By Simon F. Haeder, Penn State
President-elect Joe Biden has a lot of work to do; Tackling the runaway pandemic is high on the list, and beyond that, there are significant challenges to health care in general.
Undoubtedly, in-depth management also faces limitations. Twelve years ago, Barack Obama had a secure majority in the US Senate. This time it won’t, and many progressive dreams like Medicare for All are way out of reach. Even Biden’s humble goal of adding a public option to the Affordable Care Act is likely to fall on Mitch McConnell’s ears.
As a professor of public policy who analyzes the political landscape, I think major transformational reforms are unlikely in the next few years, especially given the controversial consequences of the presidential elections. But Biden and Vice President-elect Kamala Harris can make changes on seven smaller but important policy issues that will improve the lives of millions of Americans. The Biden administration can achieve some of these solely through regulations and other administrative measures. Others require bipartisan collaboration, but Republicans could get on board if politically convenient.
1. Take executive action
To prop up Affordable Care Act, Biden has a number of administrative policy tools in place that reverse the course of many of the actions taken by the Trump administration. In some cases he can take executive action; He won’t need a congress to work together.
In order to lower the uninsured tariff, Biden can extend the registration deadlines for the ACA marketplaces. He can also focus on advertising, public relations, and enrollment again. The Trump administration has virtually done away with this type of funding, which has had a significant impact on enrollment. It can also enact regulations that weaken the market. Dozens of other seemingly minor technical changes to regulations can cumulatively have significant effects.
2. Expansion of Medicaid Coverage
The ACA was passed with the intent that states would expand coverage for the uninsured by expanding Medicaid; Most Republican states have refused. Biden can handle that; It may encourage states to expand their Medicaid programs beyond the Section 1115 exemptions. These exemptions allow states to temporarily disregard certain Medicaid innovation testing requirements.
Under President Obama, some Republican states traded the expansion of Medicaid for smaller rewards or incentives for health behavior. Now work incentives and potential work demands can be on the table. While these requirements certainly make individual registration difficult for some, a compromise may be needed to get Medicaid coverage to the remaining holdout states, all Republicans.
3. Combating the opioid epidemic
The opioid crisis has worsened due to the coronavirus outbreak. While the Trump administration has made some effort to address the problem, people with addiction and substance use disorders need a lot more. It is crucial to return government attention to opioids during the pandemic. Otherwise it will get worse.
Biden should receive additional bipartisan funding from Congress for states hardest hit by opioids, such as West Virginia. Once again, many of these states are red. However, bipartisanism will be key to defining a comprehensive national strategy, which is vital here.
4. Improving access to organ transplants
Organ transplants don’t get much attention, but the U.S. has suffered from a severe shortage of available organs for decades. Every day, 13 Americans die from one kidney and four more from other organs. COVID-19 has further exacerbated the shortage.
The Trump administration has made progress on this issue through regulation. This includes increasing support for living organ donors. Biden should build on this progress. It could change the current approach to donation, which is based solely on altruism, by increasing financial support for donors. The Pennsylvanian Democratic Representative Matt Cartwright’s Organ Donation Clearance Bill is currently in Congress but could serve as an important step in that direction.
5. Quit surprise medical bills
The Trump administration talked about it but never managed to eliminate the surprise billing. These are medical bills that patients don’t expect, often because a provider is not part of their network.
Americans are overwhelmed by surprise bills and want a solution. Both parties to Congress have worked on the issue for years, but hospitals, doctors and insurers have worked to keep it untouched.
Some limited progress is likely through regulation. However, legal changes are needed to ensure meaningful protection for all Americans. Strong presidential and congressional leadership could make a difference here, but even then it won’t be easy.
6. Lower the prices of prescription drugs
The US pays much higher prices for prescription drugs than the rest of the developed world. This is primarily due to limited competition between drug companies and a gaming-prone patent system. In addition, our regulatory apparatus has largely focused on drug safety while emphasizing cost effectiveness for new and existing drugs.
The Trump administration’s recent proposal to address the problem has been limited. Congress should follow the German example, which is cutting prices by 30 percentage points compared to the US and concentrating on rewarding effective drugs. Pharmaceutical companies will fight vigorously to hold on to their profits, but given the general public disdain for high drug prices, a dedicated bipartisan coalition could bring some relief.