As coronavirus cases skyrocket and Trump refuses to concede to Biden, many Americans face uncertainty regarding their health care options. For the millions who have lost their jobs, coverage may be too expensive, leaving them uninsured and vulnerable.
Amidst the chaos and general unease, the president-elect is looking to expand the Affordable Care Act (ACA) to provide coverage to more Americans. In doing so, Biden could increase your health care options and change health insurance to benefit both patients and providers.
Switching from fee-for-service health care to value-based care is a mostly bipartisan effort. Regardless of who became president, this shift would likely have occurred at some point or another. However, Biden promises to prioritize value-based care and put it into effect more quickly than Trump would.
The Biden administration is also looking to minimize racial disparities that may prevent some from receiving quality care. To accomplish this, he’s promised to double the federal investment for community health centers whose patients include mostly uninsured people of color. He also plans to expand access to mental health care, which would help communities of color who are more likely to experience serious mental health issues.
Biden could also include more accountability and appeals mechanisms to further support fair and valuable care to those who need it most. Additionally, he might pay health care providers more to tackle racial disparities. Meanwhile, the Trump administration has done the opposite by requiring accountable care organizations to take on more financial risk. Moreover, Trump has yet to share any plans to combat racial disparities in health care.
The ACA already offers financial assistance to reduce monthly premiums and other out-of-pocket expenses like copays and deductibles. Generally, these federal subsidies help uninsured individuals with low-to-moderate incomes in one of two ways. The first is through premium tax credits, which help reduce their monthly premium payments for insurance coverage. The second is through cost-sharing reduction, which can minimize out-of-pocket costs. All qualifying individuals must enroll in a Marketplace plan to receive a subsidy.
Biden will likely focus on expanding ACA subsidies for uninsured Americans who live in states that didn’t expand Medicaid through a federal public option. The administration could also pursue a change in eligibility to ensure more low-income families receive tax benefits and lower premiums. Additionally, it may adopt special enrollment periods and enable family members of low-income workers to qualify for and receive subsidies. These changes would temporarily relieve premium tax credit reconciliation requirements, helping millions affected by COVID-19.
Lower Medicare Eligibility
Another aspect of Biden’s plan would lower Medicare eligibility from 65 years of age to 60. This plan would primarily benefit the near-elderly population where unemployment rates are high and premiums are more expensive. There isn’t a huge red-blue divide on this issue, either, signaling many Republicans and Democrats support the decision. Many employers would also benefit since employees in their 60s would then have coverage through Medicare. Subsequently, companies would enjoy lower health insurance costs.
As with any agenda, there are trade-offs. Medicare traditionally pays providers much less than commercial or private plans. If a large number of people leave their commercial plan at 60 to join Medicare, providers may experience a massive loss. Still, providers that serve a high number of uninsured or underinsured individuals may stand to benefit from this change.
A lower age of eligibility would be a relatively simple expansion. The general benefit structure of Medicare wouldn’t change. Plus, the House’s Democratic majority would likely support this change and push the policy through. If they decide to do so, it could only be a matter of months before this expansion of coverage goes into effect.
Lower Drug Prices
Trump came into office in 2016 promising to lower prescription drug prices. He’s since failed to authorize Medicare to negotiate drug prices and reduce costs for Medicare recipients. While his administration did reach a significant agreement to lower older adults’ insulin costs to $35, it still hasn’t established widespread regulations to curb drug costs.
Meanwhile, Biden has vowed to reduce drug prices and allow Medicare to negotiate them. He also plans to establish a new arm of the U.S. Department of Health and Human Services to assess the value of prescription medications. This new department would establish fair prices based on international pricing and allow both private and public insurers to benefit.
Additionally, Biden would limit price increases of brand-name drugs and expensive generics to the rate of inflation. Patients may also order medications from countries the U.S. considers safe drug producers. By doing so, Americans may secure cheaper prices and force Pharma to lower costs within the U.S.
Your Options Right Now
Biden’s health care plans could benefit millions of Americans, especially as the nation faces a potential second wave of the coronavirus. However, if you’re one of the many hoping for more financial assistance, you may have to wait a few more months. Biden won’t officially take office until Jan. 20. Until then, his administration is limited in what it can do for the American people. Moreover, it’s uncertain congressional Democrats will take up these health care changes and actually expand coverage.
In the meantime, you’ll have to rely on options already available to you, however, limited they might be. Since the ACA is still in effect, you may be able to enroll in a plan through the ACA Health Insurance Marketplace. Those who have managed to keep their job may choose to remain on their employer’s plan. Others may receive group coverage through COBRA, which continues employer coverage through a former employer.
Primary care memberships, medical cost-sharing programs, health savings accounts and medical services discount cards may also provide alternatives to traditional health insurance. Prices, programs and plans vary by state, so be sure to visit HealthCare.gov and your state’s health insurance marketplace website to find the best coverage for you.