The Year Ahead in Health Policy: Forecasts for Congress, the Administration, and the Courts

By Christina Ramsay , Akeiisa Coleman , and Rachel Nuzum, MPH

2022 was a momentous year in health policy. We saw major pieces of health legislation pass in Congress, witnessed executive actions that strengthened health coverage and access, and watched as Supreme Court rulings upended reproductive rights and the viability of vaccine mandates.

What does 2023 hold for health policy? Below we explore a few key areas on our radar as Congress and the Biden administration pick up where they left off.  

Making Prescription Drugs More Affordable 

Medicare Prescription Drug Negotiation 

The passage of the Inflation Reduction Act (IRA) provided Medicare with the authority to negotiate directly with pharmaceutical manufacturers on prices for certain high-cost prescription drugs. In 2023, the Centers for Medicare and Medicaid Services (CMS) will propose its data collection processes, issue guidance for the negotiation process, and publish a list of 10 Medicare Part D drugs selected for negotiation in 2026. 

As they prepare to exercise this power, Medicare is providing patients, advocates, pharmaceutical manufacturers, health plans, and clinicians the opportunity to make public comments. 

Other than a consideration for how long the drugs have been on the market, the law does not detail a process for determining fair prices. Thus CMS will need to weigh the best approach for assessing a drug’s true clinical benefit. 

Testing New Models for Lowering Drug Prices  

We also anticipate efforts from the Center for Medicare and Medicaid Innovation (CMMI) to go further in making prescription drugs affordable and test new models for lowering prescription drug prices.  

CMMI could develop models that test new approaches to reducing drug spending, such as common billing codes, reference pricing for drugs with limited clinical evidence, or increased generic and biosimilar utilization. The agency also could revisit proposals from previous administrations, like reference-based pricing for therapeutically similar drugs or the Most Favored Nation model (i.e., tying drug prices to those paid in other countries).  

Continuing to Advance Behavioral Health Policy Solutions 

Amidst rising rates of suicide and drug overdoses, policymakers can build on advances in the Bipartisan Safer Communities Act of 2022 to reduce gaps in behavioral health services. Areas ripe for reform in the behavioral health system include: 

1. advancing the integration of primary care and behavioral health  
2. strengthening and diversifying the behavioral health workforce 
3. expanding equitable access to behavioral health services, and  
4. leveraging Medicare and Medicaid to promote parity and ensure access in underresourced areas. 

Ensuring Access to Health Care Coverage and Services 

Last year, the Biden administration took meaningful steps to provide more affordable coverage options for families, including by fixing the “family glitch,” which precluded millions of family members of low-income workers — primarily children and women — from qualifying for financial help under the Affordable Care Act (ACA). Qualifying family members can take advantage of this new option beginning with the 2023 plan year. 

In the Fiscal Year 2023 omnibus spending bill, Congress decoupled continuous Medicaid coverage from the federal public health emergency, meaning states may begin disenrolling people who are no longer eligible for Medicaid on April 1. At the end of 2022, CMS released information on implementation of this “unwinding” process. With 15 million beneficiaries at risk of losing coverage, states play a crucial role in mitigating that loss and transferring beneficiaries to other sources of coverage where possible, such as the ACA marketplaces. 

Meanwhile, we’re seeing Braidwood Management v. Becerra make its way through the courts — a lawsuit that challenges the constitutionality of the ACA’s requirement that health plans cover preventive services without copayments. While the fate of this case remains to be seen, states have the power to proactively protect many of their residents by codifying access to these services without cost sharing in their fully insured markets. 

Bolstering the U.S. Public Health Infrastructure 

The Fiscal Year 2023 omnibus spending bill included several provisions from the bipartisan PREVENT Pandemics Act led by Senate HELP Committee that will improve federal and state emergency preparedness. This includes increased accountability on leadership, improved public health data infrastructure, and accelerated countermeasure discovery. This includes increased accountability on leadership, improved public health data infrastructure, and accelerated countermeasure discovery.  

The upcoming reauthorization of the Pandemic and All Hazards Preparedness Act (PAHPA) offers an opportunity for Congress to go further in fully modernizing our public health infrastructure. To that end, the Commonwealth Fund Commission on a National Public Health System offers a vision for a robust and sustainable public health system built on organizing agencies, increasing funding, formalizing processes, and improving public trust.  

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