The election killed any dreams of big health care changes

The likelihood of a Biden presidency and a closely divided Senate means that nothing big is likely to happen in health care for at least the next two years.

The big picture: For all the time Democrats spent debating Medicare for All, competing public insurance options and sweeping federal controls over drug prices, the near-term future for health policy will likely be about gridlock and incrementalism.

Biden ran as a moderate in the Democratic primary field, but the policies he's endorsed — like a public option, lowering the Medicare eligibility age and expanding Affordable Care Act subsidies — would be non-starters in a Republican-controlled Senate.

• Those proposals would still be incredibly hard to pass even if Democrats eke out a majority.

"It means that old-school bipartisanship is in session," said Rodney Whitlock, a former health aide to Sen. Chuck Grassley. "It means that if you want to try to accomplish things, you know how to do it: You find a friend on the other side of the aisle, and you work forward.”

• Bipartisanship on health care is hard to come by, especially for big-ticket items. Lawmakers tried to find common ground last year on drug prices and fixes for surprise medical bills, but both of those efforts failed.

Biden would have to rely heavily on administrative action, as KFF's Larry Levitt points out:

• He could extend ACA enrollment, reinstate ACA outreach funding and reimpose limits on skimpy "short-term" health care plans without congressional approval.
• And there are plenty of bold changes the executive branch can make in regards to prescription drug prices.

What they're saying: “Obviously a Republican majority or a narrow Democratic majority limits the scope and breadth of the agenda, but the demands of the public for action around health care will force both parties to find a pathway for progress," said a source close to Bidenworld.

The catch: “There’ll be legislative gridlock, except for in the case of invalidation of Obamacare,” said Chris Campbell, a former senior GOP Senate aide.

• A Supreme Court ruling invalidating all or much of the ACA could force Congress to act on big-ticket items like restoring protections for people with pre-existing conditions.
• "If the Supreme Court overturns Obamacare, it may be the only thing we talk about for the next two years," Campbell said.