions to stay in place, including the enhanced federal financing for the states’ Medicaid programs and continuous enrollment for beneficiaries.
Beyond the support for Medicaid under the Public Health Emergency declaration, we can expect that the administration will look for additional ways to support and strengthen Medicaid. For example, the administration may push for increased financial incentives for states that have not expanded Medicaid under the optional provisions of the Affordable Care Act (ACA) to do so now. There is also likely to be a flurry of regulatory action that revises some of the previous administration’s guidance around waivers to the Medicaid statute that discourage enrollment or create work requirements.
Potential for a federal public insurance option
President Biden has been a staunch supporter of the Affordable Care Act. And, now is his opportunity to build on that legacy. Already, the administration is expanding access to the Health Insurance Marketplace and will likely dedicate more funds to outreach and enrollment. The president, though, is also likely to push for a bigger expansion that creates a new government-run insurance program as an option for individuals and families on the Marketplace.
We are already seeing a slew of executive orders – common when a new president first takes office – but some of these bigger picture health care reforms (such as a new public option) will require Congressional action. With a slim majority for Democrats in the U.S. Congress, this will be a challenging task because Democrats only hold 50 seats in the Senate (with a tiebreaking vote possible from the vice president) but most legislation requires 60 votes to pass. The administration and democratic congressional leaders will have to seek some level of compromise or consider institutional rule changes that would allow a simple majority to pass bills.
In the short term, expect to see the new administration continue to use executive and administrative action to push their health care agenda.