As Health Policy Activity Slows, All Eyes Are On The Biden Administration

By Susan Rupe

The U.S. health policy landscape has evolved as the country enters another year of the COVID-19 pandemic and the Biden administration advances new priorities.

Health policy has focused on expanding and enhancing coverage as well as advancing health equity. A group of policy experts gave their views on the policy changes we have seen so far, as well as what levers the administration might pull to advance its own priorities, during a webinar by Manatt Health.

Allison Orris, Manatt Health partner, said the administration “is likely to pivot a bit to see how it can advance its priorities.” She noted that bipartisan efforts are needed to advance health policy in Congress as Democrats narrowly control Congress and the midterm elections will occur in November.

Orris listed the following accomplishments in the health policy landscape under the Biden administration:

Congress enacted the American Rescue Plan to fund vaccinations, make marketplace coverage more affordable, incentivize Medicaid expansion and support communities as part of a plan to address health care inequities.
The rate of uninsured Americans is lower now than it was before the pandemic. Medicaid enrollment has grown sharply due to the economic downturn as well as COVID-19 continuous coverage requirements. The Affordable Care Act marketplace saw record enrollment, driven by enhanced financial assistance.
The pandemic accelerated telehealth flexibilities in Medicare, Medicaid and private coverage, as well as increased telehealth adoption among providers and patients.
The administration rolled by Trump-era policies such as Medicaid work requirements.

All eyes are on the administration as health policy legislative activity slows in 2022, Orris said. The Centers for Medicare and Medicaid Services and the Department of Health and Human Services have regulatory tools to advance the administration’s priorities around:

Addressing the pandemic.
Enhancing and expanding Medicaid, Medicare and marketplace coverage.
Addressing prescription drug pricing.
Protecting consumers from surprise medical bills.
Advancing health equity.

Addressing prescription drug pricing is one issue that Congress and the administration could work together to accomplish, said Ian Spatz, Manatt Health senior advisor.

“One of the more politically popular things that the administration and Congress could do is bring down drug pricing,” he said. Spatz noted that drug pricing is one part of Biden’s stalled Build Back Better plan that is popular on both sides of the aisle.

The American Rescue Plan increased the premium subsidies at all income levels for health plans sold in the ACA marketplaces, but the enhanced subsidies are due to expire at the end of this year. The Build Back Better bill would continue those enhanced subsidies, but whether expansion will continue is a question, said Joel Ario, Manatt Health managing director.

“If the subsidies go away, affordability becomes a more crucial issue in the marketplace,” he said. He predicted ACA enrollment will drop if those subsidies are not renewed.

The U.S. remains under a public health emergency at least until mid-April. The continuous coverage requirement in Medicaid will end when the emergency ends. The unwinding of continuous coverage will have most significant and negative impact on coverage since the ACA was enacted, said Cindy Mann, Manatt Health partner. After the emergency ends, the states will be required to establish eligibility for nearly all of those who are enrolled In Medicaid.

“The risk of eligible people losing coverage for Medicaid is great,” she said. Under Build Back Better, Medicaid enrollees in states that have yet to expand Medicaid coverage would be eligible for enhanced marketplace coverage, she added.

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected]. Follow her on Twitter @INNsusan.