How the Direction of Healthcare Could Change After the Election

Gregory Twachtman

October 22, 2020

With the national election about 2 weeks away, the direction that healthcare policy takes could vary significantly depending on how the nation votes in the presidential and congressional races.

Speaking at the Medical Group Management Association (MGMA) annual conference, organization officials broke down four potential outcomes of the 2020 elections and what those scenarios will mean for the nation's healthcare.

The first scenario is the status quo, with Republicans maintaining their majority in the Senate, Democrats retaining control of the House of Representatives, and Donald Trump re-elected as president.

"I think you could expect to see the House to continue, at a high level, its investigations and hearings," Drew Voytal, MGMA associate director of government affairs, said. "The Senate would continue their judicial appointments from President Trump and those political divisions within Congress and between the House and the president would continue as much as we see today and have seen in the past."

Specific to healthcare, "I think the status quo would still continue," Voytal added. "The Trump administration, [HHS Secretary Alex] Azar, and [CMS Administrator Seema] Verma would continue their approach to 'Patients Over Paperwork.' We can debate on the effectiveness of that program as well as limited approach to expanding access whenever you discuss healthcare reform. The status quo would bring the status quo."

In the second scenario, Democrats remain in control of the House and take control over the Senate, while President Trump is re-elected. On a high level, Matt Devino, MGMA associate director of government affairs, said there would be some similarities with scenario one. In healthcare, "we would expect in this scenario for the Trump administration to continue its approach to 'Patients Over Paperwork' and there would be a limited approach to expanding access to healthcare."

He added that that there would be zero agreement between the president and Congress on reform, "we wouldn't expect a tremendous amount to end up happening," Devino continued.

What happens if former Vice President Joe Biden wins the presidential election, but status quo is maintained in Congress? "You could expect at a high-level Senate Republicans would block Biden's judicial nominations. That seems to be a hallmark of [Senate Majority Leader] Mitch McConnell, R-Ky, during the Obama years. Those political divisions would continue, but this time it would be the House and presidency versus the Senate," Voytal said.

For healthcare, "major healthcare reform would be stalled again because the Senate would be under control of the Republicans and there would have to be major compromises between the two parties."

Voytal suggested that a Biden administration "would look to continue value-based care but would seek to stand out from maybe the past approaches from the Trump administration."

The Biden campaign has not yet tipped its hand on how it will approach a large-scale healthcare reform effort.

Finally, what could happen under the scenario where the Democrats maintain control of the House, flip the Senate, and Joe Biden is elected into the White House?

"In this scenario, with Democratic control across the board, we would expect access to coverage expanded," Devino said. "Vice President Biden's platform includes support for a public option, Medicare eligibility being reduced to the age of 60, and additional low-income assistance to obtain healthcare coverage." He noted that there would be opposition to a single-payer system, or Medicare for All.

Devino also noted that there would be legislative support for a number of other initiatives, including surprise-billing reform and drug-pricing reform, as well as continued support for value-based care.

And while large-scale healthcare reform may only be likely under the fourth scenario, MGMA officials expect that there could still be action taken on some smaller issues that had bipartisan traction prior to the COVID-19 pandemic, including surprise billing, drug pricing, and ensuring coverage of people with pre-existing conditions.

"We fully expect these discussions to continue going on [and for] new efforts to tackle these issue," Voytal said. "Do look for those topics to be touched on in the coming year ahead, regardless of what shakes out after the election."

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