What Democratic Control of Government Means for Health Care Policy

Legislative changes to support the Affordable Care Act are more likely

Stephen Miller, CEBS By Stephen Miller, CEBS January 11, 2021
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What Democratic Control of Government Means for Health Care Policy

Following the two U.S. Senate runoff races in Georgia on Jan. 5, the chamber is split 50/50 between Democrats and Republicans, but with Democrats in control (and with an effective majority) since incoming Vice President Kamala Harris, as Senate president, can break tie votes. In the U.S. House of Representatives, Democrats also have a five-seat majority.

SHRM Online has gathered the following articles that look at how U.S. health care policy may be altered with Democratic President-elect Joe Biden in the White House and Democrats controlling Congress.

Rolling Back Trump-Era Regulations

Congress has authority under the Congressional Review Act (CRA) to reverse recent Trump administration regulations and guidance by a simple majority vote in both chambers. The CRA allows an incoming Congress to review federal agency rules issued during the last 60 legislative-session days.

Which Trump-era rules might be invalidated under the CRA? Targets for Congress could include a rule to allow grandfathered group plans to impose higher cost-sharing requirements, a rule requiring health insurers and self-insured plans to disclose price and cost-sharing information, and a rule to pass along drug company rebates to patients at the point of sale, among others.

This target list could expand if the Trump administration finalizes additional rules before the end of its term on Jan. 20. Examples of recently proposed, but not yet finalized, rules include a regulatory "sunset" requirement, the 2022 notice of benefit and payment parameters, and a rule that would allow employee reimbursement for fees for direct primary care and health care sharing ministries

The Department of Health and Human Services (HHS) and the IRS also could decide not to go forward with these regulations if they are not finalized.

(Health Affairs Blog and SHRM Online)

Higher ACA Subsidies

Congress is most likely to strengthen and expand the Affordable Care Act (ACA) and make health coverage less expensive for those who buy their own plans. One priority is raising the income ceiling for those who receive subsidies, which would expand the number of people who qualify for help. Another is rewriting formulas to peg the size of the subsidy to a more generous health insurance plan, a way to increase the amount of assistance.

With a Democratic-controlled Senate, Democrats could reconsider legislation such as the Patient Protection and Affordable Care Enhancement Act, which was passed by the House in 2020 but never considered in the Senate. That bill would have extended ACA subsidies to additional income brackets, made premium tax credits more generous, funded outreach and navigators, funded state-based reinsurance or subsidy programs, funded state efforts to set up their own marketplaces, and incentivized Medicaid expansion, among other provisions.

(BenefitsPRO and Health Affairs Blog)

[SHRM Resource: What You Need to Know About ... the Affordable Care Act]

HHS Nominee Likely to Be Confirmed

New Senate Majority Leader Chuck Schumer, D-N.Y., will schedule votes on Biden's nominees, and most will now be confirmed. California Attorney General Xavier Becerra, a staunch defender of the Affordable Care Act and a supporter of Medicare for All, is nominated to lead the Department of Health and Human Services.

On the congressional front, Sen. Ron Wyden is poised to run the powerful Senate Finance Committee, where he has been central in the push for sweeping drug-pricing legislation.

(Mercer and Politico)

Lowering the Medicare Eligible Age to 60

A Democratic Congress is more likely to consider Biden's proposal to allow Americans age 60 to 64 to enroll in Medicare. Last April, Biden wrote, "Under this concept, Americans would have access, if they choose, to Medicare when they turn 60, instead of when they turn 65. … This would make Medicare available to a set of Americans who work hard and retire before they turn 65, or who would prefer to leave their employer plans, the public option, or other plans they access through the Affordable Care Act before they retire."

Researchers have found that "the strong link between health insurance and employment in the United States may cause workers to delay retirement until they become eligible for Medicare at age 65," suggesting that earlier access to Medicare could prompt more employees to retire sooner.

(InsuranceNewsNet.com and SHRM Online)

Public Option Roadblocks

According to Biden's campaign website, "Whether you're covered through your employer, buying your insurance on your own, or going without coverage altogether, the Biden plan will give you the choice to purchase a public health insurance option like Medicare."

However, even if there was unanimous support among Democratic senators, the public option isn't a policy that fits neatly into the rigid rules that allow a simple Senate majority to pass legislation under the budget reconciliation process. Congressional procedure experts say public option legislation would need to include nonbudgetary policies, such as defining a package of benefits, that would require a more conventional legislative process that could be subject to a Senate filibuster.

And unanimity among 50 Democratic senators may be a big political challenge in any case. When Congress last debated the public option in 2010, it split the Democratic caucus and couldn't garner enough support to pass.

(The New York Times and SHRM Online)


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