Healthcare has been a hot-button issue in 2020, with the current presidential administration attempting to render the Affordable Care Act obsolete on numerous occasions. Coupled with the dire conditions of the pandemic, healthcare remains at the forefront of American minds.
The still ongoing election exacerbates many of the worries Americans have about healthcare, especially those with chronic conditions covered by the Affordable Care Act, because its policies drive down the cost of their treatments.
As COVID cases and deaths begin to peak during the winter, more Americans are experiencing first-hand the harsh realities of our healthcare system. For minority groups and low-income households especially, the obstacles to obtaining healthcare depend on the behavior of current federal leadership.
Biden’s campaign has publicized its goals to improve healthcare for all citizens, but the path forward is still unclear. With election results in the House and Senate still being finalized and growing pressure to create and distribute a COVID-19 vaccine, many questions about healthcare’s future remain unanswered. The American people want to know how the pandemic will shape the perception of public health in 2021, Biden’s strategy to contain the virus, and how he will leave his impact on the US healthcare system during the next four years.
To envision healthcare’s potential realities in 2021 and beyond, one must understand Biden’s goals to combat current health challenges. Biden’s healthcare plan revolves around increasing accessibility to all, regardless of race, gender, income level, or disability. According to his campaign site, he has pledged to institute several new reforms such as the continuation and improvement of the Affordable Care Act, a new public health insurance option for all Americans, expansion of coverage to groups in need, and limiting the power of drug corporations.
AFFORDABLE CARE ACT
The Affordable Care Act was initially intended to provide private and public health insurance to millions of Americans lacking healthcare coverage. Since the beginning of Trump’s term, it has been clear that the Affordable Care Act has been at risk for dissolution. His administration has been determined to repeal the act through the courts and upend the developments made with Obamacare. Now Biden is looking to not only protect the Affordable Care Act but to expand its policies to improve on what he and Barack Obama accomplished before Trump took office. To do so, Biden hopes to offer a unique public healthcare option and expand coverage to Americans in need.
PUBLIC HEALTH INSURANCE OPTION
One of Biden’s most ambitious goals in expanding the ACA is to create a “public health insurance option” for all Americans. Under this policy, people can choose to pay for public insurance like Medicare or Medicaid in addition to or in lieu of private insurance. A Medicare-like insurance option would cost less than most private insurances. Because it would also generate lower profit margins than private options, this plan may lower insurance premiums for those in poverty. By competing with private insurance offerings, the public option would also enable the government to bring down costs for healthcare visits and hospital stays. While this addition to the ACA has attracted much support from progressives, the chances of it being passed in a Republican-controlled Senate is slim. Yet, it could be a step forward in providing more affordable and comprehensive care to Americans burdened by the current healthcare system.
EXPANDING COVERAGE TO GROUPS IN NEED
In another step towards healthcare for all, Biden promises to protect financially disadvantaged households and individuals by offering better coverage. Biden aims to lower insurance premiums and increase coverage by upping tax credit value. According to his campaign website, Biden plans to do this “by eliminating the 400% income cap on tax credit eligibility and lowering the limit on the cost of coverage from 9.86% of income to 8.5%.”. This will allow families to purchase coverage and receive tax benefits without strict income restrictions. In his fight for inclusive healthcare, Biden also hopes to protect reproductive rights, decrease the mortality rate for mothers of color, and protect citizens from increased premiums due to gender or sexual orientation.
LIMITING POWER TO DRUG CORPORATIONS
The Biden administration also wants to ensure drug corporations negotiate drug prices with Medicare to prevent price spikes when they are launched or abusively inflated by review boards. Additionally, the team hopes to increase support and supply for the generic versions of medications, even allowing citizens to use imported medicines from countries outside the US. Currently, the government does not have the right to negotiate prescription drug prices. This policy was a result of the fight for prescription drug benefits to be included in Medicare during Bush’s presidency. To sway Republican voters to allow prescription drugs under Medicare, “Part D” of the plan put Pharmacy Benefit Managers (PBMs) in charge of negotiating drug prices. Big Pharma companies have argued for years that allowing Medicare to negotiate prices down would strip away funds needed for precious R&D. However, several studies have found that many innovative drugs come from research done at universities and biotechnology companies, not large pharmaceutical companies. Biden’s fight to ensure drug price negotiations attempts to finish the work Obama started but failed to accomplish during his presidency. This policy passed in House this past year but did not gain Republican support in the Senate. This could likely happen again if the House and Senate split their vote along party lines during the Biden presidency.
BIDEN’s BEST AND BRIGHTEST
Although Biden has addressed his plan to improve healthcare for all, the question remains: will he be able to keep the promises that he has made and build upon Obamacare’s legacy? Although a divided Congress will make landmark healthcare reform unlikely, Biden may have better success through his White House leadership picks. His choices for Secretary of Health and Human Services (HHS) and the Administrator of the Centers for Medicare & Medicaid Services (CMS) will be imperative to implementing his healthcare plan.
Several of Biden’s likely nominees were active during the COVID pandemic, including Michelle Lujan Grisham, an advocate for social distancing and free testing, and Vivek Murthy, a surgeon during the Obama era and prominent member of Biden’s pandemic task force. Outside of pandemic-related issues, other potential picks align with Biden’s pledge to provide healthcare to all. Health Chief Rebeka Gee has experience supplying Medicaid members unlimited hepatitis C medicine to eliminate the disease in Louisiana, and Karen Bass is a proclaimed supporter of “Medicare for All.” Other picks seem better fit to encourage compromise with a split Congress. Mandy Cohen, the nominee for Secretary of Health, served under both a Democratic governor and a Republican-led state legislature. Similarly, Secretary-Designee of Wisconsin Andrea Palm is steadfast in enforcing strict lockdown procedures despite the Republican-run Wisconsin legislature’s pushback.
Ultimately, the pandemic has created a unique and heightened focus on the topic of public health. Will healthcare overall, beyond COVID-19, continue to be a top priority in Biden’s term? It will be interesting to observe the pandemic’s long-term effects on the prioritization of health issues in American politics. The topic of healthcare will undoubtedly be at the top of Biden’s agenda in the coming months, but whether this will remain a lasting priority is yet to be seen. Currently, it seems unlikely that Biden will achieve a second term by putting healthcare in the backseat.