Every presidential election brings some level of change to the healthcare landscape. The election of Joseph R. Biden—along with a Congress controlled by a slim Democratic majority—brings the possibility of change, gridlock or even compromise. While it is hard to predict what the future holds for healthcare and IR, we can look to what might be on the horizon with a new administration in Washington.
Biden’s campaign proposals
While campaigning, Biden promised to keep the Affordable Care Act (ACA) while also offering more choices, including a public option similar to Medicare. Likewise, the Democratic Party platform promises a public option through the ACA marketplace, in addition to a path to universal healthcare. Whether this is achievable remains to be seen.1
In order to expand coverage, President-elect Biden proposed the following2:
Eliminating the income limit for tax credits for health insurance and increasing the size of the credits
Lowering the limit on the cost of coverage so that no family pays more than 8.5% of their income on insurance
Expanding the public option to low-income individuals whose states have not expanded Medicaid under the ACA
Automatically enrolling those who make below 138% of the federal poverty level
Eliminating “surprise billing,” or out-of-network charges when patients cannot control the providers they see; his support helped Congress pass a surprise billing fix in the COVID-19 relief bill at the end of the 116th session
Putting any proposed healthcare mergers and acquisitions under a microscope in an effort to reduce costs to consumers
“I think Biden will be very supportive of physicians and healthcare workers in general. Empathy is definitely a skill set that he has mastered and lived. I think he’ll be sympathetic to physicians who are taking care of patients.”
— Meridith J. Englander, MD, FSIR, chair of the SIR Government Affairs Committee.
Issues to watch for
In addition to Biden’s campaign proposals, a host of other healthcare-related issues will be at the forefront in 2021.
The top priority: COVID-19
Biden has made it clear that the COVID-19 pandemic is his top priority. Two days after securing the Democratic Party nomination, he appointed a COVID-19 advisory board made up of infectious disease researchers and public health experts. His initial plan for the pandemic includes:
Increasing access to testing and making it free
Accelerating the production of personal protective equipment (PPEs)
Creating a plan for the production and distribution of vaccines
Accelerating the nation’s COVID-19 vaccination program
Mandating a period of universal mask wearing
Producing evidence-based guidance for schools and businesses regarding closures and re-openings
Establishing a COVID-19 Racial and Ethnic Disparities Task Force
Rejoining the World Health Organization and reinstituting the White House office that monitors global health risks
The plan is only a broad outline of how Biden intends to handle the pandemic moving forward. Much will depend on the pandemic’s trajectory, as well as vaccine availability.
“This new administration has a whole host of policies in place that will be very patient centric,” says Charles Martin, MD, a member of the SIR Government Affairs Committee and an IR at Cleveland Clinic. “I do hope that at a time where funds are going to be appropriately diverted to COVID, there will be opportunities to recognize some of the additional work needed in the healthcare space, specifically around patients catching up on cancer screenings and general healthcare maintenance that has been deferred because of the pandemic.”
Telehealth expansion
The pandemic accelerated the acceptance of telehealth through waivers put forth by the Department of Health and Human Services and provisions in the CARES Act. Many of those changes are temporary and set to expire when the pandemic ends.
Telehealth increases access to healthcare, particularly for patients living in rural and underserved areas. It also allows IRs the opportunity to practice across state lines in ways that were not previously available or easy. Biden’s plan for rural America describes telehealth as a vital resource, and there seems to be bipartisan support on Capitol Hill for making telehealth expansion permanent.3,4
“Happily, telehealth is here to stay,” says Dr. Martin. “Even in the midst of a pandemic, when it’s not always ideal to have a patient come in, telehealth initiatives allow doctors to continue reaching out to patients.”
Uterine fibroids
Legislation introduced in the House of Representatives and the Senate in 2020 sought to increase funding for uterine fibroid education and research. Vice President-elect Kamala Harris introduced the legislation in the Senate, joining the effort started by the bill’s sponsor in the House, Rep. Yvette Clark, D-N.Y.5 The legislation would require federal agencies to provide information to women about available treatments, including image-guided therapies.
SIR leaders met with Rep. Katherine Clark, D-Mass., in September to discuss the role of IR in the treatment of fibroids.
“A lot of women aren’t even told IR is an option for fibroids, so we see this as an opportunity to educate the public about uterine artery embolization and its role in the treatment of women with fibroids,” says Meridith J. Englander, MD, FSIR, chair of the SIR Government Affairs Committee. The plan, she notes, is that SIR will work to help identify a new sponsor in the Senate to reintroduce the bill in the new 117th Congress.
Dr. Martin feels confident the increased focus on fibroids will help the IR community with reimbursement and awareness. “I’m hopeful,” he says. “It seems like Vice President Harris is committed to making it a priority.”
What lies ahead
The Biden administration’s future ability to achieve legislative success was enhanced by the outcome of the two Georgia Senate runoffs held on Jan. 5. Both of those races were won by the Democratic Party candidates, swinging control of the Senate to the Democrats. The Democratic Party now has a very narrow margin in the Senate, which is split 50-50 between the two parties, giving Harris the tiebreaking vote. The last time Democrats had control of both Congress and the White House was 2011.
Biden’s experience in the Senate and the relationships he has built over decades in Washington may help him navigate a very challenging situation in Congress. “He was in the Senate a long time and has a lot of allies on both sides,” says Dr. Englander. “I think when the president is willing to sit down and negotiate and compromise on things, then other people may be more willing to compromise as well.” Dr. Englander also sees the new president as a friend to physicians. “I think Biden will be very supportive of physicians and healthcare workers in general,” she says. “Empathy is definitely a skill set that he has mastered and lived. I think he’ll be sympathetic to physicians who are taking care of patients.”
Dr. Martin also has confidence in SIR’s leadership and government affairs committee to navigate the waters of a new administration. “Between SIR and, more specifically, the Government Affairs Committee and our leadership, we have a fantastic team,” he says. “I have no doubt that we’re in a great position to craft where we would like to go as a society with our role in the healthcare continuum and react to anything going forward.”
This article was updated as of Jan. 7, 2021. We thank Judi Buckalew, BSN, MPH, CAE, for her additional contributions.
Affordable Care Act
SIR and other groups signed the American Medical Association’s amicus brief to preserve the ACA. The latest challenge to the healthcare law was brought by 18 Republican-led states. During oral arguments in October, several of the Supreme Court’s conservative justices indicated their support for keeping the ACA intact even if the court decides to strike down the individual mandate requiring people to purchase health insurance.6 A ruling from the court is expected in June.
References
- Achieving Universal, Affordable, Quality Healthcare. Democratic National Committee. 2020. org/where-we-stand/party-platform/achieving-universal-affordable-quality-health-care/.
- Plan to Protect and Build on Obamacare. joebiden.com. 2020.
- The Biden Harris Plan to Build Back Better in Rural America. joebiden.com. 2020.
- Congress Continues to Push for Post-COVID-19 Telehealth Coverage. mhealthintelligence.com. 17 July 2020. com/news/congress-continues-to-press-for-post-covid-19-telehealth-coverage.
- 4397 – Uterine Fibroid Research and Education Act of 2020. congress.gov. 2020. congress.gov/bill/116th-congress/senate-bill/4397?r=7&s=1.
- Viser, Matt, Kim, Seung Min, and Linskey, Annie. Biden Plans Immediate Flurry of Executive Orders to Reverse Trump Policies. The Washington Post. 7 Nov. 2020. com/politics/biden-first-executive-orders-measures/2020/11/07/9fb9c1d0-210b-11eb-b532-05c751cd5dc2_story.html.
- Liptak, Kevin, “Key Justices Signal Support for Affordable Care Act. The New York Times. 10 Nov. 2020. com/2020/11/10/us/supreme-court-obamacare-aca.html.
