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February 23, 2021

Five Wildcards Impacting the Prospects for and Nature of Health Reform  

Ken Perez
Vice President, Healthcare Policy and Government Affairs, Omnicell  

How much health policy change can the Biden administration effect during the next four years? Some are urging President Joe Biden to “go big” and use his “honeymoon” period to drive his most aggressive and costly reforms, including a public option plan, expanding Medicaid, enhancing the Affordable Care Act’s health insurance marketplaces, lowering the Medicare eligibility age to 60, and promoting unionization and collective bargaining for healthcare workers.  

Which way will the political winds blow in Washington, D.C.? There are five wildcards that will likely factor into what health policy changes take place in the next few years.  

1) The Effectiveness of the COVID-19 Vaccine Rollout  

Job one for the Biden administration is to effectively manage the rollout of COVID-19 vaccines. Obviously, this is a complex task, given the many players involved—federal, state and county governments, vaccine manufacturers, distributors, hospitals and health systems, retail pharmacy chains, and others—not to mention the public. It is not an overstatement to say that most everything—the nation’s public health, economic recovery, and the political climate in the nation’s capital—hinges on the effectiveness of the COVID-19 vaccine rollout. 

2) The Level of Bipartisanship in Washington  

How Biden engages with moderate Republican senators and the tenor of the power-sharing between Senate Majority Leader Chuck Schumer (D-N.Y.) and Senate Minority Leader Mitch McConnell (R-Ky.) will serve as barometers of the level of bipartisanship and therefore the likelihood of policy changes.  

3) The Supreme Court Ruling on Texas v. California  

On Nov. 10, 2020, the Supreme Court heard oral arguments over the constitutionality of the Affordable Care Act (ACA). The justices are considering whether the ACA can stand without the individual mandate penalty, which was reduced to zero by the Tax Cuts and Jobs Act of 2017. A core issue is whether the individual mandate is severable from the rest of the statute.  

4) Potential Split in GOP  

Just as Biden spoke of fighting for “the soul of the nation” during his campaign, there is a fight over the soul of the GOP. If the Republican Party splinters, the nation would likely continue its leftward shift through the 2022 and 2024 elections, potentially paving the way for more progressive reforms by the Biden administration.  

5) The 2022 Midterm Elections  

The pendulum of American politics swings back and forth. Democratic presidents know this well. If the GOP retakes either chamber of Congress in 2022, the Biden administration’s ability to advance its policy agenda would be severely limited during 2023-2024, making moderate policies with bipartisan support the only measures able to prevail. 


While a change of administration in Washington always brings with it some sense of optimism, the current formidable challenges facing the nation and the multiple unknowns outlined here paint a picture of uncertainty with respect to the future of health policy. That in turn leads pharmacy leaders in healthcare organizations to focus on the things that they can control, such as improving efficiency, reducing waste, enhancing patient safety, launching revenue-generating activities, and maintaining compliance through  medication management solutionspharmacy software and  pharmacy management systems


The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of any other agency, organization, employer or company. Assumptions made in the analysis are not reflective of the position of any entity other than the author(s). These views are always subject to change, revision, and rethinking at any time and may not be held in perpetuity.

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