Healthcare has long been an important issue in American political discourse. However, as Election Day nears, it’s become an increasingly hot-button issue due to concerns about how COVID-19 could affect voter turnout, how a Trump or Biden administration would handle the pandemic in the coming year, and the longer-term future of U.S. healthcare—including the controversy of whether the Affordable Care Act might be overturned.

In fact, healthcare is now the number two issue of concern for likely voters behind the economy, according to a Pew Research Center survey.

The pandemic is shaping this election season in unprecedented ways. It’s clear that Trump and Biden have very different views on the future of healthcare, and that the outcome of the election will shape U.S. healthcare—and its effects on the American employer—for years to come.

Since healthcare is such a critical long-term issue, FirstPerson invited Janet Trautwein, CEO of the National Association of Health Underwriters, to speak at Week One of RESOLVE Increments. Here are five takeaways from Trautwein’s presentation on How the Global Pandemic and Election Year Impact Healthcare. To watch her talk in full, gain your exclusive access here.

A presidential candidate’s platform is a “wish list.”

Sure, Trump and Biden both have a platform, but it’s safe to assume that no matter who is elected, the president’s entire platform will not be enacted.

“I don’t know any president that has ever gotten everything that they’ve asked for,” Trautwein said. “Some of them get nothing of what they asked for. Even when Congress is stacked up very much in their favor, sometimes things just don’t happen the way they planned. But it is good to know how they lean and what they think about certain things. Remember, they’re not the king. They have to work with Congress, and that can be a real challenge sometimes.”

Biden favors legislation that could result in the elimination of private healthcare plans.

The former Vice President is not in favor of “Medicare for all.” In fact, Trautwein described him as “middle-of-the-road” in his opinions on healthcare but noted Biden has worked to gain support from others in his party who support a Medicare buy-in plan or a public option, which is a health plan run by the U.S. government.

Biden says he would lower the eligibility age for Medicare to age 60.

“That’s pretty significant for those of you who have health plans for your employees because the way he would structure it—and again he would have to get Congress to cooperate with this—is that people in employer sponsored plans could opt out of their employer sponsored plan,” Trautwein said. “It doesn’t mean that you as the employer would have to fund them buying into Medicare, but perhaps some of them would want to do it on their own.”

“The key thing about a public option,” Trautwein said, “as well as buying into Medicare or some of the other Congressional proposals for buying into Medicare, is that it creates an unlevel playing field and reduces the likelihood that private plans would continue to exist on a long-term basis.”

It’s all in the details about how extensive such a proposal would be, but the government-supported plans would pay providers at Medicare rates that are significantly lower than your health plans pay.

That means artificially lower premiums for employees who participate.

Trump wants to limit ACA implementation—and strike it down, if possible.

Trump plans to continue his administration’s efforts to limit the implementation of Affordable Care Act, and his administration is even involved in a court case to declare the ACA unconstitutional.

“This administration has been extremely aggressive on drug pricing rulemaking, maybe some of the most aggressive of any administration we’ve seen,” Trautwein proclaimed. “They’ve done things you might have noticed on television like listing prices and things like that, which haven’t been done before. But they have a lot more planned.”

Additionally, if you have a larger self-funded plan and you’re receiving benefits from a pharmacy benefit manager, you’ll want to watch whether the Trump administration would outlaw that if they’re not going to also lower the list price of a drug, Trautwein noted.

The Senate is a toss-up, but control isn’t a magic bullet for either party.

Republicans currently have control of the Senate, 53 to 47. Senators serve six years, and there are 35 seats up for election (12 Democratic and 23 Republican). Democrats need to pick up four seats to gain majority.

Trautwein noted that in the House, a bill can pass with just a simple majority (51% of the vote), while the Senate allows for filibustering and needs a super majority. 

“If anything is remotely controversial, it’s going to require 60 votes to pass. So when you see a makeup like this with 53 to 47, you can just know that getting seven people … that’s not as easy as you think to get that. It’s very, very difficult. And it would have to be something like feeding the children or something not controversial at all. And even that might be because it would be ‘which children?’ ‘what are you going to feed them?’ and so forth,” Trautwein quipped.

The Supreme Court vote is a simple majority vote with huge stakes.

Everyone is talking about the nomination of Amy Coney Barrett and what it could mean for the future of law in the United States.

The Supreme Court is currently considering Texas v. U.S., a case brought by a coalition of 18 Republican states led by Texas that says the entire ACA should be declared unconstitutional. Texas v. U.S. has support from the Trump administration. 

If Barrett is nominated, it would swing the balance of the Supreme Court to 5 to 4 in favor of conservative viewpoints. So would she be able weigh in on the Texas v. U.S. case? It’s all a matter of timing.

The Senate is slated to vote Oct. 21 on Barrett’s nomination. However, the vote could be delayed due to Senators being unable to vote in-person due to a coronavirus infection. The Supreme Court is scheduled to hear arguments on Texas v. U.S. on Nov. 10, so Barrett would have to be seated by then to hear the arguments and exercise her opinion.

If Barrett were seated after that date, she would have to recuse herself. A final decision by the Court is unlikely before June.

“If the Supreme Court says the law is unconstitutional, then there is a lot of unraveling going on,” Trautwein said. “And if markets can’t bounce back fast enough so that people are able to access the care they need, things could unravel. Now there are a lot of plans on both sides of the aisle to bolster that back up, but the question is: could it happen quickly enough? And it would depend on exactly how the [Supreme Court] opinion was written.”

So, what now?

Here are two actions you can take immediately at your organization:

Create a communication strategy for what may change post-election and how it impacts your employees. This is a crucial opportunity for leadership. Otherwise, they will attempt to fill in the blanks and may misinterpret how your HR team may respond to changing policies.

Help your employees be effective consumers of your health plan. No matter the outcome of the election, organization plan sponsors with thoughtful cost containment and engagement strategies will win.

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