As we enter 2021, amid a pandemic and with a newly minted President, the status of health care reform in this country remains a top issue. So, what can we expect in the coming year?
At the time this article was written former Vice President Joe Biden was the projected 46th president of the United States. The Democratic Party retained a majority in the U.S. House of Representatives, although the margin is slimmer than expected. Control of the Senate remained undecided with two Georgia runoff elections set for January. However, it is projected that Republicans will hold their majority in the upper chamber.
The Affordable Care Act
Throughout his campaign, Biden has pledged a commitment to ongoing health care reform that includes building on the Affordable Care Act (ACA) "by giving Americans more choice, reducing health care costs, and making our health care system less complex to navigate."
What the Biden-Harris administration will be able to accomplish depends on a number of factors, including a pending Supreme Court case. In November 2020, arguments regarding the constitutionality of the ACA were heard and the Supreme Court is expected to rule before its term ends in June 2021.
With the confirmation of 7th U.S. Circuit Court of Appeals Judge Amy Coney Barrett to the Supreme Court, many wonder what this means for the ACA. Given the 6-3 conservative majority, there is speculation that the legislation could be overturned.
While it may be reasonable to assume that Justice Barrett will vote to find the ACA unconstitutional, that is not the most important factor, according to Gerald F. Kominski, PhD, Senior Fellow at the UCLA Center for Health Policy Research, and Professor of Health Policy and Management at UCLA Fielding School of Public Health. The question is, will she be the deciding vote?
"I've seen analyses suggesting that, prior to Justice Ruth Bader Ginsburg's death, the Court was likely to rule 6-3 against the circuit court and uphold the ACA," Kominski noted. "If those analyses are accurate, this could now be a 5-4 decision. Therefore, it is not clear that Amy Coney Barrett's appointment to the Supreme Court will jeopardize the ACA.
"I understand that politically the Supreme Court appointment of Amy Coney Barrett is being cast as a threat to the ACA, and it is a potential threat, but I want to emphasize that her appointment does not guarantee that the ACA is going to be overturned," Kominski continued.
Beyond this challenge to the ACA, what happens next will rest largely on which party controls the Senate. "There are a number of possibilities in play," said Kominski, who is also Professor of Public Policy at UCLA Luskin School of Public Affairs. "If the Democrats flip the Senate, then not only has the ACA potentially survived a third constitutional challenge, but the door is open for Biden to expand and enhance the legislation."
In addition to modifying and improving the ACA, Biden has said that he wants to work with Congress to develop a "public option," like Medicare, which anyone can buy into. This could prove challenging if Republicans retain their majority in the Senate.
COVID-19 Response & Ongoing Trends
With the pandemic ongoing, the federal government's response in the coming months is crucial. Following the election, the Biden-Harris administration shared a seven-point plan to address COVID-19, which includes a focus on evidence-based guidance and resources. President-Elect Biden has appointed 13 scientists and public health specialists to a COVID-19 advisory board.
The Biden-Harris pandemic strategy emphasizes access to regular, reliable, and free testing. This will be accomplished by doubling the number of drive-through sites and investing in next-generation testing. The plan will also tackle protective equipment problems, as well as the equitable distribution of treatments and vaccines. It also calls for the implementation of a nationwide mask mandate.
As the country continues contending with the immediate impact of COVID-19, the pandemic has long-term implications for health care, especially when it comes to telemedicine.
"Telemedicine is an example of how COVID-19 has changed health care permanently," noted Kominski. "The growth in telemedicine has been exponential because of concerns regarding in-person appointments. The experts I've spoken to believe that this is not a temporary trend and telemedicine will not go back to being just a small portion of care delivery.
"[The pandemic] has shown us a way of doing things differently that will persist beyond the COVID-19 crisis," Kominski continued, noting that patients have been able to experience the value of telemedicine firsthand.
Additionally, Kominski noted that the health care industry's capacity for telehealth services has increased as result of the pandemic. "Medical groups understand that this is going to be a significant portion of their revenue streams in the future," he explained. "The shift to telemedicine was already happening, but the pandemic has forced us to change how we do business in a way that is permanently going to impact health care delivery, particularly primary care services."
Navigating changing health care policies and regulations can be difficult and it is especially challenging during a pandemic. However, it is vital health care providers remain aware of how these policies could impact their practice and patients.
"Professional organizations and specialty societies are excellent resources for health care providers," suggested Kominski. "The Commonwealth Fund in New York and the Kaiser Family Foundation in California also provide information about health care policy that can be very helpful for both health care providers and the general public."
Catlin Nalley is a contributing writer.