The new Obamacare?  Here’s what to know about Bidencare

Following the Georgia run-off election and an anything-but-normal electoral college certification, the political picture in Washington has become a lot less ambiguous. With Joe Biden as President and a Democratic majority in the House and Senate, it’s time to take a deeper dive into the plans the President is eager to put into action during his time at the White House. In short, the crux of his plan rests on building upon Obamacare and protecting the Affordable Care Act. But how? Already, President Biden ordered the reopening of Affordable Care Act exchanges and moved to restore coverage mandates and Medicaid plans undermined by his predecessor.

Here’s a look into what else we can expect from his reform:

The new Obamacare

In a lot of ways, Biden’s plans will follow the same principles of the plan he helped establish as Vice President under President Barack Obama to create the Affordable Care Act, more commonly known as Obamacare. On Joe Biden’s campaign website, he says this fight “is personal” and already the Bidencare plan is receiving support from Americans. An October poll by The New York Times and Siena College found that 67% of those planning to vote in the 2020 election supported a public health care option — even more than the 55% who support Obamacare. Needless to say, health care is an overwhelming priority for many Americans and the COVID-19 pandemic has only increased the urgency for affordable, accessible health care options.

Democrats now have control of the Executive branch and both houses of Congress. For those wondering what that means for health care, we’ll need to keep a close watch on Medicare expansion (lowering the age from 65 to 60), a public insurance option, and how President Biden plans to refresh Obamacare and counteract the changes enacted during Trump’s presidency. However, the scope and pace at which this health care agenda progresses remains to be seen.

Tempered expectations

Following the results of January’s runoff election in Georgia, Democrats have pulled even at 50-50 for control of the Senate. And while Vice President Kamala Harris will be able to break a party-line tie with a deciding vote, policies will require unanimous agreement among Democrats or support from across the aisle. There’s also the filibuster, which means that unless Democrats secure 60 votes, they will have a hard time passing major policy initiatives.

So, we’ll likely see health care reform – at a much smaller scale and limited scope – be delivered through budget reconciliation, which requires only 50 votes. It is for these reasons we expect the policy changes associated with Bidencare to occur over a longer time period and in smaller, less dramatic pieces. Think evolution, not revolution.

What About Medicaid and Medicare? 

While health care is top of mind for many Americans, nearly 30 million remain uninsured. For those considering Medicaid, Medicare, or Medicare Advantage for themselves or for family members, it is important to understand the key differences in these government programs.

Medicaid is an assistance program offered to low-income Americans at every age and those who can’t afford health care or have permanently disabling conditions. Medicare, on the other hand, is an insurance program offered to people primarily over 65, no matter their income, and is broken into four parts:

1. Hospitalization coverage
2. Medical insurance
3. Medicare Advantage plans
4. Prescription drug costs

Individuals who are eligible for Medicare Part A and Part B are likewise eligible for Part C. Part C plans are offered by private companies approved by Medicare. Part C offers vision, hearing, and dental coverage, and may also provide prescription drug coverage. Medicare Advantage is the fastest-growing segment in health insurance, thus making it a game changer for many. In fact, MA plans are projected to account for 47% of total Medicare plans by 2025.

Related: What do voters want in health care reform? 

So, what could change? There has been talk of moving the Medicare eligibility age down from 65 to 60, which would have a material impact on cost and coverage, especially for those with a chronic condition. Medicare participants with chronic conditions represent 80% of enrollees. Some necessary expenses that are not directly connected to a provider, such as transportation (to the grocery store to get medicine) are now being covered by MA plans, which will ultimately lower costs.

Why are these plans beginning to cover things like transportation? This is where we introduce another term that’s becoming more and more common – social determinants of health. The theory here is simple: It’s more cost effective for a health plan to pay Uber to take someone to the pharmacy to get their prescriptions than to wait for them to run out of their medication and land in the ER. Social determinants of health isn’t a new concept, it’s been part of Medicaid plans for years, but has now made its way more broadly into Medicare.

What’s to come? 

With 2020, and its political, economic and global health turbulence (hopefully) behind us, we’re looking forward with optimism to the future. While we may not know which of Biden’s health care proposals become reality, or the extent to which they make waves in the industry, one thing remains true: Our focus in the immediate term is on how we can champion solutions which deliver better outcomes at lower overall cost. Brokers and employers play a key role as they design benefits packages for employees in an environment where change continues to be the one constant.

Brian Colburn is SVP, Corporate Development and Strategy, at Alegeus.