The $1.9 trillion COVID-19 relief bill recently passed by Congress included a two-year expansion of Affordable Care Act (ACA) coverage, but a recent report put out by L.E.K. Consulting says further impacts on the U.S. healthcare industry over the course of the Biden administration could be minimal due to legislative changes in Washington.
The bill as passed increases ACA subsidies and would lower payments for nearly 14 million Americans currently enrolled. It also expands Medicaid coverage for pregnant women and provides Medicaid expansion incentives to states that have not yet expanded the program, according to L.E.K. Those provisions are set to expire in two years, which means they'll likely be campaign issues in the 2022 midterm elections.
Democrats narrowly control the Senate, which makes the odds of further legislative action around healthcare a long shot, according to the report. This means major reforms put forth by the Biden campaign, including an ACA public option and extension of Medicare eligibility to age 60, are unlikely to be enacted.
"The slim Democratic majority effectively rules out major reforms," says Wiley Bell, Managing Director at L.E.K. Consulting and a report author. "The healthcare industry should instead prepare for more incremental changes of a kind that can generate at least some Republican support."
Despite the potential Congressional logjam around further action, limited coverage expansion and drug price reduction might still be on the table. Some healthcare measures L.E.K.'s report says are more likely to be enacted include expanded access to Medicare, Medicaid, and ACA coverage, reduced prescription drug prices, increased access to tele-health, and support for value-based innovation, which enjoys bipartisan support.
"While there won't be earth-shattering changes in the healthcare landscape – as there might have been with a bigger Democratic margin – changes are coming," Bell says. "Industry participants should look carefully at the implications of these incremental reforms and be ready to seize opportunities."
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