Politics and health care policy: Just the facts
NAHU President Janet Trautwein gives her take on what health care policy changes can we expect to see following November's election.
“In your businesses, you have to plan what you’re going to do and you have to be ready for whatever occurs,” Trautwein told attendees. “People have opinions about things, but you better look at the math, too. When you look at electoral college projections, they’re based on polling and probability.”
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And what do those numbers say? According to Trautwein, we can expect to see Democrats retain control of the House, though the future of the Senate is more questionable. “The most recent projections are that there are only 6 tossup seats, and the current projection is 47-47,” she said, adding, “Unless a party has a giant majority, their hands are tied to a certain extent.”
Trautwein also highlighted the shift in policy positions that has occurred since Joe Biden became the frontrunner for the Democratic campaign, many of which are intended to draw in both more progressive and swing voters, including lowering the age of Medicare eligibility to 60, creating a public health care option and expanding student loan forgiveness. That, coupled with a strong backing of support from big names, both Democrat and Republican, points to a strong likelihood of victory, Trautwein said.
So, assuming Democrats win the presidential election, maintain control of the House, and hold only a narrow majority (if any) in the Senate, what policy changes can we expect to see?
Medicare for All: DOA
“Most people are worried about Medicare for All,” Trautwein said. “I don’t see any possibility of that going through under a Biden presidency. He loves the ACA. He believes he was hand in hand with President Obama and he does not want to give it up. He wants to add to it and improve it.”
Speaking of the ACA…
“A big question that I get: Wouldn’t Biden just come in and undo all of President Trump’s executive orders?” Trautwein said. “Sort of but not really. It depends on how old the executive order is and if regulations have been issued. Once a reg has been issued for a period of time, it begins to have the force of law.”
Trautwein expects there could be some rollbacks on the expansion of associated health plans and the loosened restrictions on short-term health plans, but other areas will require congressional action. And of course, the individual mandate would make a comeback.
Public option: There are options
As something of a concession to more liberal Democrats, Biden has added the idea of a public option to his platform. “He would use a different type than we have seen promoted so far,” Trautwein explained. “It would be more like a Medicare buy-in. It would be run by CMS, not insurance-based.”
This version is different from plans being explored at the state level, as well as other ideas being floated at the national level. Trautwein expects that any public option is unlikely to make it past the Senate unless Democrats have a significant majority, but it can’t be ruled out. “There are a couple of times during the year when things can pass without being subject to filibuster–during the reconciliation process, which is how we got the ACA.”
Medicare for more
Biden’s latest health policy proposals would lower the age of Medicare eligibility from 65 to 60. “This is the opposite direction of the trend; a lot of people have been talking about increasing the eligible age to match up with Social Security eligibility.”
Biden’s proposal could potentially allow those over the age of 60 but still working to opt out of their employer-sponsored plan–something that might appeal to employers, Trautwein pointed out.
Preparing for the alternative scenario
A lot could happen between now and November, and a continued Trump presidency shouldn’t be ruled out. If that’s the case, however, it’s a bit easier to predict how the next four years will play out, at least for health care reform. ”We’ll see a lot of the things we’ve seen already,” Trautwein said. “Undermining the ACA. Some additional drug pricing reforms. We’ve had a huge number of regulations come out of this administration.
“I have to say that as much as we’ve tried to be cooperative and helpful, I am worried about the employer-sponsored system,” Trautwein warned. “I’m worried about the increased efforts to take away the tax exclusion. The amount of money that is foregone because of the tax exclusion is huge. The bigger threat of that is actually on the Republican side.”
Whatever happens in November, Trautwein is looking forward to a more cooperative political landscape down the road. “Right now we’ve got so much contention, but once we get past the election, I really feel like we can move toward more bipartisanship,” she said. “If you’ve only been watching politics for 10 or 15 years, you might never have seen that. But I’ve been around longer than that. If they do become more bipartisian, it will be good for all of us.”
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