In the wake of this November’s historical U.S. presidential election, will the Affordable Care Act (ACA) be struck down? Will the eligibility age for Medicare be lowered? Will action be taken to lower drug costs? And what’s the plan for the next infectious disease event?
These are just some of the healthcare policy questions that the new administration and Congress will face, regardless of who is elected. With that in mind, L.E.K. Consulting has taken stock of top Republican, Democratic and bipartisan priorities and has broken down:
- The policies a Trump or Biden administration is likely to pursue
- The likelihood of those policies being passed (in light of congressional and Supreme Court makeup, lobbyist pressures, and available avenues to enactment)
- The impact those policies could have on health insurance coverage and healthcare spending
The 2020 election cycle may decide the fate of 9 policy proposals
Regardless of who is inaugurated on January 20, bipartisan priorities like lowering drug costs and increasing price transparency are expected to face legislative action under the next administration. With that in mind, we identified the following nine policies — each of which is either well defined in a presidential candidate’s proposed agenda or has already been introduced as a bill to Congress — and assessed them based on their political feasibility and potential impact on the country’s healthcare landscape:
- Republican: Invalidation of the ACA
- Bipartisan: Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3)
- Bipartisan: Prescription Drug Pricing Reduction Act (S.2543)
- Bipartisan: Importation of FDA-approved foreign drugs
- Bipartisan: End of pharmaceutical tax credit for direct-to-consumer ads
- Bipartisan: End of surprise billing
- Democrat: Lowering of the Medicare age to 60
- Democrat: Introduction of a public option
- Democrat: Expansion of ACA coverage
We characterized each policy’s relative impact by estimating the changes in coverage and total healthcare spending that would result from policy implementation (see Figure 1).
We also assigned each policy a feasibility score. The feasibility score was calculated by determining the likelihood that each proposed policy is implemented under different configurations of the presidency and Congress, weighted by the probability of each election outcome. We based the election outcome probabilities on betting odds from PredictIt, an online prediction market run by Victoria University of Wellington (see Figure 2).
Ultimately, we determined that sweeping change in terms of impact on coverage — for instance, invalidating the ACA or creating a public option — is relatively unlikely over the next four years. Conversely, less-disruptive bipartisan legislation, such as ending surprise billing or tackling drug costs via free market mechanisms, has a higher chance of getting through Congress (see Figure 3).
Similarly, when comparing proposed policies on cost impact vs. feasibility, we determined highly impactful policies such as the importation of FDA-approved foreign drugs and the creation of a public option are less likely to be passed. On the other hand, highly feasible bipartisan policies, such as ending surprise billing and the Prescription Drug Pricing Reduction Act rank low in cost impact (see Figure 4).
Beyond the nine well-defined policies we assessed, there are additional bipartisan priorities that are likely to be enacted via legislative or executive action. A Trump or Biden administration is likely to pursue greater price transparency, increased access to care, support for value-based care models and related innovation, and preparations for the next pandemic.
Stakeholders across the healthcare continuum will feel the impact of the next U.S. administration. Significant reform has been proposed on both the Republican and Democratic tickets. While its likelihood of passing may be relatively limited, such legislation would drive large step changes in healthcare coverage and spending with enormous implications across most of the healthcare sector. For more insight into the upcoming policy war and its likely impact on the U.S. healthcare system, see our full presentation and supplemental materials.
Editor’s note: This article and the linked presentation/supplemental materials were produced by the senior members of L.E.K. Consulting’s U.S. Healthcare Services and Life Sciences teams:
Wiley Bell, Managing Director
Kevin Grabenstatter, Managing Director
Jonathan Kfoury, Managing Director
Aru Murthy, Engagement Manager
Rosie Jiang, Global Healthcare Specialist
Max Reik, Senior Associate Consultant
Sam Rude, Senior Associate Consultant