During the Obama and Trump Administrations, the Patient Protection and Affordable Care Act of 2010 has been a centerpiece of health policy initiatives. The U.S. Supreme Court played a decisive role in 2012 by ruling that the law would remain in effect despite an attempt by Republicans to eliminate it over a provision involving an individual mandate that originally was intended as a penalty to be imposed on individuals who decided not to seek insurance coverage. The high court ruled that if the mandate was considered a tax instead of a penalty, then the law would remain intact. When Congress eliminated the tax in 2017 in overall legislation signed into law by President Trump, Republican Attorneys General around the nation argued in federal court that ending the tax provided a rationale for scuttling the entire Affordable Care Act (ACA), which no longer can be considered constitutional. The Supreme Court accepted the case and a ruling is expected to be issued later this year.
Meanwhile, total national healthcare spending in 2019 grew 4.6%, which was similar to the 4.7% growth in 2018 and the average annual growth since 2016 of 4.5%, according to a new analysis conducted by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS). The share of the economy devoted to health spending was relatively stable in 2019, at 17.7% compared with a 17.6% share in 2018. The 4.6% growth in health care expenditures was faster than the 4.0% overall economic growth as measured by Gross Domestic Product (GDP) in 2019. The growth in total national healthcare expenditures in 2019 reached $3.8 trillion, or $11,582 per person, up from 2018 when total national health expenditures were $3.6 trillion, or $11,129 per person. Spending for personal health care, which includes health care goods and services, accounted for 84% of total health care spending in 2019 and increased 5.2%, a faster rate than the 4.1% it increased in 2018. The faster growth in personal health care spending was driven largely by growth for hospital care, retail prescription drugs, and physician, and clinical services. The report includes health expenditure data though 2019, but not any of the effects of the coronavirus disease 2019 (COVID-19) pandemic on health care spending.
Undoing Trump Administration Health Policies
A common practice whenever a new administration led by one political party replaces an administration of the other political party in the nation’s capital is to undo policies implemented by the predecessor group. For example, one Trump administration regulatory initiative created Association Health Plans that do not have to comply with either ACA individual or small-group requirements, In June 2018, the Labor Department finalized a rule to expand the ability of employers, including sole proprietors without common law employees, to join together and offer health coverage through such plans. These short-term limited duration vehicles can be in effect for one year and also be subject to renewal for as many as 36 months while continuing to be exempt from the Affordable Care Act’s consumer protections. Other high profile policies that democrats found to be objectionable involved the joint federal-state Medicaid program. Examples are demonstration projects that allow work requirements and block granting of federal Medicaid funds.
Mechanisms Likely To Be Used By The Biden Administration To Reverse Trump Policies
A 50-50 split between democrats and republicans in the Senate means that tie votes can be broken by Vice President Kamala Harris. With democrats in control of the House and a fellow party member occupying the White House, legislative objectives can be achievable through the enactment of laws. A related approach would be to use budget reconciliation procedures to pass some tax and spending measures in areas, such as ACA enhancement, pandemic relief, and climate change. The process begins with a budget resolution. Next, reconciliation legislation is then considered using a fast-track process that can be passed by a simple majority without having to be filibustered in the Senate. Limitations exist since budget reconciliation cannot be used for any and all federal legislation. Instead, bills must contain provisions that affect revenue and spending, with no extraneous items allowed, according to a restriction known as the “Byrd Rule.” Named after its principal sponsor, Senator Robert C. Byrd, D-WV), the rule provides six definitions of what constitutes extraneous matter. The Byrd rule has been in effect during Senate consideration of 21 reconciliation measures from late 1985 through the present.
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