As President Joseph R. Biden Jr. was sworn into office this Wednesday, January 20, 2021, Professor Brown and I discussed expected health policy priorities for the new administration

Interview with Larry Brown

What can we expect from the Biden administration in healthcare policy given the House and the Senate’s narrow margins?

We did not get what some expected: an unmistakable repudiation of Trump policies in the November election.  This leaves the Biden administration with narrow margins and limited room to maneuver. I would be surprised to see dramatic healthcare policy innovations from the administration or Congress in the next two years. Instead, the emphasis will be on incremental changes and the undoing of damage done by the Trump administration.

We can expect the COVID response to be his focus and signature program for the immediate future. If successful, he will build political capital, but it is unclear how he will choose to spend it.  He will have to set priorities between healthcare and other areas, such as climate change, environmental protection, foreign relations, etc.  Then, he will need to prioritize among the items in his health policy agenda.

If healthcare is a priority post-COVID, where is he most likely to focus his efforts?

Biden campaigned on repairing and extending the ACA (assuming the pending Supreme Court decision in the Spring will, as appears likely, uphold the ACA).  One item he has emphasized is the introduction of a public option that would aim to increase coverage among those not eligible for Medicaid in a dozen states, but given the congressional margins, I would be surprised if a major program along these lines were to be passed. He also envisions more generous tax credits to bring affordable options to people who are not eligible for Medicaid but struggle to afford private coverage. He wants to squeeze drug prices by, among other things, using the negotiating muscle of the federal government to lower them. Reproductive rights are prominent on his agenda—expanded access to contraception, protection of the right to abortion under Roe v. Wade (threatened by a conservative majority on the Supreme Court), and restoration of funds for Planned Parenthood. He hopes to expand funding for Community Health Centers.

These and similar changes would build on the ACA and, in so doing, give it the flavor of “Bidencare.”

What about focus on minority issues, including healthcare?

He will do everything he can to advance minority rights and undo setbacks during the Trump administration, e.g., LGBTQ+ rights. We expect this based on the communities that supported his candidacy and the composition of his cabinet. Some of Trump’s conservative agenda, like the US-Mexico wall, will disappear after Trump leaves office. Immigration did not have the mobilizing power it had in the 2016 elections, and Biden has pledged to seek a (long-elusive) path to citizenship for 11 million undocumented residents. He will work to make the DACA program permanent, and, though no proponent of “open border,” will doubtless seek to undo the damage from Trump’s ceaseless demonization of migrants.

So, in summary, what trends can we expect?

These first two years are, as ever, crucial.  Republicans could reclaim a majority in the House and the Senate in 2022, so Biden’s agenda will be highly contingent on how well he manages the COVID pandemic and whether he succeeds in holding the Democratic coalition together and—perhaps—in gaining support from moderate-minded Republicans, if any such there be. 

The party’s progressive branch supported Biden’s candidacy, galvanized by the goal of removing Trump from office.  However, ideological splits in the party will likely re-emerge following his inauguration.  

Biden will, of course, be thinking about 2022 and securing majorities in the House and the Senate to continue to move his agenda forward.  The short-term focus will be on COVID above all, and then, weighing the progress of this effort, he will decide where and how to invest his political capital: 

• Where will healthcare fall within the list of top priorities post-COVID? 

• And what within healthcare will be the rank order among the options?

All this is something of a moving target. It is unclear to me, and I expect to the Biden administration as well, how these priority lists will shape up after COVID.

About the interviewee

Lawrence D. Brown, PhD, served as chair of the Mailman School’s Department of Health Policy and Management for ten years and of Columbia University’s Public Policy Consortium for three years. A political scientist, he was on the faculty of Harvard University and the University of Michigan and held positions at the Brookings Institution before joining the Columbia faculty in 1988. Brown is the author of Politics and Health Care Organization: HMOs as Federal Policy (Brookings Institution,1983) and of articles on the political dimensions of community cost containment, expansion of coverage for the uninsured, national health reform, the role of analysis in the formation of health policy, and cross-national health policy. Brown edited the Journal of Health Politics and Policy and Law for five years and has served on several national advisory committees for the Robert Wood Johnson (RWJ) Foundation. He is a recipient of an RWJ Investigators in Health Policy award and an elected member of the National Academy of Medicine.