In the face of the COVID-19 pandemic, traditional campaign rallies have been replaced by app-based messaging and Zoom meetings. Health care remains a strong topic of focus, especially with the large unemployment numbers post–COVID-19. In this article and the next in its series, we will take a deeper dive into some of the proposed policies of the Biden Plan and understand its implications.
Overall, Joe Biden’s proposed plan is focused on:
- Greater access to health insurance via protecting the future of the Affordable Care Act (ACA), expanding public health insurance options for those who are not happy with their employer-based insurance, a premium-free health insurance option for low-income adults in states that have not expanded Medicaid
- Improving health care affordability and quality by addressing surprise billing, regulating health care monopoly
- Reducing the patient burden of high prescription drug costs by allowing Medicare to negotiate drug prices, monitor and regulate drug launch prices, help ease cheaper generic competition
- Curtailing disparity in health care via improving women’s right to choose; eliminating insurance bias against gender, gender identity, and sexual orientation; promoting mental health parity
Broader Access to a Public Option Health Plan
Building on the ACA, the Biden Plan wants to give individuals the option to purchase a public option health plan where premiums for patients and reimbursement rates for doctors would be decided by the government. The plan, which promises to negotiate lower prices with hospitals and health care providers, will be available for individuals who are:
- Unhappy with employer-sponsored coverage
- Living in states that have not expanded Medicaid
The public option, which will be available through the ACA marketplace exchanges and administered by Medicare, will have at least one plan choice without a deductible and will cover all primary care without any co-payments. A significant number of low-income individuals and families who miss qualifying for Medicaid will be auto-enrolled into this program, with an option to opt out. In states without Medicaid expansion, the public option plan will be available without a premium. The plan also proposes to expand the Medicare population by lowering eligibility for the program from 65 to 60 years.
For health insurance terms and what they mean, click here.
Community health centers—primary health care delivery sites that provide cost-effective care in neighborhoods with limited access to health care—can expect increased funding under the Biden Plan, along with rural health clinics. The question is, will the plan reduce patient OOP costs as it promises to? With the large number of people that this public option will potentially cover, the government is expected to have greater bargaining clout, resulting in cheaper rates compared to private insurance plans.
Impact of Public Option Plans
While private health plans are expected to significantly lobby against a public option health plan, research conducted by the think-tank Urban Institute found private insurers might significantly lower premiums on their plans offered on the ACA marketplace exchanges to compete with the public option, and providers would accept lower reimbursement rates. According to the Committee for a Responsible Federal Budget, the Biden Plan would cost $2.25 trillion over 10 years.
Some states are a step ahead in this game: Colorado is working toward offering a state health option to increase competition in the market—this is different from a public health option in that the plans will be offered by private insurers, not the state government. The state option plan, expected to be rolled out in 2022 through Colorado’s ACA, will set a benchmark payment rate between 175%-225% of Medicare, replacing the current average of 289% of Medicare. The plans have to offer essential health benefits and direct rebate dollars to reduce the cost of individual policies.
Patients Rising Now acknowledges the important contributions of Surabhi Dangi-Garimella, Ph.D. in this article. Improving patient access is our mission and we are happy to utilize a variety of experts to carry that out.
Patients Rising is a non-partisan nonprofit organization. We are sharing our own researched information to better inform patients.