Upon taking office as the 46th president of the United States, Joseph Biden quickly set in motion his healthcare agenda and, in doing so, shifted the direction set by the prior administration. Despite the Democrats’ representation advantage in both houses of Congress, their leads are slim, likely meaning that any healthcare legislation championed by the president will be met with challenges and uncertainty and require concessions and compromise.
This blog post outlines Biden’s broad healthcare plans and the key healthcare-related actions taken during his initial days in office. From these, we can discern the core themes of the president’s healthcare agenda and their potential implications for AMCs—and the strategies that AMCs can employ to ensure their success moving forward.
President Biden’s Priorities and Actions
The president’s healthcare objectives are rooted in protecting and building upon the signature healthcare legislation of the Obama administration: The Affordable Care Act (ACA). While there is uncertainty surrounding the ACA’s fate in the Supreme Court, the administration’s policy actions and focus on various healthcare-related issues will have a profound impact on AMCs.
The president’s actions to date have included various healthcare-specific executive actions and orders, including a series of COVID‑19 relief–related initiatives. Two noteworthy longer-term and legally binding executive orders signed include:
- EO 14009, “Strengthening Medicaid and the Affordable Care Act,” intended to fortify and protect Medicaid and the ACA to make high-quality healthcare accessible and affordable for every American.
- EO 14007, “President’s Council of Advisors on Science and Technology,” which pushes to establish a revised advisory council on science, technology, and innovation.
These two orders signal the administration’s desire to improve access to healthcare and encourage the proliferation of science.
Implications for AMCs
In the immediate term, with the administration’s focus squarely on COVID‑19 relief efforts, AMCs must recalibrate to the new reality, which has been characterized by disruptions to academic and clinical activities and strains on revenue sources, including a likely shortfall in state appropriations for public institutions. Beyond this, AMCs need to be aware of possible impacts from Biden’s healthcare agenda. Based on the president’s stated healthcare objectives and his actions since taking office, it is clear that his goals are centered on:
- Fortification of the ACA.
- Belief in and support for research and science.
- Healthcare equity and inclusivity across all communities.
These priorities will manifest themselves as the administration’s healthcare policy continues to unfold and will have various implications across AMCs’ tripartite mission.
Resurgence of Healthcare Research
The biomedical research space will receive top-down reinforcement under the new administration. This support stems from President Biden’s history of advocating for the sciences, most notably evidenced when he secured $1.8 billion for the Beau Biden Cancer Moonshot in 2016. The administration has also begun rechartering the President’s Council of Advisors on Science and Technology, which will advise the president on matters involving science, technology, education, and innovation policy.
Biden’s past actions in providing funding for healthcare discovery and his immediate activity in reassessing a science advisory council mark a transition from the decline in biomedical research support under the Trump administration. Additionally, special interest groups such as the AAAS will be advocating for greater financial support for the sciences after years of declining investment. The AAMC’s 2021 priorities also highlight their desire to work closely with the NIH and other health and research agencies (e.g., NSF, VA, AHRQ, PCORI).
Inequality and Environment
Medical researchers should expect to see efforts to reduce/eliminate disparities in healthcare and consider the impacts of enhanced environmental protection on healthcare. These forces may impact priorities set by the NIH and other funders of research and ultimately the type of research that is pursued at AMCs. AMCs should evaluate their patient populations, communities served, and affiliations to ensure their research strategies align with the theme of eliminating health disparities. President Biden has already enacted a task force to battle disparities in infectious disease, which sets the tone for his efforts in reducing inequalities.
In terms of environmental agenda items, the president’s efforts to combat climate change have secondary aims of improving the health and well-being of the public and will likely drive historic investment into scientific research and innovation.
Developing Alliances
The potential for collaboration and partnerships is another key consideration stemming from the new administration’s plans. The heightened focus on and support for scientific discovery may spur partnerships beyond the walls of the AMC and lead to innovative public-private collaborations. A key arena for potential partnerships is the drug development space, due to greater cost pressures on sponsors and an increased base of insured patients. Researchers will have to prepare themselves for increased governmental efforts to curb prescription drug costs, which will impact sponsors’ strategies and approaches to the drug development process.
Reexamining Priorities
Expanded patient coverage will likely affect participation in clinical research studies, requiring sponsors to reassess their study portfolios for capacity and prioritization. With more patients covered by insurance, a potentially greater test patient pool, and greater price regulation on prescription drugs, sponsors will be facing more competitive pressures than ever before and will look for new partnerships to spread the responsibility, risk, and reward of new drug development ventures.
New Opportunities and Methods in Education
The president’s intention to use the ACA as a chassis to build upon may lead to new possibilities to educate and train future physicians. As more individuals gain access to coverage, learners will have additional patients to interact with and treat. With the administration aiming to ensure affordable care, it will look to support efforts that lower healthcare costs, such as using technology to deliver care and encouraging participation in programs that incentivize providers to maximize value for patients (e.g., ACOs, bundled payments). If successful, these activities will feed into the cycle of new patients for medical students and trainees.
Equitable Care
Healthcare equity has become a prominent issue in the US, and the Biden administration explicitly noted key populations and healthcare services that have garnered its attention (e.g., women’s health, mental health). Additionally, Biden has voiced his support for community health centers and other providers that deliver care to the underserved. Backing from the president in these areas would open the door to training opportunities that directly address his concerns while ensuring students and trainees see a diverse group of patients in various training settings and sites.
Workforce Planning
The anticipated shortfall of providers, particularly in primary care, is an issue the president and other lawmakers will look to address in various ways, including further supporting recent actions to expand training slots and rural provider funding.
Aside from the provider gap issues, the curriculum and training delivered to future physicians must be explored and modified to ensure that providers can successfully deliver care within the changing dynamic being brought upon by the administration’s policies. Physicians (and educators) will need to be adept at serving the care needs of an increasingly varied population, some of whom have historically been underserved and/or are wary of the healthcare system. This must include resources that support cultural competence, diversity, inclusivity, and equity.
Treatment Methods
Physicians must also be proficient in providing care using digital platforms that constantly evolve; in multidisciplinary care teams comprising nurses, pharmacists, and other allied health professionals; and under care models that promote value and patient-centeredness. This revised education and training will result in physicians better equipped to provide care in a healthcare industry being shaped by the new administration.
Impacts on Clinical Care
President Biden has been explicit in his desire to expand access to healthcare coverage to more individuals across the US. He has noted several levers that he may try to pull to make this happen, including:
- Increasing tax credits to lower premiums on the individual marketplace and expanding the number of individuals eligible for such credits.
- Supporting Medicaid expansion in states that have yet to do so and offering a premium-free option for eligible individuals who reside in states that elect not to expand.
- Lowering the Medicare enrollment age from 65 to 60.
- Creating a public health insurance option.
While support for these measures varies, it is clear that any mechanism(s) the administration favors could lead to an increase in patients seeking care. These patients will likely be covered by government-sponsored plans that typically reimburse providers at lower rates than commercial products, which could result in a significant payer mix shift and associated fiscal impact for providers.
Care Mechanisms
The president’s healthcare priorities will also affect care delivery. A focus on making care more affordable and less complex for patients will drive the administration to identify ways of reducing costs and eliminating unnecessary care. This could spur the delivery of care in lower-cost settings and expand the use of higher-value care technology, including at-home care and telehealth. These strategies would also benefit providers, particularly those in rural areas, who have been hit hardest during the pandemic. The Biden Plan for Rural America includes healthcare-related initiatives that focus on expanding low-cost healthcare access, keeping rural hospitals open, expanding primary care and innovative healthcare delivery models, and increasing access to mental and behavioral health services.In aggregate, these efforts will serve to combat the underlying domains of waste in healthcare.
Reimbursement
President Biden’s support for shifting from fee-for-service to value-based care will further play into the game plan for reducing costs while promoting quality. As provider involvement in value-based arrangements evolves, care teams and processes must also advance to ensure successful participation in risk-sharing programs and achievement of available rewards.
Level Playing Field
In addition to the impacts from making healthcare more affordable, Biden’s goal to eliminate inequities in care provision and outcomes will also influence clinical care. Greater attention on care disparities, particularly in women’s health, mental health, and other areas that disproportionately affect traditionally underserved communities, will garner the administration’s support and lead providers to evaluate and improve care methods to ensure greater equity and better patient outcomes.
Clear Mandates
The administration’s policies will also affect regulatory directives that may be imposed on providers. Biden supports ending surprise billing, and other actions that are consistent with his views on price transparency and protecting consumers are to be expected, such as continuing to uphold the hospital price transparency rule and the Physician Payments Sunshine Act. His regulatory stance could also impact merger and acquisition activity, where any provider consolidation resulting in greater market concentration of clinical services will receive more scrutiny and the parties will need to show that patients are protected from rising costs and questionable care changes.
How Should AMCs Prepare?
As the White House moves forward with legislative actions impacting the healthcare sector, AMCs can take steps to understand how new policies may affect them and determine how best to proceed.
- Assess readiness for change, considering existing trends and impacts from likely policies.
- Analyze existing programs and initiatives to see whether they are congruent with the new administration’s healthcare priorities.
- Perform scenario analysis across each mission area to understand the likeliness of each potential initiative and the possible fiscal and operational impacts to the organization.
Given the marginal Democratic majority in both the House and the Senate, the only certainty regarding the Biden administration’s healthcare agenda is that each component will receive a great deal of scrutiny from both sides of the aisle and will likely be modified from its original shape. Nevertheless, Biden’s healthcare priorities—whether enacted through formal legislation, executive order, or budget reconciliation—will have an impact on AMCs. AMCs must act now to position themselves and be ready for the changes ahead.
Published March 1, 2021
