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Welcome to 2021. What Can You Expect in Healthcare?

By Sarah Fontenot, JD

The inauguration of President Biden in the middle of a pandemic raises many questions about how the new administration will alter the direction of healthcare in 2021 and what those changes will mean for healthcare executives.

Addressing the COVID-19 Pandemic is Job #1.

The development of two vaccines (and two more waiting for approval) in record-breaking time under the Trump administration’s “Operation Warp Speed” project deserves all the acclaim and appreciation we can offer as a country.

Now the Biden administration must dramatically expand the rate of getting those vaccines into arms. Fixing multiple aspects of distribution and significantly increasing shots will require initiating federal leadership, fostering coordination with the states and instituting assistance with supplies and money. Lots of money.

To meet the new administration’s goal of 100 million vaccinations in 100 days, both the messaging and use of federal resources will carry a new Biden stamp:

Messaging: A federally run, locally focused public education campaign will begin immediately, plus a “100-day masking challenge” requiring masks for federal workers, in federal buildings and on any form of interstate travel, such as planes, trains and buses. The restriction to federal property reflects the prominence of state sovereignty on healthcare issues. Still, the hope is the 100-day challenge will inspire the public and encourage states to take similar action.

Invoking Federal Powers: President Biden will utilize the Defense Production Act more aggressively than his predecessor to compel the manufacturing of vaccines, glass vials, syringes, needles and other equipment necessary to support a significant increase in the vaccination rate. One hundred mass-vaccination clinics, operated by FEMA and staffed by the National Guard, will be set up within the first month of the Biden presidency. Federally Qualified Health Centers, which offer healthcare to some of the neediest populations in the country, may start to receive vaccines directly to spread inoculation in their catchment areas.

We will not be beyond the pandemic on President Biden’s 100th day in office (April 30), but we will be moving significantly toward turning COVID-19 into “the common cold.”

Strengthening and Protecting the Affordable Care Act

The second most-cited pledge of Biden when he was a candidate was preserving and protecting the Affordable Care Act. Watch for a return to essential health benefits for all insurance policies (the loosening of that requirement paved the way for short-term and association health plans under former President Trump), the reinstatement (and funding) of ACA Navigators to assist people searching for insurance and a re-opening of the ACA enrollment period. Medicaid waivers requiring work (already in trouble with the courts) will cease, and pressure will increase on the last 12 states to expand Medicaid as initially planned under the law. These repairs will all come through Centers for Medicare & Medicaid Services as administrative regulations not necessitating legislation from Congress.

With Democratic control of the Senate, look for the reinstatement of the tax associated with the ACA individual mandate through the reconciliation maneuver, which only requires a majority vote in the Senate. (This is the same procedure the GOP used to take the penalty to zero in December 2017.) Bonus: With the tax penalty restored, the current constitutional challenge to the ACA in the Supreme Court will be moot.

In addition to ensuring the ACA is saved, refreshed and replenished, President Biden will try to fulfill his vision of adding a public option to coverage choices available for purchase on the Exchange. This is not a new idea—it was part of the original ACA blueprint. Despite this, Democratic Party control of both the House and Senate may not equate with the successful passage of the public option. It was the combined forces of the insurance industry and the Democratic Party (a threatened filibuster by former Senator Joseph Lieberman, in particular) that killed the public option in 2009.

Other key Biden proposals related to the ACA, such as reducing the age for Medicare eligibility to 60 and increasing the number of subsidies to purchase insurance on the exchanges, may require executive orders to bypass the closely divided Senate.

Where is The Big Flash of “New”?

“Exciting” and “revolutionary” are highly unlikely in 2021. That is partly due to the attention necessary to end the COVID-19 pandemic because we have a 50-50 split in the Senate. With a majority in name only (i.e., the tie-breaking vote of Vice President Harris), progress will require consensus across the aisle and within the Democratic Party. The path forward for Congress is following the bright line down the middle of the road.

The irony is that it is precisely where most Americans want to ride and where President Biden has always claimed his lane.


Learn more about the future of healthcare by joining us at the 2021 Congress on Healthcare Leadership, March 22-25. Head to ache.org/Congress for more information on speakers and sessions today.


Sarah Fontenot joined the ACHE faculty in 2007 and has been the Adjunct Professor for health law in the Department of Health Care Administration at Trinity University since 1997. Her twice-monthly newsletter, “Fontenotes,” provides clear information about today’s healthcare system.

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