BPC Examines What 2020 Election Communicated About Health Care

WASHINGTON — Political players have long had different ideas about national health care, but coronavirus not only shifted policymakers’ priorities, it has also thrown the future of health care reform into question. 

The Bipartisan Policy Center convened leading pollsters and policy experts to share what they are hearing about the future of health care from the Hill, White House, and — most importantly — the American people. 

“We have a new president, and I think he’s largely president because of COVID,” said Chris Jennings, founder, and president of Jennings Policy Strategies. 

With such strong emphasis on health, health care, and health affordability as a result of the pandemic, Jennings believes that movement on major healthcare reform, including tackling prescription drug pricing and surprise medical billing, were high priorities on voters’ minds this year. 

He predicts an early focus on health care changes in President-elect Biden’s administrative actions with real efforts to look at legislative fixes as well as subsidies and tax credits.

Absent a stalemate on some of Biden’s bigger picture items, like the public option, Health and Human Services negotiating drug prices, and the expansion of the Affordable Care Act subsidy structure, a divided government must find some common ground for the public’s largest concerns, which continue to be cost, billing, and complexities of navigating the system.

“There will no doubt be greater challenges imposed than there otherwise would have been for [Biden’s] bigger visions and policies, but no matter what, there are enormous flexibilities granted to each administration,” Jennings said. “[It is also] in the interest of the nation for a compromise relief package.”

“Voters are widely in favor of a new COVID relief package,” said Celinda Lake, president of Lake Research Partners, a national public opinion and political strategy research firm. Polling points to the central divide of the election being either a coronavirus focus or a focus on rebuilding the economy, with “voting patterns heavily influenced by rising COVID-19 cases.” 

“The spike in coronavirus was helpful to Joe Biden, not that we would have wished for it, particularly among seniors and among suburban women voters.” She added that women tend to be health care-first voters in general.

Jim Capretta, resident fellow and Milton Friedman chair at the American Enterprise Institute, expects that much of Biden’s early actions on healthcare will come through executive order. 

“A new administration can do an awful lot of things through administrative action, and I expect the incoming Biden Administration to be very very active administratively… to undo the Trump administration’s efforts around the Affordable Care Act. Things like short-term duration plans, perhaps association health plans, funding the outreach system, maybe trying to come to some resolution on cost-sharing subsidies that has an equilibrium that looks sustainable…”

There will likely be a focus on new-generation treatments and cures. For example, telehealth, which suddenly became a significant part of the health care delivery system, could receive greater resources as it can be made more broadly available in underserved areas.

“People like their experiences so far with telemedicine much more than they thought they would,” said Lake, citing polling responses. 

And depleted reserves in the Health Insurance Trust Fund, which could be bankrupt by 2024 or earlier according to Congressional Budget Office projections, are also a “precipitating trigger for the administration to take action,” according to Capretta.

Ensuring solvency for Medicare is a priority for both sides, and the Fund may especially need to be financially sound as Americans are in favor of program expansion. “The [American] people are in favor of lowering the age of [Medicare] eligibility to 60,” according to Lake. “There’s even quite high support for lowering it to 50.”

Capretta also suggested that the as-yet elusive COVID relief bill might be “a vehicle” to adopt provisions of health care reform as “a public utility infrastructure.”

“The Democrats are not going to get a $2.2 trillion bill, but even a $1 trillion bill could make a big difference with the right pieces in it,” he said. 

And while this moment doesn’t look promising for Republicans and Democrats to come together for a relief package, that may change should the pandemic become an even greater crisis for the country. 

“These next two months are absolutely critical,” stressed Capretta. “Things that are decided now, particularly in the Congress… could have an impact in January, February, and March.” He cautioned not to wait for Biden to take office because then the pandemic could take control of its own course.

“If [red states] don’t want to be responsible for this crisis to become literally a catastrophe, they have to do something… despite the fact that it may be politically challenging for them. A lot of responsibility now falls on Senator McConnell’s shoulders.”