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Health policy during the Biden administration: The possible and the improbable

COVID-19 containment is a top priority for President Joe Biden and that will likely continue throughout his term. Within the realm of health policy, there are a handful of other hot-button issues lawmakers have on their radars. But with an even split in the Senate and a very narrow majority in the House, what change might actually come out of Washington D.C.?

Health equity measures

The pandemic propelled social determinants of health (SDOH) and health inequities into the spotlight, and the current administration has taken note. The COVID-19 Health Equity Task Force was established on day one of Biden’s presidency, and the U.S. Department of Health and Human Services (HHS) recently established the Office of Climate Change and Health Equity. Given that Vice President Kamala Harris is a vocal advocate for issues like Black maternal mortality, expect to see more SDOH-related initiatives. National Coordinator for Health IT Micky Tripathy is bringing the voice of health IT to these efforts by serving on two different groups focused on health equity.

Medicare for All

“Medicare for Some” will remain status quo as Biden has explicitly stated he does not support a single-payer system and instead campaigned on improving the Affordable Care Act (ACA). Proposals to build on the ACA could entail expanding value-based care models and lowering the Medicare age of eligibility from 65 to 60. Additionally, the Biden administration may propose a Medicare-style public option for ACA exchange beneficiaries, the uninsured, those in states that have not expanded Medicaid and people unhappy with their employer-sponsored coverage. However, with the midterm elections coming up in less than a year, it is highly unlikely these modifications will come to fruition before then.

Hospital matters

Hospitals have much to be happy about given the 2022 Medicare rates, Medicaid expansion and subsidies under the ACA. Despite their strong lobbying power, though, there are recent and potentially forthcoming developments with big implications for hospitals. Specifically, the Centers for Medicare & Medicaid Services (CMS) has proposed increasing penalties for failing to comply with the Hospital Price Transparency rule that went into effect Jan. 1, 2021. Additionally, as the government works on deficit reduction, hospital funding may be a target as it makes up a substantial portion of government spending.

New anti-consolidation measures are likely to be proposed as well. This was a signature issue for HHS Secretary Xavier Becerra as California Attorney General, and President Biden has already called on the Federal Trade Commission and Justice Department to crack down on hospital consolidation via executive order. Financial strains brought on by the pandemic have put dozens of hospitals at risk of closure, but mergers and acquisitions may not be the solutions for much longer.

Prescription drug pricing

The rapid development of the COVID-19 vaccine was a scientific marvel, but the halo effect for pharmaceutical manufacturers is fading just as quickly. States have been passing their own laws around drug pricing, and with bipartisan support on this issue, Washington D.C. may be next.

What that means remains to be seen. One controversial idea still being debated is a repeal of the non-interference clause, which bars the Secretary of HHS from interfering in Medicare drug pricing negotiations between health plans, pharmaceutical manufacturers and pharmaceutical benefit managers.

We could also see new proposals around international reference pricing, a strategy that would bring drug costs under Medicare closer to the prices other developed nations pay. Expanding parameters for drug importation is another possibility, as the Biden Administration issued an executive order this year directing the U.S. Food and Drug Administration (FDA) to work with states and tribes seeking to import medications that meet FDA standards.

Telehealth access and reimbursement

Telehealth’s rising favorability suggests pandemic-driven coverage changes may outlive the public health emergency. CMS could extend COVID-19 payment policies under Medicare and lift requirements to have an in-person visit before leveraging telehealth for mental and behavioral health services.

Given the increasing shortage of skilled healthcare professionals, the pause on geographic and originating site restrictions could continue as well, so patients do not have to be based in a designated “Health Professional Shortage Area” nor hold their telehealth appointments at facilities like physician offices, hospitals or rural health clinics rather than their homes.

Dive deeper on the issues

Healthcare has undergone many changes in the last 18-plus months. With the current political climate and lingering pandemic, the industry is poised to further evolve. You can make your voice and your organization’s voice heard on these issues by calling and writing to your elected officials.

For more information, watch the full session on Biden Era policy predictions from the 2021 Allscripts Client Experience (ACE).

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