With the new Congress largely in place, and the new presidential administration set to take power on Jan. 20, health care insiders are beginning to make sense of what legislation and rulemaking the Biden administration and Democrats intend to develop that could affect health insurers. Experts say that large, structural changes like a public option are unlikely, given Democrats’ narrow Senate majority, but smaller reforms including expanded subsidies in the Affordable Care Act (ACA) exchanges are up for discussion, along with pandemic-related coverage protections.

The Biden transition team included increased ACA subsidies and temporary COBRA subsidies for laid-off workers as part of the pandemic relief package that President-elect Joe Biden announced on Jan. 14, as AIS Health went to press. But that policy does face some hurdles.

Insurers and other health care organizations are halting or reconsidering donations to federal lawmakers who voted against certifying the results of the presidential election, in moves they say are designed to counter the extremism that led to the Jan. 6 insurrection at the Capitol.

In some cases, these decisions could have a noticeable impact, as many of the organizations announcing changes to their policies gave to members of Congress who voted against certifying election results. But in other cases, the decisions may not have a substantial result since the organization in question hadn’t made many donations in the past or was announcing a review, rather than a change in policy.

Continuing its spree of approving ambitious waivers before the end of the Trump administration, CMS on Jan. 8 gave Tennessee its blessing to become the first state in the nation to cap its Medicaid funding in exchange for a range of operating flexibilities. Industry insiders tell AIS Health that while the future of Tennessee’s demonstration is uncertain, its approval could still be a point of concern for Medicaid managed care organizations.

“Similar to medical loss ratio (MLR) requirements in the Medicaid managed care final rule, the waiver would give Tennessee more oversight over their Medicaid plans, from flexibility in managed care contracting to rate setting,” explains Abner Mason, founder and CEO of ConsejoSano, a health tech startup specializing in linguistically and culturally aligned Medicaid and Medicare health plan member outreach.

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