Changes to health care likely under Biden

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NEW YORK — The results of the presidential election have changed who will be the leader of the free world; but it hasn’t changed the fact that the COVID-19 pandemic isn’t going away and will be waiting for President-elect Joe Biden when he takes office on January 20. As it was during the election, COVID is certain to remain a top issue as the Biden Administration sets out to deal with the pandemic that since March has spread and spiked across the country with abandon. What’s also certain is that the incoming president will approach the virus — and health care in general — differently than the outgoing one.

President-elect Joe Biden

During the campaign, candidate Biden promised to “follow the science” as well as use more aggressive federal action to combat the virus. Biden, unlike President Trump, has encouraged mask wearing and proposed a national mask mandate, although such a mandate would be hard to enforce outside of federal property. Still, the messaging itself signals a stark contrast in how Biden’s team would tackle the pandemic. Even before the election, Biden was putting together a plan for the pandemic and recently unveiled the members of his COVID-19 task force, which is comprised of notable former government health officials, academics, and medical professionals. The task force includes Rick Bright, the former head of the vaccine-development agency BARDA, who Trump fired in April; Atul Gawande, surgeon and former CEO of Haven, the joint JP Morgan Chase-Berkshire Hathaway-Amazon health care venture; and Luciana Borio, a former FDA official and biodefense specialist.

Biden has said this team will work with state and local health officials on halting the spread of the virus and how to safely reopen schools and the economy. The task force will also look into how the virus has disproportionately affected communities of color. “Dealing with the coronavirus pandemic is one of the most important battles our administration will face, and I will be informed by science and by experts,” Biden said in a statement. “The advisory board will help shape my approach to managing the surge in reported infections; ensuring vaccines are safe, effective, and distributed efficiently, equitably, and free; and protecting at-risk populations.”

But it’s more than just COVID. Biden has made it clear he shares a different view than Trump on the issue of health care overall and that a Biden Administration is almost certain to bring changes. For one, Biden has pledged to reverse Trump’s course of scaling back federal investment and involvement in health care by building on the Affordable Care Act, President Obama’s landmark legislation signed into law when Biden was vice president. Along with working on a national COVID strategy that includes testing and tracing, Biden wants to make good on a campaign promise to create a public-option — essentially a Medicare-type insurance plan that Americans would be able to buy into regardless of age.

The benefit of a public-option is that the cost of insurance through such a plan would be substantially less due to the government’s enormous leverage in driving down the prices of both physician and hospital visits as well as prescription drug prices. For example, Medicare pays hospitals about half of what private insurance companies pay, so a public option at Medicare prices would be much less than private insurance plans. Also, a government-sponsored plan would not have a profit margin which would go to further lowering premiums.

But before a President Biden can build upon the ACA, or Obamacare, it first has to survive its latest challenge in the Supreme Court. Justices have already begun hearing arguments in the most recent effort to strike down the ACA led by the Trump administration and several Republican-led states. The basis of the plaintiffs’ argument centers once again around the individual mandate, despite prior Congressional action essentially rendering the mandate ineffective.

However, if the initial counter arguments from Chief Justice John Roberts and Associate Justice Brett Kavanaugh are any indication of where the Court might end up, it’s likely that the ACA will survive yet again. Both justices voiced skepticism of the plaintiff’s contention and should they side with the three liberal justices then that would ensure at least a 5-4 majority in favor of keeping the ACA the law of the land.

Outside of expanding Medicare into a public-option, Biden also has differing views than Trump on Medicare as well as Medicaid, both of which together provide coverage to 115 million Americans. Biden has signaled he wants to expand eligibility for both federal programs. As of now, eligibility for Medicare is 65 and in some cases those younger than 65 with certain disabilities. Biden wants to lower the age to 60 while providing dental, vision and hearing coverage in traditional Medicare. Now, most Medicare beneficiaries have to buy a supplemental policy if they want those additional benefits.

As far as Medicaid, which is run by the states for low-income Americans, Biden could potentially use executive powers to roll back restrictions, lower eligibility requirements and broaden the program’s scope, such as allowing Medicaid funds to be used for housing costs. Another major health issue in which a Biden Administration will likely differ from the current one is reproductive health. The Trump Administration has restricted federal funding for agencies that provide abortion counseling, such as Planned Parenthood. As president, Biden would likely use executive authority to reverse those restrictions. And with Roe v. Wade facing perhaps its greatest threat since it was enacted in 1973 due to Trump’s three Supreme Court picks shifting the balance of the Court solidly to the right, Biden has floated the idea of codifying Roe’s protection via Congress. A Biden Administration would also certainly allow federal funding for abortion and to guarantee no-cost contraception coverage for more employees.

But no matter how the health care landscape changes under a President Biden it will boil down to the divergent philosophies between the current occupant of the White House and the one that will be soon taking his place behind the Resolute desk. Biden has made clear he views health care in America as “a right, not a privilege.”

In a speech in Wilmington, Delaware earlier this month, the president-elect said his transition team was already at work fleshing out the details of his health care agenda. “This doesn’t need to be a partisan issue. It’s a human issue,” Biden said of expanding health insurance. Families are reeling right now. They need a lifeline, and they need it now.”



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