What president- elect Joe Biden´s administration will be able to get done regarding health care and retirement policy will depend much on the political tone in Congress.

Control of the Senate is hinging on two Georgia runoff elections in January, notes Geoff Manville, partner and government relations leader in Mercer’s Law and Policy Group. He says most observers believe Democrats will lose one of those races, which would give Republicans Senate control.

“That would make it all but impossible for the Democrats’ progressive agenda to bring expansion of the ACA [Patient Protection and Affordable Care Act] and to introduce a public health care option to move forward,” Manville says.

Proposals to roll out a public health option and to lower the Medicare age are “dead in the water,” says Kim Buckey, vice president of client services at DirectPath. “But Biden has bigger fish to fry with the pandemic and the Supreme Court ruling on the ACA.” For his more sweeping proposals, she says, “Biden may have to take a page from [President Donald] Trump’s book and issue executive orders to get things going.”

The week after the election, the U.S. Supreme Court took up a case about the validity of the ACA. Buckey points out that the law will be massively difficult to unwind. “It’s been in place for years. Employers have designed plans and programs by it and have invested millions, if not billions, to comply with its reporting requirements,” she says. “The health industry has made investments as well. Not only will it be difficult to unwind, but unwinding it will garner a tremendous amount of resentment. So, employers and the industry will be resistant to making sweeping changes if the ACA is struck down.”

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