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What Health Care Might Look Like Under A President Biden

AILSA CHANG, HOST:

The election of Joe Biden means a change at the White House and a change in many policies. Let's take a look now at health care. Biden ran on the promise of a public option and more federal involvement in the coronavirus crisis that has engulfed the nation. And here to talk us through what to expect is NPR's Selena Simmons-Duffin.

Hey, Selena.

SELENA SIMMONS-DUFFIN, BYLINE: Hi, Ailsa.

CHANG: Hi. So first, can you just give us sort of a big-picture view on how the Biden administration's approach to health and health care could be quite different from President Trump's?

SIMMONS-DUFFIN: Yeah. I think the main difference that animates a lot of Biden's policies is the belief that access to health care is a right and that the federal government has a role to play in ensuring people have access to that right. So his platform included ideas like expanding access to Medicare, giving people the option to enroll at age 60 - of course, right now it's 65 - creating a public option, as you mentioned, which is a government-run program like Medicare that people of any age could buy into, and expanding subsidies on the insurance exchanges to make premiums more affordable for more people. And the belief that the federal government should be more involved and more invested shows up in his plans to address the pandemic as well.

CHANG: Right. OK, so those are his ideas. I mean, those are the ideas he ran on, but what might actually he be able to get done?

SIMMONS-DUFFIN: Well, that's a really big question mark right now, and a lot depends on which party controls the Senate. I talked to Larry Levitt of the Kaiser Family Foundation about this, and here's what he said.

LARRY LEVITT: Many parts of Biden's plan are likely dead in the water if Republicans keep control of the Senate.

SIMMONS-DUFFIN: So if Republicans do maintain control, which won't be clear until January because we have these two runoffs in Georgia...

CHANG: Right.

SIMMONS-DUFFIN: ...Attention will turn to what Biden can do with executive actions. And Levitt pointed out that Trump has kind of made a playbook for this. He wasn't able to get any significant health legislation through Congress, so he was creative about using the power of the presidency to shape health care; for instance, promoting short-term or skinny health care plans and limiting federal funding for reproductive health. So Biden could use the same power to undo many of those things and promote his very different health care agenda.

CHANG: OK, so how would that play out? Like, what's one way?

SIMMONS-DUFFIN: Well, think about Medicaid. That is the public health program for 68 million low-income people, pregnant women and children. Jamila Michener, a professor of government at Cornell University, says that she could see states coming to the Biden administration with new ideas about how to use Medicaid funding.

JAMILA MICHENER: To cover housing costs - right? - because the notion is that housing is health.

SIMMONS-DUFFIN: So using that funding to help people from being evicted and thinking about health outside of what happens in doctors' offices and hospitals - and another point Michener made is that the pandemic is clearly a really critical crisis right now and definitely the first order of business. But, she says...

MICHENER: It would be savvy for the Biden administration to use the pandemic as sort of a vehicle for making forward progress with respect to health care.

SIMMONS-DUFFIN: For instance, by rebuilding public health and federal health agencies like the Centers for Disease Control and Prevention.

CHANG: OK, but before we get to any of the stuff that you're talking about, there is, of course, a big Supreme Court case being argued tomorrow about the fate of the Affordable Care Act. Tell us, how might that case affect the Biden agenda, you think?

SIMMONS-DUFFIN: Right. The Supreme Court will hear arguments tomorrow about whether the ACA, which is also known as Obamacare, is constitutional. Because of the details of the case, there might be a kind of simple way that president-elect Biden could work with Congress to get rid of or change the specific part of the law that the court case is focused on, which could make the case moot. And if that doesn't happen and the court does overturn the ACA, it could be a big problem. Tens of millions of people might become uninsured during a pandemic. And it's hard to see how a country and government this sharply divided could come together and pass a whole new comprehensive health law to prevent the chaos from happening if the court rules to overturn the ACA.

CHANG: That is NPR's Selena Simmons-Duffin.

Thank you, Selena.

SIMMONS-DUFFIN: Thanks, Ailsa. Transcript provided by NPR, Copyright NPR.