Public Option, Medicare Buy-In ‘Don’t Have A Chance,’ AHIP Members Told

A public option and a Medicare buy-in may be two of the Biden administration’s best-known health care initiatives, but a consultant said the partisan nature of today’s Congress means “they don’t have a chance” of becoming reality anytime soon.

Dan Mendelson, founder of Avalere Health, and Anne Phelps, U.S. health care regulatory leader with Deloitte & Touche, gave their views on the 2021 health care outlook beyond COVID-19. They spoke during America’s Health Insurance Plans’ National Health Policy Conference on Wednesday.

Mendelson said that with Democrats holding a razor thin majority in Congress, and with some Democrats having misgivings on expanding the government’s role in health care, there is not enough support in Congress for a public option or Medicare buy-in.

The American Rescue Plan, which President Joe Biden is expected to sign into law soon, “is one of the most comprehensive anti-poverty bills that has ever been passed,” Mendelson said. He noted that the bill contains a number of provisions that will shore up the nation’s health insurance system, while helping more low-income Americans obtain coverage through the Affordable Care Act exchange.

The bill opens up the ACA tax subsidies to more people. “Those subsidy increases are heavily concentrated on the near-poor,” Mendelson said. “It opens up the markets because most of the people who buy insurance through the ACA are poor or subsidy-eligible.”

The coverage expansions under the American Rescue Plan “have the potential to be hugely valuable to the industry,” Mendelson said, “particularly if we can use these next four years to create a stable individual market that has commercial and political staying power.”

Before COVID-19 took hold in the U.S., consumers’ main health-related concern was the high cost of prescription drugs, Mendelson said. He and Phelps said they believe there is bipartisan agreement to address this issue after the pandemic has died down.

“Let’s start with Congress,” Phelps said. “This issue could be a ‘strange bedfellows’ issue, which means bipartisan. A lot of the debate will focus on whether the government has the authority to set drug prices. I think Congress is looking at various ways to get to drug pricing, maybe through a particular class of drug.”

The regulatory arm of government also could tackle drug pricing, she said. “They do have a lot of levers at their disposal. There is a lot of interest at looking at some of our higher-cost drugs, looking at how other countries set prices. I predict there will be a more sophisticated, nuanced debate coming in Congress around drug prices and availability.”

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.

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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].