Finding bipartisan solutions has been an elusive goal in the nation’s current political climate.
On the morning after the first presidential debate, one writer concluded, “There was a clear loser at last night’s debate: you. Yes, you, the American voter.”a Meanwhile, commentators in foreign media across the globe pilloried the event, basically describing it as “the worst presidential debate ever.”b
In light of the debate, it is easy to be pessimistic about the future of our representative democracy. Given how divided Washington is, can anything positive be accomplished?
Common ground and the art of the possible
For years, healthcare has ranked among the top issues of concern for voters, and 2020 is no different. The Affordable Care Act (ACA) is a major political fault line, as President Donald Trump wants the Supreme Court to rule it unconstitutional, while former Vice President Joe Biden advocates maintaining and even expanding it. Nevertheless, an objective and careful assessment of the policy positions of the presidential candidates would indicate that some common ground does exist.
Otto von Bismarck, the renowned German statesman in the late-1800s, famously said, “Politics is the art of the possible.” With our three branches of federal government and two-party political system, a moderating of policy changes usually ensues at some point after an election. A prime example is the Republicans’ inability to pass legislation in 2017 to repeal and replace the ACA, even though the GOP had control of the executive branch and majorities in both houses of Congress.
Regardless of who is elected president, there are six issues in healthcare where there is some degree of common ground and bipartisanship in Congress. One could reasonably expect some progress to be made in these areas during the next two years.
1 COVID-19 vaccine distribution
This is job one in 2021. The COVID-19 pandemic has been an unexpected, extraordinary force that has adversely affected most every area of life globally. A safe and effective vaccine, efficiently administered to a majority of Americans, with priority given to healthcare workers and high-risk individuals, is the only path to restoring public confidence and ameliorating COVID-19’s wide-ranging impacts.
Robert Redfield, MD, director of the CDC, has said, “A COVID-19 vaccine is the thing that will get Americans back to normal everyday life.”c
And many have suggested a safe, effective vaccine would be a “game changer.”
Dozens of articles proclaim that telehealth is here to stay, and countless health systems and physician practices have decided that from now on, the majority of their interactions with patients will be done virtually. It is an inexorable movement. Telemedicine grew from about 10% of all patient visits prior to the COVID-19 pandemic to almost 90% by the end of May, with generally high levels of patient satisfaction reported broadly. During COVID-19, CMS eliminated the almost 50% payment differential between inpatient and virtual visits. Although it’s true that after COVID-19, CMS may reinstate some differential, it will likely be much smaller.d Moreover, Trump’s executive order on Aug. 3 directed the Secretary of HHS to make permanent many of the new policies that improve the accessibility and availability of telehealth services.
3 Surprise medical billing
Republicans and Democrats have supported reforms to protect patients from balance billing at out-of-network rates when patients have no control over the providers attending them. Both Trump and Biden have promised to end surprise medical billing, although it is unclear what mechanism they would support, whether through a benchmark or arbitration. Trump’s executive order on Sept. 24, on an “America-First Healthcare Plan,” directed the HHS Secretary to work with Congress to reach a legislative solution by Dec. 31, 2020.
4 Value-based care and APMs
Both presidential candidates support the concept of value-based care and alternative payment models (APMs), such as accountable care organizations. Biden is more likely to make APMs mandatory, in contrast with the Trump administration’s more gradual approach to date.
5 Price transparency
The Trump administration has made transparency a theme of several of its health reform pronouncements, positioning it as a consumer-empowering pathway to spur competition and reduce healthcare costs. On Nov. 15, 2019, CMS issued a final rule that will require hospitals, beginning Jan. 1, 2021, to provide patients with clear, accessible information about their prices for the items and services they provide. Specifically, the rule states that hospitals must make public, on the internet, hospital standard charges for all items and services. Hospitals also must make public payer-specific negotiated charges, the amount the hospital is willing to accept in cash from a patient for an item or service and the minimum and maximum negotiated charges for 300 common shoppable services, with updates on at least an annual basis. In contrast, Biden has simply expressed support for establishment of a “transparent all-payer pricing database,” likely with a longer list of services.
6 Site-neutral payments
Despite hospital opposition, both the Obama and Trump administrations supported site-neutral payments. CMS included site-neutral payment reforms in its 2019 hospital outpatient prospective payment system final rule, which was challenged by the American Hospital Association and other organizations in the courts but ultimately upheld by the U.S. Court of Appeals for the District of Columbia Circuit on July 21, 2020. Biden likely supports site-neutral payments, though neither the Biden-Sanders Unity Task Force Recommendations nor the 2020 Democratic Party Platform mentions them.
The contentious 2020 presidential election has certainly brought into sharp relief the nation’s deep divisions. Nonetheless, there are several areas in healthcare where common ground exists, and bipartisan agreements are likely to be forged.
a. Lerer, L., “We all lost,” The New York Times, Sept. 30, 2020.
b. Heath, R., “‘Worst presidential debate in history’: Foreigners recoil at Trump and Biden’s prime-time brawl,” POLITICO, Sept. 30, 2020.
c. Lim, D., “Top health officials warn America won’t return to normal soon,” POLITICO, Sept. 16, 2020.
d. “In-person visits are invaluable, but telehealth is here to stay,” Interview with Sara L. Douglas, PhD, RN, The American Journal of Managed Care, May 30, 2020.