At the Helm

It's (nearly) official: Biden vs. Trump. Here's our take.

by Christopher Kerns

With Sen. Bernie Sanders (I-Vt.) exiting the race for the Democratic presidential nomination, the contours of the 2020 U.S. election are now clear: presumptive Democratic nominee Joe Biden will square off against President Trump in November. Although we are likely to see many more specific policies staked out by the former vice president over the next several months, below I round up a few initial thoughts on how health care policy is likely to figure in the election moving forward:

Public option vs. Medicare for All: What would they really mean for hospitals?

  • It's reformation, not revolution.

    In coalescing around Biden, the Democratic electorate clearly prefers reforming or adding to the current health care delivery and financing system, rather than blowing it up. Although Sanders promised a revolutionary Medicare-for-All system, Biden has repeatedly focused his rhetoric on preserving the Affordable Care Act (ACA)—and has all but promised a sort of restoration of the Obama era. His most radical proposal is, of course, his endorsement of a "public option" health plan—an idea considered beyond the pale just a decade ago when the ACA passed Congress with a filibuster-proof Democratic majority.

  • The public option contains more unknowns than Sanders' brand of Medicare for All.

    Despite being ostensibly more incremental in nature, Biden's current outline for a public option—a government-sponsored insurance plan—is rather vague and highly sensitive to a host of variables. Medicare for All, for all its radical change, is a comparatively simple proposition to evaluate—but even defining the public option is open to debate. Would it be available only to the individual market? Would premiums be subsidized or based on the risk pool? How many consumers or employers would be likely to switch? Would rates to providers resemble commercial prices or Medicare?

    The answers to those questions are decidedly non-trivial for the financial health of providers, payers, and suppliers. We took a stab at the range of answers in our analysis here.

  • Covid-19 will re-write this year's health care debate with all-new arguments and talking points.

    To state the obvious: any debate parties we were hoping to have about health care this year have been overtaken by the coronavirus. But there are two factors that bear watching more than others: how U.S. Covid-19 outcomes compare to those of other Western democracies, and how much cost will be borne out of pocket by the public.

    If admissions, complications, and deaths in the United States look better than those of Western Europe, it will likely take some talking points away from those who argue for more government involvement in health care. And if costs soar and patients find themselves with enormous, unpayable expenses, voters might be looking for relief from Uncle Sam. And finally, the debate about government's role in preparing for the next pandemic is just getting started, with political and ideological lines very much in flux. No one knows how public perceptions will play out in aggregate, but those perspectives will do more to shape how Americans think about health care than any policy Democrats or Republicans have traditionally endorsed.

  • The huge government outlays this year will eventually force government to look at mechanisms for controlling future spending.

    The $2 trillion stimulus (more than $100 billion for health care providers alone) will certainly help hospitals, health systems, medical groups, and post-acute providers out of the financial hole dug by the coronavirus. And while the public by and large supports major spending to prop up the health care industry as we push through the Covid-19 crisis, the huge debts the federal government is incurring will need to be addressed sooner or later—and Medicare spending is a prime target. In the coming months, both Biden and Trump will likely have to answer the question of if and how they would rein in spending going forward. And you can bet we'll be interested in their answers.

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