No Matter Who Wins, the Presidential Election Will Change Healthcare. Here’s How

October 29, 2020
Marc Samuels
Marc Samuels
Marc Samuels

Marc Samuels, J.D., M.P.H., is the CEO of ADVI, a strategic advisory services lifesciences firm in Washington, D.C., and a member of the Managed Healthcare Executive® editorial advisory board.

A Biden presidency will mean the immediate expansion of health insurance coverage and perhaps a public option. A second term for President Trump would mean renewed efforts to repeal and replace the ACA and emphasis on consumer choice.

No matter who wins, the result will be divisive and impactful to the healthcare of millions of Americans, including those on commercial insurance.

A Biden presidency

If elected, it is likely that a Biden presidency would lead to immediate expansion of health insurance coverage for Americans impacted by the COVID-19 pandemic, specifically those who are out of work, caught between Medicaid expansion and the ACA-eligibility (i.e., individuals over 26 who cannot remain on their parents’ coverage), and those who have been systemically uninsured and uninsurable. While “Medicare For All” may be a goal of a potential Biden administration, at minimum a public option is doable and would allow Biden supporters, such as union members, to keep their Cadillac plans. Similarly, this may appeal to rural parts of America.

Biden has also promised to lower the Medicare age to 60 and allowing or mandating Medicaid coverage in the states that have not yet expanded their programs.

As has been seen during Trump’s first term, drug pricing is likely to be of paramount concern in a Biden administration. The Biden plan might allow Medicare (and possibly Medicaid) to negotiate with drug manufacturers on the prices of most prescription drugs and allow commercial payers to use these prices as a reference. House Democrats have passed and support such negotiations and reference pricing, so the price of physician-administered and possibly retail drugs would be equivalent to the prices paid in other countries.

What has been discussed infrequently is the notion that lower drug prices alone are not enough and that to achieve real savings a Biden CMS would need to curtail coverage, target drug inflation, and impose utilization management and other payer tools on federal healthcare programs.

If Biden wins but the Republicans keep control of the Senate, expect the same flurry of executive actions that Trump has used to be Biden’s tool of choice. Such actions may include but wouldn’t be limited to demonstration authority to expand coverage and control costs; executive action to roll back restrictive policies in the Medicaid program; and reinstatement of anti-discrimination protections for the LGBTQ community.

A second Trump term

A second term for President Trump would center around what the President tried and failed to do even with a Republican majority: repeal and replace ACA, to the extent possible, through administrative action.

In Trump’s view, this action is necessary to provide Americans with more and better coverage choices that are less expensive. Such choices would be consumer-centric and allow for additional flexibility – for consumers, states, and the federal government. Unlike the Biden vision, Trump’s plan would be decentralized and tailored to the individual, not a federal, one-size-fits-all mandate.

Trump’s focus would remain on the consumer, which has been his stated priority since the beginning of his current term because he wants consumers to have more choices.

Similarly, Trump wants to eliminate federal mandates that increase the cost of health insurance across government programs. This is likely to mean additional private-sector options for health care coverage and affording states more power to manage their populations as they see fit including the Medicaid program, which is jointly funded by the states and the federal government.

Trump would balance better value, with lower prices, and more choice. He would continue to drive for value-based arrangements and other demonstration opportunities with the hopes of reduced costs like the Oncology Care Model and a model for curbing the costs of radiation treatments and imaging.

During his second term, Trump would proceed with the implementation of his executive orders related to cutting the price of physician-administered and retail pharmacy drugs. He would also impose a similar reference pricing construct as Biden and the Democrats, using the cost of drugs in other countries as a ceiling. Finally, he and the Democrats would agree on other initiatives around drug pricing such as an inflationary cap and increased utilization management.

Marc Samuels, J.D., M.P.H., is the CEO of ADVI, a strategic advisory services lifesciences firm in Washington, D.C. He recently joined the Managed Healthcare Executive® editorial advisory board.