Big plans for BidenCare doomed if Republicans keep Senate majority

President-elect Joe Biden’s ambitious plan for a dramatic and costly overhaul of America’s health care sector that would start us down the road to socialized medicine and worse health care has no chance of approval if Republicans capture majority control of the U.S. Senate.

And even if Democrats manage to control the Senate by the slimmest of margins, odds are high that Biden couldn’t go as far as he wants in restructuring health care.

Last week’s elections will leave the 100-member Senate with 50 Republicans and 48 Democrats in January — with two more seats to be filled by runoff elections Jan. 5 in Georgia.

Republicans will keep majority control of the Senate if they win at least one of the two seats up for grabs. If Democrats win both seats, each party will have 50 seats in the Senate. Sen. Kamala Harris, who becomes vice president Jan. 20, would then cast the tie-breaking vote to give Democrats majority control without a single vote to spare.

A GOP-controlled Senate will never approve Biden’s ambitious health care agenda. Democrats won’t be able to do so either unless every single Democratic senator supports BidenCare. Odds are high that at least one moderate Democrat — such as Sen. Joe Manchin of West Virginia —wouldn’t want to go as far as Biden wants.

Does this mean that no reforms of our health care system will take place after Biden becomes president? No, not at all. It means that both parties can still get together to pass bipartisan measures that will actually improve health care in America.

Biden has called for a public health insurance option that would compete against private insurers — a major change that would pave the way to single-payer health insurance. In other words, Uncle Sam would eventually be the insurance agent for all of us, without any competition from the private sector.

Biden has also proposed lowering the eligibility age for Medicare from 65 to 60. And he wants to make ObamaCare’s premium subsidies more generous, while offering them to more people.

Under BidenCare, the federal government would cap the amount that anyone who makes more than four times the federal poverty level (nearly $105,000 for a family of four) pays for insurance coverage at 8.5 percent of income.

While there’s no way Senate Republicans will get behind these enormously costly proposals, less drastic reform is possible.

For instance, Biden could lobby for an end to surprise medical billing — a positive step supported by Democrats and Republicans alike. Surprise billing occurs when a patient gets an unexpected bill after inadvertently receiving care from an out-of-network health care provider.

To date, many of the proposals aimed at ending this practice have favored the interests of insurers at the expense of providers, or vice-versa. The insurance industry has backed reforms that would establish a government-mandated cap on what out-of-network providers can charge. Providers, meanwhile, have supported some form of government arbitration for settling billing disputes with insurers.

A more even-handed approach, like that advanced by the Galen Institute’s Doug Badger and Brian Blase, would require providers to offer timely, accurate information about the price of care before treating a patient. They also recommend a system of “truth-in-advertising“-style penalties on insurers and providers who fail to inform patients when a given doctor is out-of-network.

This is precisely the kind of commonsense reform both parties should be able to support. It would bring some much-needed price transparency to the health care market, while also addressing a top concern of ordinary Americans.

Biden may be tempted to roll back some of the Trump administration’s efforts to boost access to health insurance options that are more affordable than those for sale on ObamaCare’s exchanges. But doing so would be an unforced error.

President Trump has expanded short-term, limited-duration health insurance plans. These plans aren’t subject to ObamaCare’s cost-inflating regulations. For many people, short-term plans can provide coverage that’s equivalent to what’s available on the exchanges for far less money.

The Trump administration upped the maximum duration of a short-term plan to one year, from three months under the Obama administration. Trump also gave insurers the option to renew those policies for up to three years.

Democrats have long hated these reforms, arguing that they draw people out of ObamaCare’s exchanges. Several states are not fans, either; in 11 states short-term plans are not available at all.  But where they are an option, short-term plans have given millions of Americans access to affordable coverage they didn’t have under ObamaCare.

Or consider the Trump administration’s expansion of health reimbursement arrangements (HRAs). These arrangements have long allowed companies to give employees pre-tax money they can use for out-of-pocket health care costs. The Trump administration modified the rules to allow health reimbursement funds to be used to pay individual insurance premiums as well.

The result is that more workers are now free to enroll in coverage that suits their specific needs —  and to own their coverage, so they can take it with them after they leave a job.

If Biden rolls back this expansion of HRAs he would again take choices away from consumers — with no commensurate benefit. If anything, Biden should urge employers to offer HRAs as a way of bringing more people into the individual market and thereby stabilizing ObamaCare’s exchanges.

So while Biden’s overhaul of our heath sector most likely won’t happen unless Democrats pick up more Senate seats and hold the House in the 2022 elections, there’s room for incremental improvements to our health sector before then — if Democrats and Republicans are open to working together to enact them.


Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on Twitter @sallypipes.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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