The 2021 federal health policy outlook started to come into sharper focus in early January, when runoff elections for both of Georgia鈥檚 Senate seats were decided. The election of Democratic Sens. Warnock and Ossoff means that the U.S. Senate is split 50-50 between the parties, with the Democrats holding the slimmest of majorities (Vice President Harris holds a tie-breaking vote).

Democratic control of both chambers of Congress gives President Biden somewhat more leeway to advance his health care agenda via legislation. Possible avenues include: passing legislation by regular order, which would require gaining significant Republican support to meet the 60 vote filibuster-proof threshold in the Senate; passing legislation via budget reconciliation, which requires only a simple majority vote in each House; or pursuing reforms via regulatory action. It is likely that the new Administration will try a combination of these approaches.

With an immediate focus on combating COVID, President Biden unveiled a $1.9 trillion 鈥淎merican Rescue Plan鈥 ahead of the inauguration. Some key provisions of the proposed 鈥渞escue鈥 package include:

  • Additional funding for COVID vaccination and testing programs;
  • Additional financial impact payments to individuals and families;
  • Extending and expanding unemployment insurance benefits;
  • Subsidizing COBRA premiums through September 30, 2021; and
  • Expanding and increasing the value of premium tax credits to make the purchase of health insurance more affordable, ensuring that enrollees pay no more than 8.5% of their income for coverage.

Senate Majority Leader Schumer announced that the Senate could take up a budget resolution in early February, signaling an intention to use the budget reconciliation process to advance sweeping COVID relief measures.

Meanwhile, on January 28th, the Biden administration announced that it will re-open the insurance marketplaces for a special enrollment period running from February 15-May 15, 2021, creating new opportunities for uninsured people to get coverage during the pandemic. The Kaiser Family Foundation estimates that almost 15 million uninsured people would be eligible to sign up for coverage during this special enrollment period; of that group, some 8.9 million would qualify for subsidies that would lower their premiums.

The January 28th Executive Order also directs federal agencies to take additional steps to strengthen Medicaid and the Affordable Care Act. The agencies are instructed to re-examine and, where warranted, revise or revoke:

  • Policies that undermine protections for people with pre-existing conditions;
  • Demonstrations and waivers under Medicaid and the ACA that may reduce coverage or undermine the programs (such as Medicaid work and reporting requirements);
  • Policies that undermine the Health Insurance Marketplace or other markets for health insurance (for example, the prior Administration鈥檚 expansion of short term health plans);
  • Policies that make it more difficult to enroll in Medicaid or other ACA coverage; and
  • Policies that reduce affordability of coverage or financial assistance, including for dependents.

Quick hits:

  • The Biden Administration announced a plan to purchase 200 million additional doses of COVID vaccine. The Administration also plans to increase vaccine shipments to states and tribes from 8.6 million doses per week to 10 million per week for at least the next three weeks, as part of an effort to vaccinate the majority of the U.S. population by the end of this summer. For information about the COVID vaccine, tailored to the bleeding disorders community, click here, or watch recorded HFA Q&A sessions with medical experts in English or Spanish.
  • The Trump Administration finalized a spate of rules in the final weeks of President Trump鈥檚 term. These included the 鈥淪UNSET rule,鈥 which would require the U.S. Department of Health and Human Services to review all regulations every 10 years, and a drug pricing rule, linking Medicare Part B payments for 50 doctor-administered medicines to the lower prices paid overseas. Both rules drew extensive negative comment (including from HFA); two courts have entered orders halting enforcement of the drug pricing rule.
  • Other eleventh-hour regulatory steps taken by the outgoing Trump Administration included:
    • Launch of a 鈥渄emonstration project鈥 allowing Medicare Part D plans to limit coverage of drugs in the so-called six protected classes. (Two years ago, the Trump Administration had proposed this step via rulemaking. HFA and NHF, along with many other patient groups, had opposed that proposal and, at the time, the Administration did not move forward to formalize it via rulemaking.)
    • Spelling out a new, nine-month process that will make it harder for the incoming Administration to reverse course on restrictive Medicaid waivers approved in recent years, such as work and reporting eligibility requirements.
    • Approval of the nation鈥檚 first Medicaid block grant in Tennessee, a step opposed by HFA and other patient advocates. The Tennessee decision would, for the first time, allow a state to exclude drugs from its Medicaid formulary and still keep automatic Medicaid rebates.
  • In response to these and other late-breaking Trump Administration regulatory actions, the incoming Biden Administration announced it would freeze all pending agency rules and guidances that have not yet taken effect. The new Administration may ultimately act to undo or re-open some of the decisions and actions taken in the waning months of President Trump鈥檚 term. Another possibility: certain rules can be overturned by Congress invoking the Congressional Review Act.
  • The Acting Secretary of HHS wrote to the nation鈥檚 governors on January 22, announcing that the Administration will extend the declaration of a public health emergency through the end of 2021. The PHE declaration means that state Medicaid programs will continue to benefit from boosted federal funding and other flexibilities 鈥 and that state Medicaid programs cannot disenroll beneficiaries for the period of the PHE.

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