President Biden has laid out an ambitious healthcare agenda, some of which is linked to the stimulus legislation that’s making its way through congress. Historically, Americans haven’t been overly enthusiastic about healthcare reform. The COVID-19 pandemic, however, presents a different set of circumstances. As Biden has said repeatedly, he deems economic recovery to be inseparable from pandemic recovery. In tackling the pandemic, Biden and the Democrats might be able to make healthcare reform progress simultaneously. But the fate of his efforts largely depends on the willingness of the Republican minority to cooperate, and on outside influence from the healthcare and pharmaceutical lobbies. Meanwhile, American physicians and healthcare workers must hold the line against the pandemic, and prepare for changes within their industry over the next four years. These are some of the possible changes: Public option The big number: 10.9% A Kaiser Family Foundation issue brief says 10.9% of Americans lacked health insurance in 2019. That’s 28.9 million uninsured Americans. The number has been on the rise for 3 years, since 2017. In 2017, this number was 27.4 million. According to the Kaiser report, the uninsured are mostly non-elderly adults from working families. Lower-income families are more likely to be uninsured, and people of color are more likely to be uninsured than white people. Another big number: 60 Biden would like to lower the Medicare eligibility age from 65 to 60. Biden’s plan: President Biden wants a Medicare-like public option that competes with private insurers and is available to those who don’t have health insurance through their employer. This could reduce costs for consumers, as this public option would negotiate for lower prices from health care providers. Does it have a shot? This is a highly divisive issue. Plus, healthcare organizations and physicians may not be so enthusiastic about lower reimbursement rates, especially as the care that they provide becomes more costly to administer. Lowering the medicare eligibility age would have a similar effect. A recent STAT First Opinion piece also highlights how a public option could increase federal deficits during economic crises, such as the COVID-19 pandemic. Eventually, the authors argue, politicians will succumb to the pressure to reimburse doctors and hospitals at rates closer to private insurers. One of the few options they’ll have to close the gap is deficit spending. Furthermore, NPR reports that the Medicare Hospital Insurance Trust Fund will become insolvent in 2024. How does this affect doctors? A public option with similar reimbursement rates to Medicare could mean a higher patient volume for physicians. It could also translate to lower reimbursement rates for physicians and healthcare organizations. Expanded Affordable Care Act tax credits The (not-so-) big number: 2 It’s a small number, but a big deal in this case. The COVID-19 relief bill also includes a provision that extends the Affordable Care Act’s (ACA) financial aid for 2 years. Another provision caps ACA insurance premiums at no more than 8.5% of income. The current cap is 10%. Plus, for the first time, middle-class families would also get some relief. For example, a middle-class family of 4 making about $100,000 would now be eligible. Does it have a shot? ACA has been a Republican trigger word for years. Though the Democrats now control both houses, the bill’s passage (as is) isn’t a slam dunk. For example, there’s already Democratic infighting over the $15 minimum-wage proposal. How does this affect doctors? Once again, this means greater access to care, but it might have financial implications as well. For example, a 2016 survey from CompHealth found that 40% of queried physicians said the ACA increased the cost of healthcare and had negative impacts on their practice, their ability to meet patient demand, and their salaries. The survey included about 1,000 doctors from private, group, and hospital-based practices. COBRA subsidies The big number: 85% The COVID-19 relief bill making its way through congress contains an 85% subsidy for the cost of COBRA coverage. In the event of job loss, COBRA coverage allows people to keep their former employer’s healthcare coverage. Why this is important: According to the Bureau of Labor Statistics, the current unemployment rate stands at 6.2%. Extension of COBRA benefits would be beneficial to these Americans, especially since the pandemic continues. Extended coverage would also alleviate the financial strain on the US healthcare system. How does this affect doctors? More patients would retain their coverage and, theoretically, use it if needed. Private insurance reimbursement rates likely are preferable to physicians and their employers, rather than accepting public-option or charity rates. Prescription drug costs The big number: 44% According to a May 2019 JAMA Network Open study, 44% of America’s top-selling brand-name drugs have more than doubled in price since 2012. 78% have seen out-of-pocket and insurer cost increases by more than 50%. The researchers predicted that the increases would continue, meriting greater price transparency. Biden’s plan: The president has proposed repealing existing legislation that exempts pharmaceutical companies from negotiating prices with Medicare. Biden would also control pricing of new pharmaceuticals that face no competition. In this case, a Health and Human Services review board would “recommend a reasonable price.” Biden has also called for allowing Americans to buy prescription drugs from other countries. Does it have a shot?: This is one of the few things that legislators on both sides of the aisle can agree on. Last week, legislators met to discuss this issue and called for “faster approval of complex generic prescription drugs,” The Hill reports. How does this affect doctors? Making drugs more affordable would likely bolster patient adherence to drug regimens. However, it also could have a chilling effect on new drug development since new drugs are costly to bring to market. Mental Health and Substance Abuse The big number: $4.25 billion The most recent stimulus package calls for $4.25 billion to support mental health and substance use treatment. A recent Kaiser Family Foundation poll found that: 36% of Americans are experiencing difficulty sleeping 32% are having difficulty eating 12% report an increase in alcohol or substance use 12% are experiencing worsening chronic conditions Year over year, overdose deaths from January-April 2020 were up about 20%, according to the Overdose Detection Mapping Application Program. Levels of anxiety and depression among US citizens have reached all-time highs, according to CDC data. Biden’s plan: His platform included expanded funding for mental health services, as well as implementation of the federal mental health parity law, which requires health insurance coverage on par with medical and surgical benefits. Does it have a shot? This is another somewhat bipartisan issue. Red and blue states have been ravaged by opioid addiction, and the mental-health consequences of the pandemic will affect Republicans and Democrats alike. How does this affect doctors? People needing psychiatric care and support may be more likely to seek it if they know it’s covered by insurance. Pandemic-related The big number: $20 billion Biden has called for $20 billion to support tribal governments to assist their response to the COVID-19 pandemic. Currently, American and Alaskan Natives are experiencing a mortality rate that’s 1.8 times that of non-hispanic white Americans, according to the CDC. Another big number: $20 billion Biden’s pandemic response includes another $20 billion to support veterans’ health. Like many Americans, veterans have lost jobs and private health insurance. This puts increased pressure on the VA to fill the gap. Does it have a shot? Historically, Americans have attempted to do right by their veterans. Supporting troops is also a bipartisan issue. President Biden’s late son, Beau, was also a veteran. However, historically, Americans have not done right by Native Americans — to put it mildly. How does this affect doctors? VA and Indian Affairs physicians might have more financial resources to support these patients. Source
