The difficulty of policymaking with a divided government and electorate was the underlying theme of the Research into Policy and Practice webinar sponsored by the Department of Health Policy at Vanderbilt University Medical Center as panelists and attendees gathered virtually to take measure of the post-election American landscape, over which hangs the pall of a surging pandemic.
The moderator was Joanne Kenen, executive editor of health care at POLITICO, a news media group which covers politics and policy in the United States and abroad. Panelists included Melinda Buntin, PhD, Mike Curb Professor of Health Policy and chair of the Department of Health Policy; Stacie Dusetzina, PhD, Ingram Associate Professor of Cancer Research and associate professor of Health Policy; and John Graves, PhD, associate professor of Health Policy.
The panel covered a range of topics including steps an incoming Biden administration could pursue to fortify the Affordable Care Act (ACA) and to address inequities in health care. Continued challenges brought by the pandemic and the complexity of delivering a safe vaccine to the world were also discussed.
“This is a unique time for policymaking to both address existing gaps and challenges in access to health care and health insurance, and to respond to this pandemic,” said Buntin. “There’s really never been a more important election for health policy.”
Kenen agreed, adding that the pandemic has forever altered who we are both as a nation and as individuals.
“All of us are putting one foot in front of each other,” she said. “There’s a lot of stress in life, there’s a lot of demands on us and we’re going through a national trauma.
“As a country, we don’t believe that health care is a right. We do believe in covering pre-existing conditions, and that’s a change. So, what else will change? I like to think that even after 20 years in Washington, I’m still an optimistic person. I’d like to think that we’ll come out of this with some ability to solve problems and some understanding that we’ve gone through a collective national and global trauma. But I also am not real optimistic about the ability to get a lot done fast in Washington.”
Buntin began the discussion by defining constraints on the Biden administration. Voters have issued a mandate for improved management of the pandemic, possibly including a coordinated federal response related to supplies and testing policies, as well as clear guidance on vaccination delivery, she said.
However, successfully tackling health care reforms will likely be limited both by a possible 50/50 split in the Senate as well as by fiscal hurdles. For example, Biden cannot lower the eligibility age for Medicare, as he proposed during his campaign, without Congressional support, but he could, through executive actions, roll back some of the Trump administration’s actions that narrowed the ACA.
“And because of the pandemic, our tax revenues are down,” Buntin said. “So, there will be constraints on what Congress is willing to do going forward in terms of reforming the ACA and adding coverage, because adding coverage generally costs money.”
Graves addressed the incoming administration’s potential unwinding of Trump-era federal or federally directed policies. For example, the Trump administration loosened restrictions on buying what are known as short-term, limited duration insurance health plans that aren’t required to conform to the ACA’s rules on benefit standards and on covering pre-existing conditions.
The Biden administration could return to the standards set by the Obama administration, which limited enrollment in short-term plans to no more than three months at a time. The Biden administration could also reverse waivers of federal rules related to the Medicaid program and the health care exchanges, he added.
“On the stability front, there might be some traction for what’s known as reinsurance programs,” Graves said. “This is a way to stabilize the insurance exchange by injecting it with money for very high-cost individuals, thereby bringing down premiums.”
Dusetzina addressed Biden’s proposals to manage prescription drug costs, including continued federal negotiation of drug pricing, as well as limiting price increases to inflation for Medicare or public-option plans. The Biden plan also includes establishment of an independent evaluator to negotiate prices for expensive, specialty drugs, including cancer treatments, as well as a proposal to limit out-of-pocket spending for beneficiaries of Medicare Part D.
“What I’m hopeful for is less talk and more action when it comes to drug prices and drug pricing policy under the Biden administration,” she said.
“The public really wants lower drug prices; it’s bipartisan,” commented Kenen. “Pre-pandemic, it was the top health care item in many polls for both Democrats and Republicans since around 2015. Some of Trump’s ideas were more akin to things Democrats had proposed for a number of years, but a Republican president did not get most of it through a Republican Congress. If Trump couldn’t get this through a Republican Congress, can Biden get any of the drug price measures through a Republican Congress?”
Dusetzina said there may be opportunities for bipartisan agreement on limiting price increases and redesigning the Medicare Part D benefit to improve coverage for seniors, but goals of drug pricing negotiation would be more challenging.
At the event’s conclusion, Buntin noted that the federal impasse when it comes to addressing and resolving key issues in 2020 is in stark contrast to the rapid mobilization of health care organizations throughout the country in response to the pandemic.
“What’s happened here at Vanderbilt University Medical Center is pretty astounding,” she said. “What front-line workers have patched together and learned on the fly is astounding. Their experiences are a real challenge to the status quo. Can we preserve some of the things that worked? Will we, for example, continue telehealth in the future? The response of the health care system was impressive, with everyone pitching in. I hope everyone in Washington can carry a fraction of that spirit into the next Congress.”
