As the nation prepares for Donald Trump’s return to the White House, the president-elect is making plans for change across many areas of federal policy, including healthcare.
Federal programs
Two likely areas of focus for the new Trump administration and Congress are in the realm of health insurance coverage: Medicaid and the Affordable Care Act marketplace, according to Nick Hut, a senior editor at the Healthcare Financial Management Association.
“We could see [Medicaid] turned into a block grant program,” Hut said. “States would get a sum of money to distribute to their eligible population as they see fit and based on the coverage criteria of their choosing,” Hut said. Such a move could result in a reduction in access to Medicaid coverage, he said.
“If Congress can’t quite muster the political capital to make a big change like that, it could keep the traditional federal-state partnership, but there could be stricter work requirements for beneficiaries,” Hut said.
Those who purchase insurance on the healthcare marketplace could find their ability to secure coverage affected.
“Enrollment in the insurance plans available through the Affordable Care Act has surged over the last four years or so, largely because of enhanced availability of subsidies that you can use to buy these plans, but these subsidies expire at the end of 2025, and Republicans are reluctant, at best, to renew them,” Hut said.
Should subsidies expire without a renewal, the Congressional Budget Office projects a drop in enrollment by almost 7.5 million before 2030, which could lead to a significant increase in the uninsured population, he said.
Key players
Trump has announced two key players to head up efforts for healthcare reform, namely Robert F. Kennedy, Jr. as U.S Secretary of Health and Human Services and Mehmet Oz, MD, as administrator of the Centers for Medicare & Medicaid Services. Hut calls the picks “wild cards” but said Kennedy’s efforts to tackle chronic conditions might be popular.
“That could represent a landmark change for health in this country,” he said.
However, Kennedy’s views on public health issues such as medical research and development could affect public opinion in a negative way.
“I think he’ll win fans if he focuses on chronic diseases and refrains from stifling the nation’s medical innovation apparatus, which has always been a strength of the U.S. healthcare system,” he said.
As for Oz’s appointment, Hut said Kennedy could find a good fit in terms of goals and priorities, particularly when it comes to chronic diseases, but his positions on other policy issues such as ensuring hospitals are reimbursed at rates that allow them to stay financially solvent, are less clear.