UPH Government & External Affairs

Presidential Update

by | Jan 27, 2021

For any new President, a measure of their administration is its first 100 days – what is proposed and what is achieved. This timeframe started ticking down with the inauguration of President Joe Biden on January 20.

Issues: President Biden campaigned on a larger health care platform, but the first 100 days will have a tighter focus.

  • COVID-19 Response: No surprise, this is the top priority. Out of the gate, a face covering mandate was issued for the federal workforce and federal properties. On the Administration’s second day, it unveiled its National Strategy for the COVID-19 Response and Pandemic Preparedness. Key items involve a national vaccination program, increased testing, investment in COVID-19 treatments, expanded emergency relief and supplies, protection for workers and expanded health insurance coverage, and outreach support. To assist with care delivery and planning, HHS also issued a letter to State Governors that indicated the federal Public Health Emergency (PHE) would likely be extended through the end of 2021, and that states will receive at least 60-days’ notice prior to the PHE end.
  • Coverage Expansion: Efforts will concentrate on shoring up the ACA Marketplace to promote coverage. Areas likely to be revisited are Funding for marketplace navigators and outreach; Reopening marketplace enrollment periods; Limiting availability of short-term, limited duration insurance and association health plans; Preserving Marketplace user fees; and with Congressional approval, Expanding Marketplace subsidies. For Medicaid, increased coverage efforts will likely take the form of Incentives for states to expand Medicaid; Innovative value-based solutions; and Removal of work requirements and funding caps.
  • Reshaping Trump Era Regulations: Targeted rules are generally areas where reform is needed, but there is disagreement as to the approach. The Biden Administration could revoke or revise regulations or alter how they are enforced. Rules we are watching include drug pricing (Most Favored Nations model and rebates for Pharmacy Benefit Managers) and price transparency.


Political Context: President Biden campaigned on being the President for all Americans regardless of political party or leanings. Now, the President must work with Congress, where bipartisanship is more challenging. With close margins in the House (222 Democrats / 211 Republicans) and Senate (50 Democrats & Independents / 50 Republicans), major progressive policies like Medicare for All are unlikely in the next two years – Democrats can’t afford to lose more than a half-dozen votes in the House, and a 60-vote threshold will still be required to move most legislation in the Senate.

Advocacy Takeaways:

  • COVID-19 response will be the key priority, and while other UnityPoint Health advocacy work will continue, legislative solutions are not likely in the short term.
  • Most legislative proposals will need bipartisan support to advance for the next two years.
  • Purely partisan proposals, in this case Democratic platform priorities, will be limited to the reconciliation process. By Senate rule, this enables legislation to pass with 50 votes, but issues are limited to fiscal policy that result in significant changes to federal revenue or spending. In 2021, reconciliation may only be used twice, and health care must compete with other issues such as taxes, energy, environment, and the like.
  • Regulations advanced through federal agencies will continue to be an important avenue to advance policy and UnityPoint Health priorities.
  • Executive Orders from the President will continue as a vehicle to signal policy directions. There is expected to be 53 executive actions taken within the first 10 days of the Biden Administration. On January 28, the health care executive actions are scheduled for release.

Your UnityPoint Health Government & External Affairs team is committed to keeping you apprised of relevant developments from the new Administration. For more information on federal advocacy, legislative, policy and regulatory issues of impact to UnityPoint Health, please contact Cathy Simmons, executive director of government and external affairs, or Stephanie Collingwood, government and external affairs specialist.