A Biden Business Agenda: Expanding Access to Healthcare

The Biden administration’s first concern will be curbing the pandemic. What should they do to bring COVID-19 under control?

Miller: The biggest challenge the administration will face is coordinating the vaccine supply chain. The private sector will need to work closely with federal, state, and local governments to distribute vaccines to the highest-priority individuals as quickly as possible.

Another important area where the Biden administration can improve is in public health messaging. Health protocols such as wearing masks, limiting indoor gatherings, and social distancing have taken on an increasingly partisan aspect, so the Biden administration has to strike a tone that simultaneously promotes harm-mitigating behavior, emphasizes the temporary nature of these measures, and makes an effort to reach skeptics.  

If a divided Congress keeps major changes to the healthcare system off the table, what more targeted actions can and should the Biden administration take to improve healthcare access, quality, or affordability? 

Miller: There are a number of seemingly “minor” items that President-Elect Biden could undo that could improve the functioning of the health insurance exchanges. Two examples are increasing the open enrollment period back to its original 90-day length and rolling back access to non-Affordable Care Act-compliant, short-term healthcare plans. Both of these policies will likely boost enrollment and participation in the ACA marketplaces. The Biden administration could also further encourage states to take up the ACA Medicaid expansions. 

At the same time, there are several executive actions pursued under the Trump administration that the Biden administration may want to continue. For example, President Trump signed an executive order instructing the Centers for Medicare and Medicaid Services to negotiate more aggressively with drug companies. 

Does it make sense to lower the age of eligibility for Medicare, as Biden has proposed?

Miller: In my own work, I have found that those who benefit the most from health insurance coverage are those just below the Medicare eligibility age, i.e. those age 55-64. Most of the short-term gains in terms of health and mortality of a “Medicare for All” program could be accomplished with a more modest policy that lowers eligibility to age 55. 

At the same time, there are other benefits to health insurance — such as reducing financial distress and improving ability to access care — that could accrue to younger workers and their families, which may make expansion of Medicare eligibility to younger ages also desirable.

If Biden does end up with Democratic majorities in both houses of Congress, what should they then pursue? Is a “public option” for health insurance a good idea to achieve universal coverage?

Miller: The Affordable Care Act sought to expand coverage through a combination of publicly provided insurance (via the Medicaid program) and insurance purchased on the individual marketplace. In the end, the Medicaid expansions proved to be fairly popular and successful, enrolling many more people than anticipated, while the market-provided coverage largely fell flat, enrolling far fewer people than anticipated.

Even after the ACA, more than a third of low-income adults experience some spell of uninsurance within a given year. It is hard to see a path to universal or near-universal coverage in the United States that does not involve a larger role of the public sphere in the provision or financing of that coverage. A valuable first step in this would be making the Medicaid expansions universal.

With a fairly clear anti-abortion majority on the Supreme Court, is there anything the Biden administration should do to protect abortion access?

Miller: Practically speaking, one of the most important things the Biden administration can do right now to improve access to reproductive healthcare is get the COVID-19 vaccine distributed, so that people can begin using and accessing all types of healthcare again.

Sarah Miller is an assistant professor of business economics and public policy at the University of Michigan Ross School of Business.

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