Vaccine distribution, regulatory rollbacks top 2021 health agenda

Health care battles in Washington are going to take a new turn next year with the arrival of a Democratic president and the departure of President Trump. 

President-elect Joe Biden has vowed the federal government will take a far larger role on COVID-19 than the Trump administration, which mostly left the response to individual states. Biden is also likely to take unilateral action to shore up ObamaCare and undo regulations issued by Trump, and there might even be some room for bipartisan action on health care.

Here’s what to watch on health policy in 2021:

Combating COVID-19

The coronavirus response will be at the top of Biden’s agenda as his administration oversees the vast majority of vaccines distributed in the U.S.

Two companies have asked the Food and Drug Administration (FDA) to authorize their COVID-19 vaccines for emergency use, with the first vaccines for health workers and the elderly potentially just weeks away.

While the Trump administration expects to begin shipping out the first vaccines this month, Biden’s administration will be responsible for distributing millions of doses into 2021.

Biden has also emphasized increased testing and has said his administration will take a greater role in fixing supply shortages and working with businesses to expand the production of items like masks and gloves for health care workers.

Currently, state governments must buy their own personal protective equipment and other supplies, only reaching out to the federal government for help if they can’t find enough.

Still, one of the biggest changes in the federal response to COVID-19 will likely come in the form of messaging from the Oval Office.

Biden has vowed to take a new approach after Trump repeatedly downplayed the pandemic, publicly argued with doctors advising him and insisted the outbreak was turning a corner even as it got worse.

The president-elect has pledged to listen to a team of public health officials, infectious disease experts and doctors advising him on COVID-19.

The Biden administration should “ensure that federal public health guidance is clear, consistent and science-based,” the National Association of City and County Health Officials wrote in a document providing recommendations for the incoming president.

Biden has also pushed for workers to receive paid leave as part of another COVID-19 aid package, which he is likely to advocate next year.

“I think that the Biden administration will want to work with Congress on another large COVID stimulus, economic recovery package that would include both health care items, but also some of the economic provisions that were in some of those earlier COVID stimulus bills,” said Allison Orris, counsel with Manatt Health.

Rolling back Trump health care moves

Biden campaigned in part on protecting and building on the Affordable Care Act (ACA), which the Trump administration is trying to have overturned in the courts.

While lowering the age of Medicare eligibility, establishing a public option and expanding ObamaCare’s premium subsidies will be difficult if Democrats don’t win control of the Senate, there are actions Biden could take administratively to shore up the ACA, said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.

“I suspect the Biden administration will look for some early high-profile actions to show the contrast with the Trump administration on health care, in particular, looking to reverse many of the Trump administration’s actions,” he said.

Biden is expected to reopen the ObamaCare exchanges for a special enrollment period next year, after the Trump administration faced heavy criticism for not doing so for the nearly 30 million people who were uninsured before the pandemic.

Trump’s successor could also reverse funding cuts to ObamaCare marketing and outreach programs that sought to increase the number of people signing up for plans.

In the early days of his administration, Biden is also expected to issue Medicaid guidance, laying out the types of requests from states for program changes he may approve while rejecting work requirements favored by Trump.

Biden is also likely to try to reverse a number of Trump-era regulations. While reversing regulations is time-consuming and could potentially face lawsuits, Biden is likely to target rules that ban family planning providers from offering or referring for abortions, disqualify immigrants for green cards if they’re deemed likely to use public assistance like Medicaid, and expand access to alternative health plans that are cheaper but cover fewer benefits.

“Particularly if Democrats don’t control the Senate, the Biden administration will likely try to get creative in trying to use executive authority in pushing forward its health agenda,” Levitt said. 

Confirmation battles

Nominees to lead the Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention and the FDA typically face intense scrutiny, and Biden’s picks will be no different, especially given the pandemic and various partisan policy disagreements.

Confirmation battles ”just seem to take up so much time and the energy of a new administration, as well as the Senate,” said Ian Spatz, a senior adviser at Manatt Health.

“Some of those may give us some clues as to what may be possible in health care, just to see what kind of questioning, what kind of objections are raised to various Cabinet appointees.” 

Bipartisan health legislation 

The political makeup of the next Congress is still in flux, with two Georgia Senate races heading to runoffs in January, but Republicans are favored to keep a narrow majority in the Senate.

If that happens, congressional observers are skeptical there will be an appetite for bipartisan action on health care next year given the long history of disagreement on the issue. But should Biden and Senate Republicans find a desire to work together on health care, action on surprise billing and high drug prices appear to be the areas most ripe for bipartisan agreement.

“I think there’s a strong desire to do it,” said Christopher Holt, director of health care policy for the conservative American Action Forum think tank, referring to a surprise billing fix.

“I would imagine that could happen in the first part of next year if Biden engaged aggressively on it.”