Joe Biden's inauguration on January 20 marks the beginning of a new presidential administration, as well as a new era for health care. "Vote like your health care is on the ballot—because it is," Biden tweeted back in September. True to his tweet, the president-elect has plans to make big changes that may affect your own health and access to medical care. Here's what to expect from Biden on five key health issues.
Stopping the spread of COVID-19
Mask mandates: The coronavirus pandemic is the number one health issue in the country right now. As soon as he takes office, Biden will reportedly issue an executive order that face masks must be worn on federal property and on interstate planes, trains, and buses, according to the New York Times on January 16.
The president doesn't have the authority to mandate masks across all states and cities. But Biden intends to call on governors and mayors to create face mask mandates, and he has said that he will ask all Americans to wear a mask for the first 100 days after he takes office. "Having the White House publicly endorse mask-wearing on day one and asking Americans to protect themselves and their neighbors is a hugely important step," Michael Williams, MD, director of the University of Virginia Center for Health Policy, tells Health.
Vaccine distribution: Biden has pledged to administer 100 million vaccines in his first 100 days in office, enough to cover 50 million people. (He's already received both doses of the COVID-19 vaccine, the first in December and the second on January 11.) "That may be an overpromise, just due to the logistical challenges we're currently facing," Daniel B. Fagbuyi, MD, an ER physician and Obama administration appointee to the National Biodefense Science Board, tells Health. "It's going to be crazy in the Herculean effort to move the needle."
Testing and treatment: The new POTUS wants to double the number of drive-through coronavirus testing sites by building at least 10 mobile testing sites and drive-through facilities per state. He also has said that he'll rein in the costs of COVID-19 testing, treatment, preventative services, and vaccines free to all Americans. Per his campaign website, the president-elect wrote that the Biden Plan, "[e]nsures that every person, whether insured or uninsured, will not have to pay a dollar out-of-pocket for visits related to COVID-19 testing, treatment, preventative services, and any eventual vaccine. No co-payments, no deductibles, and no surprise medical billing."
Health disparities: To help track the virus and its spread, Biden intends to create a National Contact Tracing Workforce made up of at least 100,000 Americans. Per Vice President Kamala Harris's proposal, the new administration is establishing a COVID-19 Racial and Ethnic Disparities Task Force, which will address the outsized impact the coronavirus is having on minority communities.
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Expanding health insurance coverage
Covering those with preexisting conditions: In 2019, 92% of Americans had private or public health insurance coverage, but that percentage dropped in 2020 as people lost their jobs in unprecedented numbers due to the pandemic. Biden's goal is to insure more than 97% of Americans by expanding the Affordable Care Act (ACA). He'll also protect the ACA provision that guarantees coverage for people with pre-existing conditions.
"If you've got a diagnosis of COVID, you've got a pre-existing condition," says Dr. Fagbuyi. "We need to hold insurance companies and other entities that would be providing health care accountable to be able to ensure that people's preexisting conditions will not ding them or deny them care."
Creating a public option: Biden plans to introduce a public health insurance option like Medicare that will reduce costs for patients by negotiating lower prices from hospitals and other providers and cover primary care without co-payments. This would especially help low-income Americans, including those in the 14 states that have not expanded Medicaid under the Affordable Care Act; they would be automatically enrolled in Biden's option. Instead of giving states a choice about providing health care, "Biden is saying the federal government can and will step up and support the enrollment of the five million-plus citizens who were kept out of Medicaid expansion," says Dr. Williams.
Tax credit for coverage: Right now, there's also an income cap on tax credit eligibility for insurance bought on the marketplace: If a family makes more than 400% of the federal poverty level (that works out to about $50,000 for a single person and $100,000 for a family of four), they don't qualify for financial assistance. Biden wants to eliminate that cap on tax credit eligibility, and lower the limit on the cost of health insurance coverage from the marketplace so that no family has to pay more than 8.5% of their income (that percentage is currently 9.86) on coverage.
Biden's health care reform also includes prohibiting "surprise billing;" keeping drug costs down by assessing launch prices for new drugs and limiting drug price increases to the general inflation rate; and allowing consumers to buy prescription drugs from other countries.
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Protecting abortion rights
Safeguarding Roe v. Wade: After conservative justice Amy Coney Barrett was nominated to the Supreme Court last fall, candidate Biden told Newsweek that if SCOTUS were to overturn Roe v. Wade, his "only response to that is [to] pass legislation making Roe the law of the land." In his plans to support women during the COVID-19 crisis, he called abortion "essential." He also said during the Democratic primary in 2019 that he supports the repeal the Hyde Amendment, which prevents Medicaid from covering abortion in most circumstances.
Abortion access and family planning: During his time in the White House, President Trump instituted a "domestic gag rule," which bars Planned Parenthood and any other provider that performs abortions or offers abortion referrals from receiving funding under Title X, the federal grant program that funds family planning and related preventive health services. Biden has promised to overturn that domestic gag rule, as well as the "global gag rule," which blocks US aid to international organizations that offer abortions or or counsel women about them.
Legalizing medical marijuana and decriminalizing cannabis use
Medical marijuana: The most common use of medical marijuana is for pain control; it's reported to help replace the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, which can have negative side effects. Marijuana is also considered safer and less addictive than opiates.
In January 2020, Biden told the New York Times that he's against cannabis legalization without further research. However, the plan for veterans he released during his campaign and his plan for people with disabilities both support the legalization of cannabis for medical purposes and indicate that he will reclassify cannabis as a schedule II drug. (Currently the DEA considers marijuana a schedule I drug, which means it has no "currently accepted medical use.") Says Dr. Williams: "This opens up a vast array of clinical questions that we can now ask without having to go through really burdensome regulatory hurdles," which will allow scientists to more broadly study cannabis and prescribe medicinal marijuana more easily.
Decriminalizing cannabis use: In the same New York Times interview and under his criminal justice plan, Biden said marijuana use should be decriminalized, and anyone with a record should have it expunged. Instead of sending people to jail for illegal drug use, he'll require federal courts (and incentivize state courts) to send individuals to "drug courts" where they'll receive treatment for their substance use disorder.
Ending the opioid epidemic
Funding for treatment: When he was vice president, Biden—who has often talked about his son Hunter's battle with addiction—helped pass the 21st Century Cures Act, which included $1 billion in funding for states to address the opioid epidemic. Now he wants the federal government to invest another $125 billion over the course of 10 years to expand access to treatment and recovery services, increase medical training for preventing overdoses, and invest in research that will improve treatments for chronic pain. Where, exactly, will this money come from? Increased taxes on pharmaceutical corporation profits.
Substance use ACA coverage: His expansion plans for the Affordable Care Act ensure that as many people as possible will have access not just to traditional medical care but to substance use disorder treatment and mental health services. His criminal justice plan also stipulates that he'll reform the system so that no one is incarcerated just for opioid use.
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