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Photo illustration: Aïda Amer/Axios. Photos: Jim Bourg-Pool, Jon Cherry/Getty Images

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.

Go deeper

Amy Harder, author of Generate
Nov 16, 2020 - Energy & Environment
Column / Harder Line

Biden's Day 1 challenges: Climate change

Illustration: Aïda Amer/Axios

President-elect Joe Biden will face constraints of both politics and time when it comes to pursuing his aggressive climate-change agenda.

Driving the news: Biden will enter a White House after four years of President Trump rolling back climate policies and time running out to substantively address the problem.

Updated 4 hours ago - Politics & Policy

Key government agency says Biden transition can formally begin

General Services Administrator Emily Murphy. Photo: Alex Edelman/CNP/Getty Images

General Services Administrator Emily Murphy said in a letter to President-elect Joe Biden on Monday that she has determined the transition from the Trump administration can formally begin.

Why it matters: Murphy, a Trump appointee, had come under fire for delaying the so-called "ascertainment" and withholding the funds and information needed for the transition to begin while Trump's legal challenges played out.

Updated 5 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Vaccines: Key information about the effective COVID-19 vaccines — Oxford and AstraZeneca's vaccine won't just go to rich countries.
  2. Health: U.S. coronavirus hospitalizations keep breaking recordsWhy we're numb to 250,000 deaths.
  3. World: England to impose stricter regional systemU.S. hotspots far outpacing Europe's — Portugal to ban domestic travel for national holidays.
  4. Economy: The biggest pandemic labor market drags.
  5. Sports: Coronavirus precautions leave college basketball schedule in flux.