Joe Biden’s Plan for American Health Care
AUGUST 26, 2020 2:49 PM
On August 18, 2020, former Vice President Joseph R. Biden, Jr. was officially nominated as the Democratic Party nominee for President of the United States. Throughout 2019 and early 2020, Biden faced 11 major candidates for the party nomination – including progressive Senators Elizabeth Warren (D-MA) and Bernie Sanders (I-VT). Despite Sanders and Warren leading a nationwide push for a single-payer, “Medicare-for-All” health plan, Biden won the nomination favoring an approach that builds upon, rather than upending, the 2010 Affordable Care Act.
Nonetheless, the progressive insurgency in the 2016 and 2020 primaries have shifted the Overton window, and Biden has responded by proposing a health care platform that is considerably more left-leaning than that of his former boss, President Barack Obama. Rather than eliminating private health insurance altogether, as many of his Democratic opponents proposed, Biden’s health care plan centers on the establishment of a “public option,” a government-run health plan that would compete with private insurance on the ACA’s Health Insurance Marketplace. The public option, which was viewed by progressives as a political compromise and included in early drafts of the Affordable Care Act, was ultimately cut out of the 2010 health care law.
The public option’s resurgence and inclusion in Biden’s platform is a testament to the shifting health care policy debate in the U.S., particularly as the nation continues to grapple with the COVID-19 global pandemic. The ongoing coronavirus public health crisis, and in particular the current administration’s response to that crisis, have further shaped the Biden health care platform.
As with most candidates’ platforms, details on Biden’s health care plan are sparse. This WSC Policy Report is intended to summarize – and contextualize – the proposals included in Biden’s 2020 health care platform. The information in this document was compiled from numerous sources – including post-primary party platform negotiations, candidate interviews and columns, and the Biden campaign itself.
Testing and Contact Tracing
- Make available on the marketplace a platinum-level, federally administered health insurance option with low fees and no deductibles. This option will remain available as an emergency measure until the pandemic ends and unemployment falls significantly.
- The federal government would cover 100 percent of the cost for COBRA insurance and would automatically roll unemployed individuals over to other coverage when their COBRA eligibility period expires.
- Should the U.S. find itself in another pandemic or severe economic downturn in the future, these protections will again be made automatically available.
- Anyone who gets called back to work would have access to free, frequent testing with rapid and reliable results throughout “the duration of the crisis.”
- Anyone sick with COVID-19 would have access to fully paid sick leave funded by the federal government for as long as needed, plus a guarantee that they can return to their jobs. The same benefit would apply to anyone taking care of someone sick with COVID-19.
- The Occupational Safety and Health Administration would take steps to ensure workplaces are implementing worker protections and reopening safely; add protections for public workers and others not covered by OSHA; and fine corporations that break these rules.
- Direct the federal government to work with private-sector manufacturers to dramatically scale up the U.S. domestic manufacturing capacity for both personal protective equipment (PPE) and essential medicines.
- Substantially increase funding for the Centers for Disease Control and Prevention and for state and local public health departments, many of which suffered deep budget cuts during the Great Recession.
- Put automatic triggers in place to ensure that additional federal support to secure affordable health care is immediately put into place when a pandemic, including COVID-19, or a severe economic crisis threatens the nation’s health and security.
- Create a “public option,” a high-quality, affordable plan that consumers may choose through the ACA marketplace.
- Administered by the traditional Medicare program; rates would likely resemble traditional Medicare reimbursement.
- Would provide at least one plan choice without deductibles.
- Cover all primary care without any copayments.
- Control costs for other treatments by negotiating prices with doctors and hospitals.
- The lowest-income Americans not eligible for Medicaid will be automatically enrolled in the public option at no cost to them, although they may choose to opt out at any time.
- Everyone would be eligible to choose the public option or another ACA marketplace plan, even those who currently have employer-sponsored health insurance.
- Lower the age of Medicare eligibility from 65 to 60.
- This change would make roughly 20 million more Americans eligible for Medicare.
- Those who prefer to remain on their employer plans would be permitted to do so, and employers would have to comply with nondiscrimination laws and would be prohibited from excluding older workers from coverage.
- The public option – as well as other subsidized private plans available to individuals through the ACA – would remain available.
- The expansion’s funding would come from regular tax revenues instead of the shrinking Medicare trust fund (the Hospital Insurance Trust Fund, which finances Medicare Part A, is expected to run out of money within six years without congressional action).
- Eliminate the 400% income cap on tax credit eligibility.
- Lower the limit on the cost of coverage from 9.86% of income to 8.5%, regardless of income. o Currently, the 9.86% cap only applies to individuals below 400% FPL; those above that threshold do not have a ceiling.
- Calculate the size of tax credits by calculating them based on the cost of a more generous gold plan, rather than a silver plan. o Currently, plan subsidies are based on the cost of a middle-coverage "silver" plan with a 70% actuarial value, where consumers are responsible for 30% of the costs of all covered benefits.
- Biden is proposing determining the subsidies based on a more expensive "gold" plan with an 80% actuarial value, increasing the size of premium tax credits and reducing deductibles and co-pays for subsidized beneficiaries.
- Offer premium-free access to the public option for the 4.9 million individuals in non-expansion states who would otherwise be eligible for Medicaid.
- The public option would cover the full scope of Medicaid benefits.
- States that have already expanded Medicaid would have the choice of moving the expansion population to the premium-free public option as long as the states continue to pay their current share of the cost of covering those individuals.
- Automatically enroll people making below 138% FPL when they interact with certain institutions (such as public schools) or other programs for low-income populations (such as SNAP).
- If a family is covered by their employer but can get a better deal with the 8.5% premium cap, they can switch to a plan on the individual marketplace (i.e., fix the “family glitch”).
- Under current law, families are not eligible for Marketplace premium tax credits if the cost of a family member’s employer-sponsored insurance for the employee only is less than 9.86% of household income.
- The “glitch” here is that the cost of covering the rest of the family is often well above this percentage. Nonetheless, premium tax credit eligibility is based solely on whether the cost
- Bar health care providers from charging patients out-of-network rates when the patient doesn’t have control over which provider the patient sees (for example, during a hospitalization).
- Biden has not commented publicly on whether he favors establishing a benchmark rate or utilizing arbitration to settle payment disputes between payers and providers. Implement price transparency in the health care system across all payers.
- Reduce paperwork through uniform medical billing.
- Use existing antitrust authority to address market concentration/consolidation in the health care industry. Specifically, these efforts would target “mega-mergers” in the hospital, insurance, and pharmaceutical industries.
- Expand the National Health Services Corps to address critical shortages of health care providers in rural areas, including primary care nurses, dental professionals, and mental health and substance use counselors.
- Require all employers funded by taxpayer dollars (e.g., Medicare and Medicaid) to pay their workers at least $15 an hour and protect workers’ rights to organize.
- Repeal the existing law explicitly barring Medicare from negotiating lower prices with drug corporations.
- Currently, corporate pharmacy benefit managers are responsible for acquiring and negotiating prices for the Medicare Part D prescription drug benefit.
- AARP estimates Medicare could have saved $14.4 billion on medications in 2016 alone if it had been allowed to negotiate.
- Establish an independent review board to recommend “reasonable” prices for new drugs based on the average price in other countries (a process known as external reference pricing).
- If the drug is entering the U.S. market first, the price will be based on an evaluation by the independent board members.
- This reasonable price will be the rate that Medicare and the public option will pay.
- Private plans participating in the individual marketplace would be able to access a rate similar to the rate established by the independent review board.
- As a condition for participation in the Medicare program and the public option, all brand, biotech, and generic drugs would be prohibited from increasing their prices more than the general inflation rate. A tax penalty will be imposed on manufacturers that violate this.
- Allow consumers to import prescription drugs from other countries, as long as HHS has certified that those drugs are safe.
- Terminate the tax break for pharmaceutical corporations’ advertisement spending.
- Ensure that generic manufacturers are able to purchase samples from brand drug manufacturers for the purpose of developing a cheaper alternative (the Biden campaign specifically endorses the CREATES Act of 2019).
- Repeal the Hyde Amendment, a legislative provision barring the use of federal funds to pay for abortion except to save the life of a woman, or if the pregnancy arises from incest or rape.
- The public option would cover contraception.
- The Justice Department would “do everything in its power” to reverse state targeted restrictions on abortion providers (TRAP) laws, parental notification requirements, mandatory waiting periods, and ultrasound requirements.
- Reissue guidance specifying that states cannot refuse Medicaid funding for Planned Parenthood and other providers that refer for abortions or provide related information.
- Reverse the Trump administration’s rule preventing Planned Parenthood and certain other family planning programs from obtaining Title X funds.
- Maternal Mortality: Implement a nationwide strategy based on the California Maternal Quality Care Collaborative, a public-private partnership that halved the state’s maternal mortality rate over the span of eight years.
- Health Center Funding: Double the federal investment in community health centers and rural health clinics, which provide primary, prenatal, and other important care to underserved populations. Enact longer, multi-year funding cycles for these services.
- Mental Health Parity: Redouble efforts to ensure enforcement of mental health parity laws and expand funding for mental health services.
- Outreach and Enrollment: Expand funding for ACA outreach and enrollment programs, particularly for low-income and minority consumers.
- 1135 Waivers: Empower the states to use ACA innovation waivers to develop locally tailored approaches to health coverage, including by removing barriers to states that seek to experiment with statewide universal health care approaches.
- Long-Term Care Services and Supports: Support measures to eliminate state waiting lists for home and community based care, including through a significant expansion of the home care workforce.
- Nursing Homes: Pursue policies to improve nursing home staffing and quality standards, strengthen accreditation processes, and combat corporate abuses in nursing homes.