Stakeholders Discuss Biden Healthcare Agenda Ahead of Inauguration Day

Ahead of his swearing-in ceremony, HealthLeaders spoke with numerous stakeholders about the Biden healthcare agenda and what actions to expect from the new administration.

President-elect Joe Biden will be sworn in as the 46th president Wednesday afternoon and healthcare executives are paying careful attention to how the incoming administration will address the ongoing COVID-19 pandemic along with other outstanding issues facing the industry.

Biden has already given indications for what his administration will prioritize on its healthcare agenda, namely introducing a $1.9 trillion COVID-19 relief package, a plan to distribute 100 million vaccines in the first 100 days, and building on the existing structure of the Affordable Care Act (ACA).

On Friday, the Association of American Medical Colleges released a statement that the organization was "grateful" for the Biden administration's recognition of the "immediate need to combat the coronavirus pandemic" through its proposed stimulus package.

Ahead of his swearing-in ceremony, HealthLeaders spoke with numerous stakeholders about the Biden healthcare agenda and what actions to expect from the new administration.

Wendell Potter is a former vice president of corporate communications for Cigna Corp. and current president of Business Leaders for Health Care Transformation.

Potter said his message to the incoming Biden administration would be to be mindful of "special interests," namely health insurers that have recorded record profits at the expense of consumers and providers.

"My advice to President-elect Biden, Vice President-elect Harris, and Attorney General Becerra is to have a singular focus on what is best for consumers and patients, and that includes people who have insurance," Potter said. "There needs to be a focus on the ways that special interests were able to shape the ACA in ways that assured their profits but have been disadvantageous to patients."

Potter's strategic advice for healthcare executives, both in the payer and provider communities, is to "put some skin in the game" just like patients have in recent years.

"I'm, quite frankly, sick of hearing that the problem is with patients and consumers; we're seeing hospitals in many cases, even during the pandemic, doing well financially and many are not," Potter said. "It's not a monolithic industry by any means, so I think they need to understand that as we move forward, they are going to have to make some sacrifices that their shareholders may not like but that is going to be necessary if we're ever going to be able to increase the number of people who have health insurance and are able to use it."

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Heather Meade, a principal at Washington Council Ernst & Young, told HealthLeaders that the Biden administration is likely going to have a list of policies it "wants to do" and policies it "has to do."

Meade said that during the first quarter of 2021, Biden will have to focus on remedying the economic and clinical impacts of the coronavirus while also addressing the vaccine distribution plan.

Beyond the COVID-19 response, Meade said that the Biden administration will have to use its regulatory and administrative power. Because of the narrow margins in Congress the administration is expected to use reconciliation if it wants to "advance healthcare policy in Congress."  

Priority areas include improving health coverage affordability, addressing equity and the social determinants of health, as well as focusing on stabilizing the ACA.

Still, she said that given the slight edge the Democrats hold in the Senate, generating consensus on healthcare policy on Capitol Hill will be a challenge for Biden.

"In a narrow environment, I think it makes it nearly impossible to start with a big healthcare reform [like Medicare for All] if the administration is going to be able to work on other policies on a bipartisan basis," Meade said. "We probably will see some of those more lofty ideals that were raised during the campaign put to the side as the administration focuses primarily on COVID-19 and economic recovery."

Meade added that Becerra, who spent many years as a congressman before serving as California's Attorney General, will be able to draw from his experience as a legislator who helped to craft and defend the ACA. 

She said that while passing major reforms may be off the table, Becerra is a leader who is "well-positioned" to help the administration move its priorities on a regulatory basis.

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Michael Abrams, co-founder and managing partner of Numerof & Associates, a healthcare consulting firm, told HealthLeaders that outside of addressing the COVID-19 concerns, the Biden team is likely to pay attention to costs associated with ACA health coverage.

Abrams noted Biden might focus on actions that could garner bipartisan support, such as lowering prescription drug prices, policies addressing value-based care and alternative payment models, along with promoting health equity through curbing racial disparities.

He added that California Attorney General Xavier Becerra, Biden's nominee for HHS Secretary, could use his position to take a harder line on corporate consolidation in healthcare, citing his past opposition to megamergers in the Golden State.

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Sebastian Seiguer, JD, MBA, is CEO of emocha Mobile Health Inc., a Baltimore-based health technology company.

He told HealthLeaders that any changes in healthcare policy affecting the telehealth space will be driven by Biden's choice for CMS administrator, which hasn't been announced yet.

"How that person sets the strategy will be critical because CMS policy is what drives reimbursement and the evolution of the value-based models," Seiguer said. "We could anticipate that the Biden administration's policy initiatives would continue [the work done] under [current CMS Administrator] Seema Verma. In a way, we can expect evolution to continue, meaning a more favorable landscape for telehealth and virtual care."

When asked what point he would make to Biden and his healthcare team, Sieguer said that he would look for changes to the definition of medication adherence measures as part of Star Ratings, specifically asking for providers to be "accountable for the extent to which the physician's orders are executed as they have been prescribed."

"This sounds so basic but could you imagine a world where the physician's orders were followed as prescribed and correctly, how chronic disease would be managed?" he asked. "We would then shift to a world where we can talk about prevention of chronic disease or reversal in some cases, but people feel better when they take the right medication at the right time, and they do it correctly. Put that onus on the healthcare payer and the provider."

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Tim Gronniger is CEO of Caravan Health and former chief of staff and director of delivery system reform at CMS.

Gronniger said the Biden healthcare team will remain focused on issues related to the pandemic first and foremost but also highlighted policies that the administration and Congress might pursue later in the year, such as health coverage issues and revisions to value-based purchasing models. 

"I think that there is a combination of everyone in healthcare and healthcare policy has to be focused on getting through coronavirus and making sure vaccinations happen as quickly as possible," Gronniger said. "Then there will be opportunities for [the Biden administration] to do a review of every innovation center model that's out there. They're gonna need to take stock of the status of various Medicare payment programs, payment incentives, and programs that are out there. So, there's pretty deep support for value-based purchasing programs once you get beyond the immediate urgency around coronavirus, and insurance coverage."