The Democratic presidential nomination has essentially boiled down to a two-way race, and healthcare policy is a key point of contrast between former Vice President Joe Biden and Sen. Bernie Sanders (I-Vt.).
Moderate Democrats have coalesced around Biden as the leading alternative to self-proclaimed democratic socialist Sanders, who wants to push for a single-payer healthcare system. While Sanders' Medicare for All plan has been scrutinized on debate stages, Biden's healthcare plan to strengthen the Affordable Care Act and create a public insurance option has garnered significantly less discussion so far.
While early campaign contributions from healthcare executives favored moderate Democrats like Biden, a coalition of leading health industry groups including the American Hospital Association, America's Health Insurance Plans, the Biotechnology Innovation Organization, Pharmaceutical Research and Manufacturers of America is fighting public option policies nationwide, showing that they would likely still fight a public option in Congress.
How much would the public option plan pay hospitals?
Biden said he plans to create a public insurance option "like Medicare" that would be open to individuals with employer-sponsored insurance, those who purchase insurance in the individual market, and those who are currently uninsured. The plan would save money for consumers, he contends, by "negotiating lower prices from hospitals and other healthcare providers," but Biden does not offer details about the reimbursement rate.
How much would consumers pay under the public option?
One of the biggest perks for consumers under the Medicare for All proposal is that it would eliminate copayments, premiums and deductibles. Biden proposes providing primary care without any copayments, but his plan is silent on other potential out-of-pocket costs. Biden also proposes expanding federal subsidies so that no one purchasing insurance in the individual market would pay more than 8.5% of their income for health insurance premiums.
Biden's plan would be cheaper than Medicare for All, however. His campaign estimates that it would cost $750 billion over 10 years and proposes paying for it by rolling back some of the Trump administration's tax cuts.
What would happen to Medicaid expansion populations?
Under Biden's plan, individuals who would have been eligible for coverage under a Medicaid expansion but live in states that chose not to expand would be eligible for a premium-free version of the public option. States that have already expanded Medicaid could switch to the new option, but it is unclear if expansion states would switch because they would still be required to pay a share of costs.
How would surprise medical bills be resolved?
Because private insurance options would, in theory, be preserved under Biden's plan, there would still be a potential for patients to receive surprise medical bills. Biden advocates for not holding patients accountable for those bills when they do not have a choice in which provider they see. But he does not provide any details about how he would address payment disputes between providers and insurers that have roiled Capitol Hill in recent months.
How aggressive would antitrust enforcement be?
Biden's plan says he would use existing authority to "tackle market concentration" in the healthcare system. The campaign doesn't provide many details but linked to an Open Markets Institute report on consolidation in healthcare areas such as pharmacy benefit management, ambulance manufacturing, medical device manufacturing, electronic medical records systems and surgical apparel manufacturing.
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March 05, 2020 at 04:31AM
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5 questions about Joe Biden's healthcare plan - ModernHealthcare.com
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