Despite strong rhetoric on healthcare from campaigning politicians, the outcome of the 2020 election is unlikely to bring about profound, industry-shaking change. Instead, the heated political contest likely will determine the fate of Trump administration policies on Medicaid, the Affordable Care Act (ACA), pricing transparency and trade.
The election nevertheless could clear a path for lawmakers from both parties to address consumer-pleasing, bipartisan issues, such as drug pricing reform, a rethink of Medicare Part D and, possibly, a federal solution to surprise billing.
Healthcare continues to be a top priority for voters, according to a survey of American consumers conducted by HRI in the fall of 2019. Seventy-one percent of adult Americans of both parties said they were likely to vote for a candidate based on their healthcare policies or ideas. The election’s outcome will determine the fate of policies championed by the Trump administration that do not enjoy bipartisan support. The administration has used its regulatory power to tweak the administration of the ACA, efforts that could be rolled back under a Democratic president. This includes expanding sales of association health plans and short-term, limited duration insurance, both of which are exempt from some of the ACA’s consumer protections for the group and nongroup markets.
It also includes encouraging states to apply for waivers to impose work requirements on some Medicaid beneficiaries, a move that has been struck down in lower courts and is working its way through the legal system. The administration also is working with several states on proposals that would create “block grant”-type payments for federal funding for Medicaid.
The administration’s efforts around drug pricing have mostly bipartisan support and have coalesced around increasing approvals of generic products and requiring drug companies to publicize list prices in television ads, a move that was struck down by the courts. Both parties support changes to Medicare Part D to protect seniors with expensive prescriptions from skyrocketing out-of-pocket costs. Legislation drafted by the Democratic-led House and the Republican-led Senate proposed structural changes to the benefit and out-of-pocket caps for seniors. These bipartisan efforts, slowed in an election year, could gain momentum after Election Day.
Overall, 2020 likely will be a slow year for action on healthcare out of Washington, DC. An analysis of regulatory activity shows a decline in the 12 months before a presidential election and a rebound in the 12 months after one. For the healthcare industry at large, leadership may be as important as policies. One of the most important decisions a president can make is the appointment of leaders for key agencies such as the FDA, HHS and CMS. Companies should pay attention to who is angling for these jobs in a new administration and what the effects could be for key policy issues and agency operations.
Providers and Medicaid managed care plans should prepare for a continuation of the administration’s efforts to
These efforts have helped reduce Medicaid enrollment, driving up the numbers of uninsured Americans. Providers serving large numbers of Medicaid beneficiaries in states enthusiastically embracing these policies could see increases in uncompensated care and bad debt. Children’s hospitals could be affected, as the number of children losing Medicaid coverage has increased, according to an analysis by The New York Times. Medicaid managed care plans may find reductions in enrollment and increased churn as beneficiaries lose coverage more often.
Democrats also appear less likely to continue the Trump administration’s Chinese trade policy, and pharmaceutical and life sciences companies, in particular, may benefit from increased certainty in this area. But pharmaceutical companies likely will continue to experience some degree of uncertainty around trade no matter who wins the White House. Tariffs on essential chemicals produced in China have complicated supply chains for drug companies, which should scenario plan for extended trade tensions with this key nation.
Both parties favor the federal government’s shift toward paying for quality and not quantity of services. Publicly rating healthcare organizations also has bipartisan support. Health organizations should continue to invest in information infrastructure and staff that are able to collect and analyze data necessary for maximizing value-based payments.
For citations, implications and insights, please read our full report, Top health industry issues of 2020: Will digital start to show an ROI?