Payers Expect Biden to Expand Affordable Care Act in 2021

The American Benefits Council (ABC) issued a release outlining what payers should expect legislatively post-election including COVID-19 relief and stimulus legislation, Affordable Care Act expansion, and other efforts to ensure Americans have access to the coverage they need.

“Without the support of a fully Democratic Congress, President-elect Biden’s broad health plan will be largely stalled,” the release stated. “However, there may be some opportunities for more targeted bipartisan health care legislation and the Biden administration will turn to executive action to pursue policy changes without Congress.”

“If Democrats win both Senate seats in Georgia and the Democratic sweep does materialize, more dramatic changes for employer-sponsored coverage may lie ahead,” the release continued.

In terms of healthcare coverage, President-elect Biden has stated that his administration will “protect and build on” the ACA as the law faces an uncertain fate in the Supreme Court. The outcome of that pending litigation this spring will play a large role in determining the direction of future health policy.            

A Republican-controlled Senate is likely to block Biden’s bolder proposals. Such proposals might include the creation of a public health insurance option through the ACA Marketplace that would aim to reverse the increase in uninsured and underinsured Americans over the last four years.

However, a combination of more modest plans could produce a similar effect, such as lowering the Medicare eligibility age from 65 to 60, offering plans in states that did not expand Medicaid, and expanding subsidies. Therefore, the American Benefits Council expects that the Biden administration will focus its intent on achieving ACA expansion.

If Medicaid eligibility is extended to all Americans age 60 to 64, it could increase coverage for up to 20 million Americans and reduce insurance costs for employers. Therefore, unless a Democratic sweep of Congress materializes, the ABC predicts Biden’s administration will take more limited regulatory action to achieve ACA support and expansion.

The Council called President-elect Biden’s plan to lower healthcare costs “a non-starter” in a Republican Senate as it hinges on the aggressive use of antitrust authority to address market consolidation as well as government negotiated rates within a public option.

A divided Congress would also make the enactment of prescription drug legislation passed last year (HR-3) unlikely.

The report authors made predictions about COVID-19 relief and stimulus. Since the document's publishing, Congress has passed some COVID-19 relief.

The new administration is expected to focus on the socioeconomic and racial health disparities that the pandemic has highlighted. Biden haspromised to establish a COVID-19 Racial and Ethnic DIsparities Task Force which will then turn into a permanent Infectious Disease Racial Disparities Task Force. 

The Biden Administration and Democrats in the new Congress are expected to make paid sick, family, medical leave a top legislative priority. However, Democrats and Republicans have yet to reach a consensus on any federal leave legislation.

Should Biden face a divided Congress—Georgia runoffs stand to determine this—the administration is likely to turn to aggressive regulatory action to revise or do away with a number of rules endorsed by the current administration. Moves may include topics of health care nondiscrimination, short-term insurance, and association health plans. The American Benefits Council predicts that the recently released price transparency rules, which might get hung up in the DC Circuit Court of Appeals, will stay in place.

Other healthcare consulting firms are predicting the same similar predictions.

“In many ways, President-elect Joe Biden is proposing a return to the Obama administration’s approach to healthcare,” a PwC report detailed. “However, healthcare executives cannot simply dust off their Obama-era playbooks. Biden will assume the presidency in a country that is very different than it was in 2009, when he became President Barack Obama’s vice president.”