Health care was a focal point of Joe Biden’s presidential campaign. In his first two months in office, President Biden has already addressed several core issues. However, there’s much more to come. Topics such as the Affordable Care Act (ACA), the establishment of a public option, expansion of Medicare and Medicaid, lower drug pricing, and pricing transparency are all next on the Democratic agenda.

The Future Of The ACA

As the future of the ACA rests in the hands of the US Supreme Court, the Biden administration must consider two options. In the event that the ACA is upheld—the outcome the administration is pushing for in court—Biden is expected to move forward with an expansion of ACA programs. This will include establishing a public health care option and expanding the availability of Medicare and Medicaid. In the event that the ACA is not upheld in court, the administration will set out to draft a replacement.

Public Health Care Option

A public health care option would compete with private markets and provide relief to both patients and small businesses, which would no longer need to provide coverage for employees. Biden aims for this option to offer lower prices through price negotiation, cover copayments for primary care, and improve coordination between health care providers.

Medicare and Medicaid

Biden has stated he will lower the age for Medicare eligibility from 65 to 60. This change will allow an additional 20 million individuals to participate in the program.

A Medicaid expansion would occur at the state level. States that already have expanded Medicaid programs in place would have the choice of moving the expansion population to the public option, provided the states sustain the cost of covering those individuals. The expansion would grant health care access to almost 5 million people, including access to extended coverage for those falling below a certain percentage of the federal poverty level.

Drug Pricing And Pricing Transparency

By allowing Medicare drug pricing negotiation, limiting drug price increases, monitoring new drugs, and importing drugs to cut costs, the Biden administration intends to lower prescription drug costs for all health care consumers

The administration also plans to put an end to surprise billing, which will be accomplished through enhanced pricing transparency measures. Part of Biden’s approach is to prevent health care providers from charging out-of-network rates to patients when they can’t control which health care provider they see.

Stay In The Know!

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This article was published in the Spring 2021 issue of the General Insurance Services Risk & Business Magazine. Access the full publication here