The new Biden Administration will seek to defend and expand on the Affordable Care Act, reversing some of the regulatory actions taken by the Trump Administration and broadening coverage options. Absent a change in Senate procedural rules, legislative changes will require compromise with Senate Republicans in order to pass the Senate.

Reversing Trump Administration Actions

Based on Biden campaign statements, his Administration is likely to:

• Expand funding for marketing and promotion programs to increase ACA enrollment

• Limit short-term health care plans to three months and make them ineligible for renewal

• Reimpose limits on premium increases for exchange plans

• Reverse the prohibition on Title X funds for Planned Parenthood and other clinics

Public Option

Legislation will be proposed to create a “public option” in the marketplace that relies on Medicare, with no copayments. The option will be available to individuals instead of employer-provided plans, or to individuals who are below 100% of the federal poverty level and not eligible for Medicaid coverage under the ACA. Senate Republicans will strongly resist efforts to establish the public option as proposed.

Expanding Coverage

The Biden Administration will propose:

• Increasing premium tax credit eligibility for exchange plans by (a) removing the current 400% of poverty income cap and (b) lowering the cap on the cost of coverage to 8.5% of total income

• Supporting Congressional efforts to ban surprise billing

• Doubling of funding for community health centers

• Enforcing anti-discrimination policies that protect underserved communities

• Promoting California’s plan nationally to decrease the maternal mortality rate

Drug Pricing

Biden will try to break the Congressional impasse by:

• Requiring pharmaceutical companies to negotiate directly with Medicare for Part D plans

• Establishing an independent review board to recommend prices for specialty drugs

• Limiting brand, biotech, and generic drugs price increases to the rate of inflation in the Medicare program or under the public option

• Allowing imports of prescription drugs manufactured outside the United States

• Repealing the tax deduction for prescription drug advertising