Democratic majorities in both congressional chambers increase the odds that significant health care reform will be enacted with the progressive wing of the party pushing for a public option. The 2021 health care policy debate will focus on affordability, surprise billing, and transparency rules, which presents opportunities and challenges for employers. The Biden administration will focus on regulatory actions to implement the surprise billing protections and transparency requirements included in the year-end legislation, and the Association’s American Health Policy Institute will be ready to help shape the employer requirements. The new administration will also decide which elements of the HR Policy-supported transparency regulations implemented under Trump survive. Bipartisan measures regarding telehealth, HSA modernization, behavioral health services, and health care inequality are also in play.
The most likely ACA reforms include:
- Expanding ACA premium and cost-sharing subsidies to reduce out-of-pocket costs;
- Funding for state reinsurance programs and incentivizing states to expand Medicaid; and
- Increased education and outreach funding for ACA exchange plans.
A public option and reducing drug costs will be more difficult to enact unless the filibuster rules are changed. Without the cost savings that would come from enabling the government to negotiate drug prices, corporate tax increases will be needed to fund the health care reforms listed above.
Next COVID-19 relief bill will likely include COBRA subsides for employers to cover permanently laid-off and furloughed employees and completely eliminate cost-sharing for COVID-19 testing, treatment, and vaccinations.
New Senate committee chairs will press their health reform agendas. Sen. Patty Murray (D-WA), who wants to expand access to quality health care coverage and ensure access to mental health benefits, will chair the HELP Committee, Sen. Ron Wyden (D-OR), who has pressed for sweeping drug pricing legislation, will chair the powerful Finance Committee, and Sen. Bernie Sanders (I-VT), a single-payer advocate, will chair the Budget Committee. President Biden’s HHS nominee, Xavier Becerra—a public option and single payer advocate—will also be quickly confirmed.
Opportunities and challenges for employers in the regulatory arena. The Biden administration will focus on regulatory actions to implement several new mandates on employer health care plans including:
- The arbitration provisions regarding surprise medical billing;
- Several new costly transparency requirements; and
- Enhanced mental health parity requirements.
The new administration will also decide which elements of the HR Policy-supported transparency regulations implemented under Trump will be rolled into the legislatively required rules above. HHS may also encourage states, under the ACA rules, to implement public options and single payer systems. The American Health Policy Institute plans to actively engage the Biden administration on these and other regulatory issues to help shape their impact on employer plans.
Greater oversight and enforcement. Employer health plans and the entire health care supply-chain will be under the congressional microscope to ensure they comply with all ACA and ERISA regulations.
Vaccine distribution: The federal government will likely take greater control of the vaccine distribution.
The Supreme Court will most likely uphold the ACA while striking down the individual mandate.
Medicare Trust Fund depletion in 2024 will initiate a debate over how to “save” the program. CBO currently estimates it will take a 1.2 percentage point payroll tax increase, or a 17% spending cut, or some combination of the two in order to address the funding problem.