What Will the Biden Administration Mean for Healthcare?

With the Associated Press, NBC and other news organizations calling the race for Joe Biden today, it’s now safe to start considering what a Biden administration’s will mean for American healthcare. Here is a quick rundown:

• COVID-19. Biden has talked often about heeding the advice of scientists and public health officials, a contrast to President Trump's moves to question and undercut them. Presumably Anthony Fauci, M.D., will be play a prominent role in shaping a Biden administration COVID-19 policy. Don’t surprised if Biden recruits former FDA commissioner Scott Gottlieb, M.D., into playing sone kind of role in his administration’s COVID-19 response. Gottlieb is a gifted, media-savvy communicator who has been critical of Trump on occasion. Biden will promote mask wearing and can mandate with an executive order that masks be worn on federal property. News reports have said he could use his authority to require masks on public transportation.

• COVID-19 vaccine. The race to develop a vaccine is on and the Biden administration certainly won’t want to slow it down, but Biden is more likely to listen to advice he gets from FDA and other government science officials about being cautious and waiting for full trial results to be in. It's a safe bet that Biden will be cautious and won't be making promises about when a vaccine will be available. Senator Elizabeth Warren has said that Moncef Slaoui should be fired because of ethics and conflict of interest issues. But others have said it would be a mistake for Biden to remove the head of the Trump administration’s Operation Warp Speed. “It’s a big dilemma: you risk loss of coordination and time if you replace the person who is really leading the charge on vaccines, and it’s time that we don’t have,” NYU bioethicist Arthur Caplan told Stat in late October.

• HHS Secretary. Politico identifies three contenders for the top health position in the Biden administration: Michelle Lujan Grisham, the governor of New Mexico; Vivek Murthy, M.D., the former surgeon general and founder of Doctors for America; and Mandy Cohen, M.D., the North Carolina secretary of health.

• The ACA. Biden stood out from many of his Democratic rivals during the primary season when he did endorse a single-payer, Medicare for all system. His more middle-of-the-road proposals include increasing premium assistance for people in the individual market who buy coverage through the federal or state-run ACA exchanges and raising the income levels used to determine who is eligible for those subsidies. Experts say those changes would translate into more Americans signing up for ACA coverage and reduction in the number of nonelderly Americans who are uninsured; currently, about 30 million Americans are in that category, according to the Kaiser Family Foundation. Biden has also proposed lowering the age of Medicare eligibility to 60. But the keystone of “Bidencare” would be creation of a public option. The Medicare-like coverage would be one of the choices on the exchanges, and Biden has proposed that people with low income in states that haven’t expanded Medicaid would automatically be enrolled in his public option. However, the Biden’s healthcare plan would likely leave employer-based health insurance largely intact because the public option couldn’t be offered as a choice by employers and employees wouldn’t be able to use their employer’s share of the premium to buy into the public option.

• Drug prices. Two weeks ago Biden said that Germany might serve as a model for how a Biden administration might deal with drug prices. If he follow through on that idea, it would mean a combination of government negotiation and the use of experts to determine a fair price. Biden's campaign website says he would repeal the law that bars CMS from negotiating prices for the Medicare. It also mentions the creation of an independent review board to assess the value of drug. For those who follow drug pricing in this country, the Steve Pearson's Institute for Clinical and Economic Review comes to mind. That board, says the website, will recommend a “reasonable price,” based on prices in other countries or if the drug is entering the market for a first time, an evaluation by this independent board. The campaign website also says the Biden administration would take steps to limit price increases to the general inflation rate and end the tax deduction for prescription drug advertising.