Summary

Kim Monk and Rob Smith, making up the healthcare policy team at Washington, DC-based Capital Alpha Partners, began their call on the differing healthcare plans between Democrats and Republicans. The Democratic party swinging further to the progressive left have healthcare as one of their top priorities, with the aim of supplying universal healthcare coverage. Kim went on to explain Biden’s Public Plan Option, which would look to crowd out employer-based healthcare coverage, with the public plan option having potentially more generous benefits. In terms of election predictions, Capital Alpha predicts Democratic candidate Joe Biden to prevail in the Presidential election and the Democrats to retain the House of Representatives, however a much closer contest in the Senate. If the Republicans are able to hold a slim Senate majority, much of these Democratic healthcare initiatives could be blocked. However, even with a Democratic sweep, major disruptive reform would be extremely costly and require killing the filibuster. A Democrat sweep would be met with a major COVID relief package, costing at least $3 trillion which would contain various healthcare measures but would not be pressured to offset. On the other hand, the Trump Administration’s healthcare agenda is less planned out, with price transparency and a focus on lowering drug prices and banning surprise medical bills. Trump is adamant he has a replacement plan but has given few details. Kim went on to discuss bi-partisan issues which will be legislative items regardless of the election outcome, including the medical supply chain reform, telehealth, drug pricing, 340B reform, COVID flexibilities, price transparency, surprise medical bills, and Cures 2.0. On the California vs Texas case, the current question asked before the Supreme Court: Is the Affordable Care Act’s individual mandate constitutional (i.e. can it still be justified as a tax)? Capital Alpha believes the Supreme Court is likely to rule the individual mandate as unconstitutional, however this then poses the question of which parts of the law can be severed? Capital Alpha believes the rest of the law will likely be upheld by the Supreme Court. Rob Smith focused his part of the call speaking about drug pricing reform - Trump’s election messaging Executive Orders, which include drug coupons, buy American, most favoured nation, drug rebate rule, drug importation and 340B. However, Rob does not expect much to come of these, especially before the election, with pushbacks from pharma, legal barriers, and the lateness of the proposals. Rob says in the outcome of a Democratic sweep, they will look to do a coverage expansion and use drug pricing reforms to offset the costs. Killing the filibuster would allow legislation to go through Congress with just the bare majority vote, opening the realm of possibilities for what can be achieved. Rob believes the actual chances Trump will be able to move forward on his Most Favoured Nation Order is very low, as it would need more than an Executive Order, but also to go through a very lengthy regulatory process. Re. COVID vaccine outlook - Trump’s idea of a vaccine produced before the election has been put to bed by the FDA saying they will need 2 months of safety and effectiveness follow up for any product used as a vaccine. This would put the earliest a manufacturer can submit an application towards the end of November.

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