As the Biden administration takes office, there will be a stark contrast with the Trump administration on almost all policy areas. Perhaps no issue area will show as much contrast between the two presidents as much as health care. Regardless of the two men’s ideological differences, Biden should leave Trump’s health care executive orders in place.
As a part of the administration that got the law passed, Biden is a staunch defender of the Affordable Care Act. He campaigned on expanding the ACA to cover more people through a public option. In 2016, Trump campaigned on repealing and replacing the ACA. The president and the GOP majorities in both chambers of the 115th Congress weren’t successful in this goal. Shortly after, the House of Representatives gained a majority of Democrats in the 116th Congress, virtually guaranteeing the ACA would stay in place.
While the Trump administration failed on its ultimate health policy goal, to repeal and replace the ACA, there was progress made on the health care front via executive order from the Trump administration. As is always the criticism with lawmaking through executive order, rather than an act of Congress, the next presidential administration can simply reverse them. There are two executive orders from the Trump administration, one concerning health coverage and one concerning price transparency, which the Biden administration should leave in place because they are beneficial policy.
The first executive order dealt with expanding coverage through association health plans, health reimbursement accounts, and short-term, limited-duration insurance. The second one dealt with the opacity in health care pricing requiring that hospitals must post prices up front for most services and that insurers disclose prices and cost sharing estimates with patients.
First, Trump’s coverage executive order was a three-pronged approach to expand health insurance coverage to those who are currently uninsured or to those who struggle to afford their current plan. AHPs and STLDI gave individuals additional coverage opportunities outside of what the ACA offers. While these plans aren’t for everyone, there are many populations who benefit from their expanded access.
By expanding the use of AHPs, small businesses and self-employed owners are given opportunities to band together and purchase health insurance as a group. Individuals and small businesses are subject to much more burdensome regulations compared to large employers. AHPs offer a more level playing field for individuals and small businesses, those who were hurt the most by the cost of complying with the law.
The Trump administration also expanded the use of STLDI by increasing the duration which these plans can be renewed. STLDI is exactly what is sounds like — short–term health insurance plans. In an effort to funnel individuals into the ACA exchanges, the Obama administration limited the amount of time for which these plans could be renewed. These plans don’t have to cover all of the essential health benefits as the plans sold on the exchanges, and for that reason they are much more affordable. They give individuals who may be uninsured, between jobs, or right out of college an opportunity for temporary coverage.
HRAs were expanded to help employers struggling with the costs of covering their employees. Compared to participating in the plan the employer offers, these employer-sponsored accounts allow employees to take the funding and purchase plans on their own in the market that meet the needs of that individual or their family. These accounts give more options to employers and employees as well as help boost participation in the individual health insurance market that can lead to lower premiums for everyone in the risk pool.
Second, Biden should allow the Trump executive order on hospitals and insurer price transparency to go forward. One of the biggest problems in health care arises when patients do not know the cost of care until after a procedure is complete. Price opacity leads to uninformed and susceptible consumers. The result is often exorbitant and unexpected health care bills.
The Trump rule would require hospitals to post the final prices they negotiate with insurers. An earlier rule required hospitals to post “standard charges,” which are the prices charged to individuals without insurance, or a starting point for negotiations with insurers. The new rule requires hospitals to go a step further and make public the final negotiated prices for consumers. The rule would apply similarly to insurers. Most employer-based insurance plans would need to provide patients with access to cost–sharing estimates up front so there aren’t any surprise bills after the fact.
While we know that the Biden administration is going to try and expand the government’s role in health care through a broader government run plan, his administration should leave in place these measures from the Trump administration. One must admit that the ACA did not uniformly help everyone. Some, like small businesses and individuals, were made worse off by the health law and benefit from the additional options that provided by the Trump administration. Furthermore, the price transparency measures will inject much needed consumer information into the health care marketplace which has the potential to benefit all consumers, not just the ones who use the price information.
The Biden administration should not alter these policies that have been in place and are currently helping Americans access the health care system.
Jordan Roberts is health care policy analyst at the John Locke Foundation.