For the first time in more than a decade, healthcare will not be a big first-term agenda item for Congress, and instead, those picked to run federal healthcare agencies will have a degree of latitude on what pieces of the healthcare puzzle they decide to focus on.
That’s the message from Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid, who was speaking at the all-virtual 39th J.P. Morgan Healthcare Conference.
Though the discussion was recorded in December, before it was clear that the Democrats would control the Senate, Slavitt — who is now general partner of Town Hall Ventures and board chair of United States of Care — discussed a wide range of healthcare topics and what he expects to see from President-elect Joe Biden and his administration in their first term.
Like many have predicted, Slavitt too believes Biden will take actions to strengthen the Affordable Care Act, including reversing decisions taken by the Trump administration. But it is unlikely Biden will take any actions that will rankle the opposition such as making the ACA subsidies more generous.
“I don’t think Biden is looking to pick big divisive fights,” Slavitt said. “He ran on uniting the country and I think that is going to be important to him.”
Instead, Slavitt expects to see actions at the state level and from those who are picked to run agencies like CMS and the CMS Innovation Center. These could be things like Medicaid coverage expansion.
Indeed, Biden’s pick for secretary of health and human services — vocal ACA supporter Xavier Becerra — has already sent a signal to the industry that the healthcare law will likely be protected and bolstered in the years to come.
Slavitt does expect to see movement on issues like health equity and racial justice, as Biden and Vice President-elect Kamala Harris have made clear that these will be the focus of their administration, alongside Covid-19 relief, rebuilding the economy and mitigating the threat of climate change.
But those in the industry who are hoping Biden might pull back such that some of the rules the Trump administration finalized in the past few months will not take effect may be disappointed. Slavitt believes that these rules will likely not see much opposition from the new leadership.
Rules and regulations like CMS’s Geographic Direct Contracting Model, the drug pricing rebate rule and the hospital price transparency rule — which providers fought hard to prevent — are not necessarily partisan issues. Though some details of the rules may become sticking points, overall, they will not face ideological obstacles, Slavitt said.
Drilling down into plans for Medicare specifically, Slavitt noted that the trust fund, which finances healthcare services for Medicare beneficiaries, is projected to become insolvent by 2024, amid Biden’s term.
“So that will mean that they are going to have to do some things to tighten the belt,” he said.
But making payment cuts to private payers that administer Medicare Advantage plans may not be one of the cost-saving options the new administration decides to take — the opposite of the market’s perception of what a Democrat-led government would put on the chopping block.
“I think the question of Medicare Advantage is pretty bipartisan,” Slavitt said. “All you have to do is look at the congressional support for Medicare Advantage. It is led by very prominent Democrats and Republicans.”
Another service that appears to have bipartisan support? Telehealth.
The final physician fee schedule for 2021 added more than 60 services to the Medicare telehealth list, which means they will be covered even after the Covid-19 pandemic has ended, indicating continuing support for virtual care from the federal government.
But according to Slavitt, telehealth still doesn’t have “universal industry support.” Healthcare stakeholders generally agree that telehealth services are good for patients and the industry, but when it comes to the details, protected interests emerge, and disagreements arise.
“It’s like, everybody says, ‘I’m against surprise medical bills’ except, you know, if it hurts me,” Slavitt said. “I think a similar situation will emerge with digital health in that way.”
With the Covid-19 pandemic accelerating across the country, concerns about a slow vaccine rollout, the incoming administration and its agency chiefs will have their hands full. Given this climate — especially last Wednesday’s insurrection — it remains to be seen how CMS and other healthcare agencies approach industry issues in the coming year.
Picture credit: Spencer Platt, Getty Images