In the weeks surrounding the November 3, 2020, election, many discussed what could happen under the new Biden/Harris administration. President Joe Biden was, after all, second-in-command during the Obama administration when the Affordable Care Act (ACA) was developed and first enacted.

According to health care policy experts interviewed by Fierce Healthcare, the new administration could move to shore up the ACA exchanges. That might include a change in subsidy eligibility, so more people qualify for tax credits that reduce their out-of-pocket premium cost. Changes could also include resumed funding for marketing of the federal and state exchanges, which was reduced by 90% in the past several years, as was funding for ACA navigators who assist with enrollments.

The Biden tax credit proposal put forth during the 2020 campaign would save nearly all current federal and state marketplace enrollees hundreds of dollars monthly – and likely push more into the individual marketplace, according to an analysis by the Kaiser Family Foundation.

In the final weeks of the Trump administration, the Centers for Medicare & Medicaid Services (CMS) announced several changes governing public health insurance exchanges, some of which are slated to begin this year and in 2022. While the Biden team may maintain some of the recent CMS alterations – like lower user fees – it may act to roll back others. That includes state waivers to test new options for their exchange populations and to collaborate with private firms to create “next generation exchanges.” Georgia has already received approval to transition from the Federally Facilitated Marketplace (FFM), www.healthcare.gov, to a state access model that enrolls consumers in coverage through private web brokers or directly with carriers.

The return of the Individual Mandate is likely to be reconsidered by Congress and the White House. You may recall that changes in 2017 eliminated the mandate as part of a GOP tax bill. That helped set up the legal challenge to the ACA, which is still being considered by the U.S. Supreme Court. (The assertion made is that the ACA is invalid in whole because the tax penalty for not having coverage is now zero.) A ruling could come any day – or as late as June 2021. Some analysts have suggested that immediate action by Congress could make the legal challenge moot.

The new administration could use executive power to undo the expanded availability of limited duration health plans enacted by President Trump. Federal laws currently allow for up to 36 months of non-ACA-compliant, short-term health care coverage. These plans are considered by some to be “junk” because of their limited coverage, pre-existing condition limits, or dollar amount caps on what’s included, which is why the California legislature banned limited duration plans as of 2019.

Renewed efforts to reduce prescription drug pricing is likely. According to reporting by NBC’s “Meet the Press” blog, President Biden could repeal existing law that bans Medicare from negotiating with drug manufacturers. His administration may also act to limit future price increases and push for competition among drugs that currently lack it.

While there was some advocacy by Democrats for a Medicare-like public option during the primary campaign, that seems far less likely now for a couple of reasons. While Sen. Kamala Harris was a proponent (before becoming Vice President), President Biden has always been less enthusiastic. Democrats have only a razor-thin edge in the U.S. Senate (50/50), with the new Vice President tipping the scale in the event of a tie vote. It’s important for the Biden/Harris team to push for proposals that can attract bi-partisan support.

COVID-19 was a top issue for voters in November, and a different approach to the pandemic is expected this year. According to the transition team, Biden and Harris have a seven-point plan to combat COVID-19, including:

1. Access to regular, reliable, and free testing
2. Increases in the supply of Personal Protective Equipment (PPE)
3. Evidence-based guidance of how communities can navigate the pandemic
4. Equitable distribution of treatments and vaccines
5. Increased protections for older and higher-risk individuals
6. New defenses for predicting, preventing, and mitigating pandemic threats
7. Mask mandates nationwide

During the week of January 11, then President-elect Biden announced a new $1.9 trillion COVID-19 relief bill that includes planned investments in supplies for financially strapped hospitals, increased funding for vaccines and testing, as well as money to expand PPE manufacturing in the U.S.

Stay tuned to this blog for further updates as ideas turn into legislation and proposals work their way through the U.S. House of Representatives and U.S. Senate.