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The First 100 Days of Health Policy in the White House

By Daniel B. McLaughlin

The first 100 days of a new presidential administration is an important milestone, as policy direction for the future is frequently set during this time. During this period, President Joe Biden has made substantial progress in some areas, but challenges are still ahead.

The new administration has had one of the most ambitious agendas in recent years; much of its focus was set during the campaign with an extensive healthcare policy agenda and additional goals were set in the administration’s first days, as reported by NPR. The major action agenda focused on dealing with the COVID-19 pandemic and its impact on the people and economy of the United States. However, some of the resulting legislation also contains important policy improvements for the U.S. healthcare system.

Progress

In January, the Biden administration released their national COVID-19 response plan, which had seven major goals:

  • Restore public trust with a science-first approach.
  • Mount a comprehensive vaccination program.
  • Expand testing and strategies to mitigate the virus spread.
  • Use of the Defense Production Act to increase supplies.
  • Reopen schools, businesses and travel.
  • Protect those most at-risk individuals across racial, ethnic and rural/urban lines.
  • Build better preparations for future threats.

Most of these goals have been met or are in progress. The administration moved rapidly to expand contracts with vaccine manufacturers and the U.S. now leads European countries in the percentage of its adult population that have had a least one vaccine dose. While the U.S. has vaccinated more than 52% of adults age 18 and older, France has only been able to vaccinate 20% of its adult population as of April 23.  The New York Times projected in late February that the U.S. will reach herd immunity as early as July

The Biden administration also developed—and Congress approved—the American Rescue Plan. This plan has provided support for the administration’s COVID-19 mitigation efforts and for struggling businesses and individuals throughout the country.  

An important health policy component of the American Rescue Plan was the expansion of the Affordable Care Act’s enrollment dates and subsidies; 3.7 million individuals are newly eligible for subsidized insurance, according to a Kaiser Family Foundation analysis. The plan also begins to address many of the social determinants of health by extending unemployment benefits, implementing homeowners and renters assistance, and increasing childcare assistance and supplemental nutrition benefits.   

Unmet goals

The goal of providing a public health insurance option has not yet been met. In addition to strong opposition from many healthcare industry stakeholders, it is also unclear whether this policy is really needed. The increased subsidies in the marketplaces make individual health insurance more affordable, which was one of the key attributes of the public option. In addition, privately delivered healthcare is increasingly attractive to Medicare beneficiaries with 36% now choosing Medicare Advantage over traditional Medicare.

Another Biden goal was to improve drug costs and affordability. This continues to be an issue but a federal policy solution and action by Congress is not on the immediate horizon, as the priority will be addressing the COVID-19 pandemic, according to one blog from The Commonwealth Fund.    

Long-Term Challenges

The COVID-19 pandemic has obscured another epidemic—the surge in drug overdoses which are now accelerating. New efforts will be needed to increase preventive and recovery issues.

The Biden program has been expensive and the Congressional Budget Office projects the federal budget deficit to be $2.4 trillion, the second largest in U.S. history. Because federal health programs make up 25% of the federal budget, it is likely that this deficit pressure will precipitate legislative proposals to reduce spending in these programs. Combating the rise of healthcare costs will be a continuous challenge for the Biden administration over the next four years.

Even in face of numerous challenges, the first 100 days of this administration has seen significant progress in addressing the pandemic and in making important improvements to the U.S. healthcare system.


Daniel B. McLaughlin is the senior executive fellow in the Opus College of Business at the University of St. Thomas in Minneapolis, and an ACHE member. He is also an author for ACHE’s Health Administration Press.

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