Very few, if any, U.S. presidents have embraced the approach coined by legendary football coach Lou Holtz: “Don’t ever promise more than you can deliver, but always deliver more than you promise.” It’s too soon to tell whether the Biden administration will deliver on its campaign promises.
“New presidents typically set ambitious healthcare agendas only to see them whittled down by political or economic realities,” said Jason Almiro, senior vice president of healthcare lending at BOK Financial.
Candidate Biden outlined plans to lower the Medicare age and institute a public health plan option. Facing a pandemic, economic turbulence and political intransigence, it remains to be seen what President Biden will actually be able to deliver.
Political realities shift focus from legislation to regulation
With Democrats holding only a small majority in Congress, passing large-scale controversial programs via legislation will be difficult. Instead, Biden will likely pursue several more modest initiatives through regulatory changes initiated by his appointed officials at the Department of Health and Human Services and the Center for Medicare and Medicaid Services, and through Congress’ budget reconciliation process where only a simple majority is required for passage.
Leadership and staff selections at key regulatory agencies will be an important lever in enacting the administration’s healthcare priorities. President Biden will lean on his nominees—including California Attorney General Xavier Becerra for Health and Human Services secretary and Obama-era policy official Chiquita Brooks-LaSure to lead the Center for Medicare and Medicaid Services—to lead significant regulatory changes for the U.S. healthcare system.
While Becerra and Brooks-LaSure favor single payer or universal coverage, they understand that these policies will be difficult to enact. As such, they will likely promote regulatory changes within the healthcare industry in line with Biden’s agenda, said Almiro.
Immediate priorities focus on expanding insurance coverage
The current administration has outlined a wide range of topics including combating the COVID-19 pandemic, expanding insurance coverage and reducing healthcare inequities (see sidebar). Although some actions will require lengthy review and regulatory oversight, a number of actions are already—or will soon be—underway.
The administration has already announced a special enrollment period for the Affordable Care Act (ACA) from February 15 through May 15. President Biden’s administration has also begun efforts to roll back Medicaid work requirements and to join COVAX, an international effort to distribute two billion doses of the (COVID-19) vaccine to low-income countries.
“It’s clear that change is coming to the American healthcare system,” said Almiro. “The change may not be as monumental as some wish, but President Biden is passionate about healthcare and is determined to restore the ACA and Medicaid system to the way they were prior to the previous administration.”