Boston Business Journal: Biden’s Ability To Influence Health Care Will Depend On These Two Factors
Biden’s ability to influence health care will depend on these two factors
With the election of Democrat Joe Biden as president, the question of whether health care coverage will be expanded depends on two things: the outcome of a Supreme Court case against the Affordable Care Act, and a run-off election to decide who will control the Senate.
Jonathan Gruber, an MIT economist and one of the creators of the Affordable Care Act, believes that “the bigger issue” is the Supreme Court case. “If Republicans hold the Senate and the court case goes the wrong way, then all hell breaks loose,” he said.
On Tuesday, the U.S. Supreme Court heard arguments in the most recent challenge to the Affordable Care Act (ACA), also known as Obamacare. The case, led by Texas and supported by the Trump administration, seeks to abolish the 2010 law in its entirety after Congress eliminated the penalty for failing to obtain health insurance.
While the court may be hard pressed to do away with health insurance covering 20 million Americans, six of the nine legal justices could create a hole in the mandate that could be hard to patch up.
A legislative fix would be complicated by runoff elections in Georgia Senate that could decide which party controls the Senate in January. Unless Democrats secure both seats, Washington would be hard-pressed to substantially alter the ACA if it survives, and unlikely to find a suitable replacement to the Affordable Care Act, eliminating billions in federal subsidies to states and kicking thousands off health insurance in the midst of a pandemic. Gruber says it would be a “nightmare” if Republicans refused to cooperate. “Then the whole ACA goes away,” he said.
But absent that doomsday scenario, widescale changes within the industry are not likely. Gruber said it was difficult to get all Democrats to agree when the Affordable Care Act was passed the first time, so even if Democrats win the Senate, one or two defections would make it difficult to make changes like lowering the Medicare age to 60, or creating a public option.
Even reinstating the penalty for not having insurance would be a challenge, since most senators will be hard-pressed to pass a law that features only the stick of health care reform, without the carrot of already obtained preexisting condition coverage.
Michael Chernew, a Harvard professor who specializes in health care policy, agreed that big changes are unlikely. The overall deficit and fiscal challenges facing Medicare could complicate efforts to broaden the program, coupled with concerns of a potentially Republican-controlled Senate.
Still, a Democratic administration is likely to tinker at the edges of the ACA, if it survives, lending greater stability to a market that has continually changed since the ACA was passed in 2010.
“I suspect (a Biden administration) will be more inclined to promote access,” Chernew said in an email. “If the ACA survives the courts, which I expect but cannot guarantee — and it may survive in altered form — I think the Biden administration will work to strengthen it. Because of the Senate, I do not anticipate major legislation — e.g. public option — but they may be amenable to state experimentation.”
Kim Buckey, vice president of client services of the Massachusetts-based benefits firm DirectPath, was more optimistic. She hoped that if the ACA survives, that a Biden administration could create lasting change, including expanding subsidies for ACA plans, reducing eligibility age for Medicare to 60, and addressing rising pharmaceutical costs.
“President-elect Joe Biden will undoubtedly build off of many initiatives and policies during his time with the Obama Administration, including the Affordable Care Act,” she said in an email.
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(Jessica Bartlett covers health care, including hospitals, health IT, health policy and insurance, as well as the beer and marijuana industries.)