The first thing on the President-elect’s agenda has to be the COVID pandemic. The in-coming administration is developing plans to implement on “day one.” Part of the plan includes national testing and contact tracing programs.  Implementation of those plans will be stymied by limited through-put capacity for processing tests especially in rural areas, on-going shortages of PPE, and a dearth of contact tracers.1-3

Testing capacity and PPE issues could be addressed by the administration without needing to involve Congress. However, monies to hire and train contact tracers would require action by Congress to approve new funding.

For health plans, the Biden pledge that the Federal government will cover the costs of massively expanded testing programs as well as a vaccine, can only be good news.

Healthcare Insurance Reform

The President-elect has made strengthening the Affordable Care Act (ACA) and working with Congress to create a Medicare-like public option that anyone can buy into a priority.4

But first, the Biden Administration will need to assure that the ACA is not struck down by the Supreme Court (SCOTUS). One possible way would be to make the current case moot. Working with Congress, the ACA could be altered so that the conditions raised in the case no longer exist, thus rendering a decision by the high court unnecessary.

Regional payers generally are supportive of the ACA with added customers and strong financial years in 2018 and 2019.5 Were the ACA be invalidated by SCOTUS, these insurers would likely lose millions of customers and, of course, the premiums paid for coverage.

In terms of a ‘public option,’ regional payers would be less enthused, as this would represent a significant source of competition, putting additional pressure on margins generated by ACA business.

Another avenue to a partial version of a public option would be to lower the eligibility age for Medicare from 65 to 60 years of age6. This idea has broad support across the political spectrum. A poll conducted by the Kaiser Family Foundation found that about 85% of Democrats and 69% of Republicans favor allowing those as young as 50 to buy into Medicare7.  Lowering the age of eligibility for Medicare would require action by Congress.

As noted, many of the in-coming Administration’s plans will require Congressional action. This means that, assuming Republicans maintain control of the Senate, action could be blocked. If Democrats gain control of the Senate, Republicans still could stymie House-passed bills, so long as the filibuster remains intact. It is possible that the long-standing relationship between President-elect Biden and Senate Leader McConnell could create space for deal-making that would allow some version of the administration’s agenda to move forward.

We’ll have to see what happens. But controlling costs and ensuring affordable healthcare is on the top of the agenda after COVID-19. Therefore, it is important for market access stakeholders to continue to monitor the political landscape and the impact of new proposed policies and regulations.


  1. Greater Minnesota COVID-19 tests have lagged and they could be slowed further by growing demand. Accessed November 23, 2020.
  2. ‘My hospital is a hot mess.’ Nurses plead for more PPE, safety measures amid COVID-19 surges. Accessed November 23, 2020.
  3. As Covid-19 cases surge, health care workers say PPE is still a struggle. Accessed November 23, 2020.
  4. What Biden’s election means for U.S. health care and public health. Accessed November 20, 2020.
  5. Corlette S, Blumberg L J, Lucia K. The ACA’s effect on the individual insurance market. Health Affairs. March 2020.
  6. Biden wants to lower Medicare eligibility age to 60, but hospitals push back. Accessed November 20, 2020.
  7. KFF Health Tracking Poll – January 2019: The public on next steps for the ACA and proposals to expand coverage. Accessed November 20, 2020.