By - January 6, 2021

The Future of the ACA Under President Biden

President Biden

As the Biden administration prepares to take over presidential duties, the future of the Affordable Care Act remains secure.

The special runoff elections in Georgia cemented the Democrat’s control of the Senate. Since they already have the House majority, this gives President-elect Biden even more bandwidth to advance his healthcare agenda.

Once President-elect Biden and Vice President-elect Harris take their oaths on January 20th, the tempo and strategy with respect to the ACA will be revealed. Let’s take a look at three scenarios of potential legislation and political agendas:

Minimal Changes

Ongoing funding related to COVID-19 could take priority, leaving the ACA as is over the first few months of 2021. We may see an executive order to reverse the allowance of “Trumpcare” plans, which are non-ACA compliant catastrophic insurance plans that don’t offer Minimum Essential Coverage. But, with the Supreme Court ruling expected in June, the administration and Congress may choose to leave the ACA alone and focus on more pressing concerns.

While Open Enrollment is over, President-elect Biden will likely restore funding and attention to the exchanges by increasing advertising budgets for the next season and the support of navigators that made the ACA’s rollout a success in 2015.

Moderate Changes

Legislation to increase the individual mandate penalty to as little as $1 could be introduced to head off the Texas vs. California lawsuit. Even as experts say the Supreme Court is likely to keep the ACA intact without the individual mandate, this move would restore that clause’s role in keeping the ACA constitutional.

Another change that could see bipartisan support is President-elect Biden’s desire to increase the threshold for qualifying for a Premium Tax Credit (PTC) for plans purchased on the exchange. On the campaign trail, President-elect Biden floated the idea of removing the 400% income cap on tax credit eligibility and lowering the limit on the cost of coverage from 9.86% to 8.5%.

Also, now that “surprise billing” legislation has passed, Congress may look to reign in the pharmaceutical industry, such as limiting new drugs launch prices and allowing Medicare to negotiate prices for prescription drugs, something currently not allowed.

Significant Changes

One of the more aggressive changes to the healthcare system would be copying Medicare and offering all citizens, regardless of age, a public health insurance option, as President-elect Biden is proposing.  It leaves existing insurance plans, such as those offered by employers, in place but gives employees a new choice that leverages Medicare-like negotiated rates and provides primary care without co-payments.

President-elect Biden also has his eye on Medicaid expansion in states that refused to expand it; he would simply make the Public Option available to qualifying citizens at no cost. To ensure enrollment, those who qualify would be automatically enrolled when they start school or use federal assistance programs, such as food stamps.

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