Editor’s Note: Lanhee J. Chen, Ph.D., is the David and Diane Steffy Fellow in American Public Policy Studies at the Hoover Institution and the Director of Domestic Policy Studies in Public Policy at Stanford University. He previously served as policy director on the Romney-Ryan 2012 campaign and senior adviser on policy to the National Republican Senatorial Committee. The views expressed in this commentary are his own. View more opinion on CNN.
Few issues have been as polarizing over the last several years as health care reform. Much of the rancor extends back to the partisan passage of the Affordable Care Act (ACA) in 2010 and was inflamed by Republican efforts to repeal the law in 2017.
As President Joe Biden begins his tenure, with narrow majorities in both the US House of Representatives and the US Senate, he will need to work with lawmakers in both parties to advance his legislative agenda. Even though Democrats now control both chambers, most legislation will still need to clear a 60-vote threshold to assure final passage in the Senate, and bipartisan support for his initiatives will therefore be crucial to ensure their passage.
Biden has advocated for some health policy changes that are unlikely to garner Republican support – for example, a proposal to create a public health insurance option or one to lower the Medicare eligibility age. But there are other ideas that would be more popular and even pass with bipartisan votes in the US Senate.
In December, the parties worked together to address “surprise” medical billing by including a fix to address the problem in the Covid relief package that passed Congress before Christmas. Biden should build on this momentum.
First, the President can address one problem that has generated bipartisan interest in the past – prescription drug costs.
In 2019, a bipartisan group of senators agreed on a number of reforms to address prescription drug pricing. Their legislation included, for example, capping out-of-pocket costs in Medicare’s prescription drug benefit; requiring pharmaceutical manufacturers that increase the list price for their drugs faster than inflation to pay a rebate; and mandating price transparency measures for drug-makers seeking to unveil a new medicine or increase prices on an existing one. While each of these measures alone may not do much to impact drug costs, together they constitute a consequential package of reforms that could garner substantial support in the Senate. All that’s left is presidential leadership to get it across the finish line.
Second, in response to the Covid-19 pandemic, the Trump administration made a number of temporary policy changes to increase access to telehealth and other technologies that make it easier for patients to get care. For example, it increased the type of telehealth services covered for Medicare patients, made it easier for providers to furnish telehealth across state lines and provided telehealth services at federally qualified health centers and rural health clinics.
The Covid-19 pandemic has illustrated the importance of leveraging technology to ensure access to our health care system, particularly where in-person visits are difficult. Millions of Americans – including many with conditions that place them at higher risk of adverse outcomes if they catch Covid-19 – have used telemedicine and other technologies to safely get access to health care since the start of the pandemic.
However, without further action, these reforms will go away. Biden should work with Congress to enshrine these changes into law and make them permanent – for example, by incorporating them into a Covid relief package soon after he takes office.
Finally, Biden may be able to work with moderate Republicans to extend coverage under the Affordable Care Act, a law that the Supreme Court seems unlikely to overturn anytime soon, if ever. While the ACA dramatically expanded the number of Americans with health insurance, almost 30 million still remained uninsured in 2019. Both parties must compromise to address this challenge. Democrats must drop their insistence that coverage expansions come primarily by way of even more widespread expansions of state Medicaid programs, the government-run health insurance that many low-income Americans use. Conservatives have opposed these expansions because they don’t want to put more people on government-run insurance and have long had concerns about fraud and the quality of care provided in Medicaid.
For their part, Republicans should set aside their blanket opposition to the ACA and find ways to tweak the law so that it works better. It’s up to Biden to convince enough Democrats to accede to a deal and a few Senate Republicans to come together with a willingness to address the coverage conundrum.
The outlines of a deal, based on these terms, could be relatively straightforward: Congress could provide states with funding to partially expand their Medicaid programs in conjunction with greater flexibility to give additional assistance – via tax credits or other subsidies – to low-income residents looking to purchase private insurance. Neither side would get all of what they’re looking for, but this “goldilocks” approach could be the ticket to increasing the number of Americans with health insurance – particularly in states like Texas and Florida, where governors and legislators have consistently opposed full Medicaid expansion. This compromise would allow both sides to claim some measure of political credit for an important accomplishment.
Since passage of the ACA in 2010, presidents have largely resorted to unilateral executive action to make health care policy changes. But more consequential and durable reforms will require Biden to find a way to work both with progressives who are looking to replace what we have now with Medicare-for-all and Republicans who believe the ACA remains fundamentally flawed. Neither of these points of view will win out over the next four years, so it’s up to Biden to convince skeptical Republicans, in particular, that there are actually a few things they can do together to improve America’s health care system.
Correction: An earlier version of this piece advocated for a bipartisan solution to surprise medical billing, but did not note that Congress included such a measure in a Covid relief package that was passed in late December 2020.
