Biden is More Likely to Maintain Stability in MA Than Make Major Change

by Lauren Flynn Kelly

From strengthening the Affordable Care Act to addressing the COVID-19 pandemic, President-elect Joe Biden will have plenty of health care-related items on his plate when he moves into the White House. Part of Biden's campaign pledge to improve health care coverage included lowering the Medicare eligibility age to 60, but his ability to enact any kind of sweeping health care reform will be severely limited by a likely divided Congress.

If Biden were to succeed with his Medicare-at-60 plan, "it would probably be a very big boon for Medicare Advantage," given that a younger aging population might not use as many services as an older population and since MA is now a popular alternative to traditional Medicare, observes Stephanie Kennan at McGuireWoods Consulting. Passing such a change, however, depends on several key factors, says Kennan.

One factor is the makeup of the Senate, which will be determined by runoff elections in Georgia that are scheduled for Jan. 5. If Republicans retain control of the Senate, some might interpret Medicare-at-60 as a progressive, public option-style plan, therefore making it harder to pass legislation enacting such a change, suggests Kennan. The other major issue is that the Medicare Hospital Insurance Trust Fund "really needs to be shored up," she says.

Meanwhile, MA organizations under the current administration have enjoyed a fair degree of flexibility. Could a Biden administration rein in any of that?

"I think that when it comes to things like network adequacy and quality of care and making sure there's enough access," that's where a Biden administration is more likely to focus rather than "trying to retract benefits," says Kennan. "I think in general they're going to be very concerned about access to services, affordability of services…and making sure that there's information available to folks so they can make a good decision" and understand their health care choices.

During a Nov. 5 webinar hosted by Avalere Health, Avalere Founder Dan Mendelson suggested that regulatory changes aimed at maintaining stability and protecting consumers are far more likely than any major legislative change to MA.

"I think the opportunities arise in these more regulatory changes around the edges to shape the plans in a way that…protects the beneficiary, [helps] to close racial disparities, those kinds of things that are primary policy objectives of a new administration," Mendelson said.

From RADAR on Medicare Advantage