November 23, 2020

After the Election: Policy Priorities for Health Care Programs

Health care policy has been a key issue leading up to the 2020 elections, and the final outcome of the presidential and congressional elections will likely impact the health care policy priorities of the future. While the COVID-19 pandemic has sidelined key issues including drug pricing and cost of care, the pandemic has also increased the focus on health care issues such as expanding access to — and utilization of — telehealth and digital medicine. Additionally, the fate of the Affordable Care Act is up in the air as the Supreme Court considers the constitutionality of the entire ACA in California v. Texas. While the Court heard oral arguments on November 10, the Court’s decision may not be released until next spring.

For all these reasons, stakeholders, including payors, are increasingly focused on the future of health care programs including the ACA, Medicare and Medicaid. Here are the key health care priorities that are likely to be pursued in 2021 and beyond, regardless of the final outcomes of the federal election:

  • Reducing drug costs. Both parties have introduced proposals on common themes, such as:
    • Increasing drug price transparency
    • Enhancing generic drug competition
    • Reforming the current drug rebate system

  • Restructuring Medicare Part D. There seems to be general accord between the parties on many aspects of a restructured Part D program, including:
    • Reducing enrollee out-of-pocket spending
    • Eliminating the ‘donut hole’ coverage gap
    • Shifting more of the financial responsibility for the catastrophic phase away from the federal government and to Part D plans and drug manufacturers

  • Addressing surprise billing. Surprise billing was a pre-COVID priority for both parties, with several federal bills offering comprehensive protections using both payment standards and an independent dispute resolution process. Attention to this issue has increased as the pandemic elevated the potential for out-of-network billing by health care providers and laboratories.

  • Price transparency. The Trump administration finalized the Transparency in Coverage rule in the final days leading up to the election. Full implementation of the rule could take several years, and although price transparency is generally favored by both parties, a Biden administration may attempt to stall implementation or repeal the rule in favor of a different approach.

  • COVID-19 relief package. After negotiations failed to produce additional relief aid prior to the election, the next prospect for pandemic-related aid could be the upcoming December 11 spending deadline or in late January after the new Congress is sworn in.

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