The 2020 election saw historic turn out with over 62% of the eligible voting population and more than 148 million votes cast. Healthcare was a key issue this election, particularly given candidates’ divergent policies and the increased attention on public health during the current COVID-19 pandemic. The episode opens with a discussion of what a Biden presidency could mean most immediately for the healthcare industry (01:11), from a more federally-driven approach to managing the pandemic, to reversing President Trump’s decision to leave the World Health Organization, to expanding funding for mental health services and the 21^st Century Caregiving Workforce. At (04:09), the conversation shifts to a wider perspective of Biden’s healthcare agenda, from building off the Affordable Care Act to expand access and affordability in the modern healthcare ecosystem, to reversing some of President Trump’s healthcare executive orders and increasing awareness of the ACA marketplaces. With run-off elections in Georgia likely to determine the Senate majority, the President-Elect will need to be thoughtful in his cabinet selections (08:30) and which levers he can pull to impact healthcare change outside of congressional channels (10:00). However, there is no escaping that core components of his agenda require Senate cooperation, such as adding a public option, allowing CMS to negotiate directly with drug manufacturers, and increasing the premium tax credits (10:52). Adding to the uncertainty over what a Biden administration will be able to accomplish from their healthcare agenda is the looming Supreme Court ruling on the Affordable Care Act (12:46). Unwinding the ACA would have far-reaching implications across the healthcare industry, from individual coverage to value-based care to biosimilars approval (13:55). Scenario planning will be key for healthcare organizations as they navigate the uncertainty around the severability of the individual mandate (16:37); however, recent events have shown the strength of the ACA marketplaces even in the absence of a functioning federal mandate (17:56). Anticipation is high to see just what next year’s run-offs and Supreme Court rulings mean for Biden’s policy and healthcare industry.