President-elect Joe Biden has one relatively simple way to restore healthcare policy to pre-Trump status: revoke all of Trump's disastrous healthcare orders. This means things like no more work requirements for Medicaid, a rollback of restrictions on abortion and contraception, and health care for LGBTQ people.
Just reverting to where the nation was under the Affordable Care Act before Trump’s sabotage will help, and he's likely to bring back many Obama administration alumni to help get to that. Those people who have an intricate understanding of the vast and complex system will be best positioned to restore it. People close to the transition expect to have the team beefed up with actual physicians to help deal with the immediate pandemic crisis. Former Obama policy director Kavita Patel told The Washington Post, "I do think there will be a course correction for wanting to have more scientists and doctors" in the new administration. No one has said as much, but expect a reempowered and unleashed Anthony Fauci to keep his job.
Also expect a new special enrollment period on Healthcare.gov to open right away—it opened on Nov. 1 this year, and will close on Dec. 15 for plans beginning Jan. 1, 2021. Biden will open it back up, and will restore funding to the enrollment campaigns for advertising and outreach. Even with the Obamacare law in front of the U.S. Supreme Court and a decision expected next spring, the new administration is expected to go all out in getting people enrolled, particularly those who've lost their coverage because of the epidemic. In fact, a massive enrollment could help save the law from SCOTUS.
The new administration is also likely roll back Trump's expansion of junk health plans, the "short-term" plans that were allowed under Obamacare to help people bridge gaps between coverage. They were intended to be used for no more than a few months, and didn't have to comply with the full coverage requirements of long-term health insurance plans, like the requirement to provide comprehensive coverage regardless of someone's medical history. Trump expanded them to last for months, effectively undermining protections for people with pre-existing conditions. They are low-cost and many consumers have been fooled, enrolling in them without the understanding that they don't provide actual coverage. Rolling these plans back is a relatively simple, day one-kind of action. Others are going to take some time to unwind.
That includes Medicaid work requirements in a number of states, which are still in the courts in the few states that took them up. The administration can immediately say: no more waivers to states to implement work requirements going forward. But it'll take some time to kill them entirely and the administration can crack down on states that do have them to make them really adhere to the requirements for coverage under the law. It can also expand what states can do with their Medicaid programs—particularly under COVID-19, like expanding telehealth to make accessing care safer.
Expect Planned Parenthood to come back to the Title X family planning program, getting federal dollars to provide important reproductive health care to millions of people. The organization left when the Trump administration finalized rules to ban grantees under Title X from referring women for abortion and also requiring them to financially separate facilities that provide abortion services from other services.
Expanding the ACA as Biden has promised (if the Supreme Court doesn't scrap it) is going to depend an awful lot on what finally happens with the Senate and the two pending runoff races in Georgia. But right now, the healthcare industry is just relieved that there's not going to be more Trump chaos. It means "we get preservation and enhancement of ACA to ensure that the newly unemployed and anybody else who lacks insurance has access," said Chip Kahn, president of the Federation of American Hospitals. They're not alone in their relief.