A change in the White House means changes to healthcare policy and changes to healthcare regulatory actions taken by the Department of Health and Human Services (“HHS”) and other federal agencies. Although a changing healthcare landscape, COVID-19 pandemic, and political wrangling are likely to alter the goals and actions of the incoming administration, here are some of the healthcare policy priorities currently articulated by President-Elect Biden that providers may see.
Health Insurance Public Option
While foregoing the “Medicare-for-all” approach and leaving the commercial health insurance industry intact, a health insurance public option could increase competition for commercial insurers and exert downward pressure on rates. A new health insurance public option would also seek to use its bargaining power to negotiate lower prices. The increased public option would also provide Medicaid-like coverage for low income individuals who live in states that have not expanded Medicaid, but who would otherwise be eligible for Medicaid.
Prescription Drug Prices
Several prospective policies involve prescription drug prices, including the goal of allowing Medicare to negotiate prescription drug prices. Another policy goal would be to increase the supply of generic drugs. However, perhaps inconsistently, another proposal would restrict the pricing of generic drugs. For instance, a proposal would create a review board at HHS to assess and set approved prices for newly launched drugs. Approved prices may be based on prices in other countries or, if none exist, an independent analysis by the board. Another proposal would tie the price of brand and generic drugs to Medicare participation. As a condition of participation in Medicare, drugs would be prohibited from increasing their prices more than the rate of inflation.
Increased Funding for Some Providers, Increased Costs for Others
Some providers may see increases in their funding through federal programs, such as community health centers. Other proposals would increase or restore funding for family planning clinics and providers, such as Planned Parenthood. Home health agencies may see an increase in operating costs from proposals to increase the wages of home care workers. However, these may be offset by other proposals to accelerate the testing and deployment of innovative solutions for home care. The use of antitrust authority to target market concentration in the healthcare system has also been articulated as a policy goal.
For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding new developments in healthcare regulation. If you or your healthcare entity has any questions pertaining to healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or wapc@wachler.com.