Healthcare Under 2nd Trump Administration

Donald Trump won the Presidential election, so what now? This blog post will examine what President-elect Trump might do in a second term in healthcare. There is a lobbyist for every body part in Washington, so I won't try to guess what happens to the 340B program for instance, but I will cover those issues I have experience.

Regulatory

News stories the day after the election noted the rise in stock prices for health insurance carriers. This year’s AEP has been the most disruptive ever due to a host of Administration policies including the Inflation Reduction Act and regulatory actions taken by the current Administration. Year-over-year regulations have created headaches for carriers, FMOs, and agents leading to steep premium increases, carriers pulling out of markets and non-commissionable products, and general market uncertainty. Wall Street is aware of the role of regulations to either provide clarity and certainty, or uncertainty and market disruption. 

The new Administration will replace the current political appointees at all the federal agencies including CMS. This is important because the political appointees will reflect the views of the Administration and therefore direct the staff in the desired policy direction. 

Expectations are that the Trump Administration may reduce the regulatory burden on the private sector side of Medicare, thus returning them to greater profitability. Many of the rules governing call recordings, disclaimers for example, and including the scope of appointments could be dropped altogether. 

Planning for that should begin now, holding meetings with the transition teams to provide ideas for the incoming Administration.

Potential Policy Direction for 2nd Trump Administration

1. Inflation Reduction Act

This Act was the last legislation passed by Congress during COVID-19 behind closed doors and largely without stakeholder involvement or input. This led to some well-intentioned, but questionable provisions.

1. Congress may want to revisit several provisions of the law. 
   1. $2,000 deductible cap
   2. Allowing patients to request smoothing payment plans on drugs
   3. Probable illegal use of taxpayer money to fund a “demonstration project” to fund beneficiary price increases to the carrier and mask the true cost of the premium.
2. Prescription drug
   1.  The President-elect has spoken about negotiated drug pricing in the context of threatening to pay more than the other European countries for drugs, but not creating a list of drugs for negotiating and striking a deal on price with pharmaceutical companies as the Biden Administration did. 
   2. Could seek to use transparency tools to leverage lower prices through PBM reform and some unspecified mechanisms with PhRMA.   

ACA Marketplace

1. Allow the additional premium support included in the IRA to expire at the end of 2025.
2. Eliminate funding for navigators. This program has been controversial and expensive with little evidence of ROI.
3. Allow for longer short-term limited duration plans

1. Transparency
   1. Add teeth to the hospital transparency Executive Order perhaps through legislation
2. HSA reform
   1. The Ways and Means passed legislation to modernize HSA including allowing people over 65 to make contributions.
   2. Allow direct primary care arrangements in using HSAs
   3. Legislate additions to the IRS 213(d) list of uses of HSAs. Other than minor changes, the Treasury and IRS have been reluctant to make changes.
3. Surprise Medical Billing
   1. Providers may see an opportunity to reopen this law and could find sympathetic ears with the new Administration.