WASHINGTON — A second term in office could bring major changes to health care access and costs, even as former President Donald Trump is still ironing out the details.
There has been much speculation about what the former president will do if he is re-elected next month. Despite President Trump, the Democratic Party is running a fierce campaign against the Project 2025 agenda set out by a conservative think tank. claim He doesn’t support that blueprint.
The extraordinary attention to the proposal has obscured some of the former president’s own words about his priorities on abortion access, addiction policy and insurance coverage, surrogates and former officials say. . They point to actions in his first administration, although many details were withheld from Trump himself during the campaign.
Joe Grogan, president of the right-wing think tank Paragon Health Institute, told STAT this month that “there are a number of organizations working to provide appropriate options if President Trump is elected.” “I think just looking back at his first semester, you can see the trends and the direction he needs to go.”
Here, we summarize President Trump’s stance on health care policy and potential top priorities in his second administration.
Rethinking the Affordable Care Act
President Trump has insisted that he has no intention of reviving the failed Republican attempt to repeal and replace the sweeping Affordable Care Act, but he is reforming the comprehensive law and providing Americans with lower costs. We have a “planning concept” that provides cost options.
In a debate with Vice President Harris, Trump said, “If I could come up with a plan that would reduce the burden on the people and the people and provide better health care than Obamacare, I would absolutely do it.”
His running mate, Ohio Sen. J.D. Vance, elaborated a bit more after the debate. In an interview with NBC. Vance’s comments suggest that the Trump administration will allow insurance companies to separate enrollees into different risk pools and offer them different plans based on their health risks and costs. Democrats slammed the comments, warning that the plan would return Americans to the pre-ACA days when insurance companies could deny coverage to people with pre-existing conditions.
Mr. Vance later spoke about “reinsurance regulation.” This is another possible route for states to cover high medical costs for ACA members.
Next year, Congress will debate whether to extend expanded ACA plan subsidies that were expanded during the Biden administration beyond 2025. Many Republicans argue that the subsidies distort incentives and increase costs and should only apply to the sickest enrollees. President Trump has not yet spoken specifically about these subsidies, but his comments about wanting to improve Obamacare indicate he is open to reevaluating these billions in tax credits. Suggests.
“We have the most sophisticated risk adjustment system in the entire world in Medicare Advantage,” said John C. Goodman, president and CEO of the Goodman Institute. , to apply the same system to the Obamacare exchanges.” Public policy research.
A second Trump administration may also revive previous efforts to offer shorter-term health care plans. These insurance options, which were extended during President Trump’s first term and then scaled back by Biden, do not have to cover everything required by ACA plans. a 2018 KFF Survey For example, it was found that 71% did not cover prescription drugs.
Public Health Service Reform
President Trump has vowed to address the “alarming” rise in chronic diseases and the number of patients they cause, which may require restructuring federal health agencies that oversee research, advocacy and drug development.
“It’s time to ask, ‘What’s going on? Is it the food they eat? Is it the environment we live in? Is it the overprescription of certain drugs? Is it the food that they eat? Is it the overprescription of certain drugs? Is it the food that they eat? “Is it a toxin or a chemical?” he asks himself. Campaign site. President Trump has promised to create a presidential commission to study the rise in chronic disease.
These comments parallel a growing “Make America Healthy Again” movement that blames ultra-processed foods, environmental factors, and the pharmaceutical industry for the rise in autoimmune diseases, obesity, and autism. The movement has brought Mr. Trump some unusual allies, including Robert F. Kennedy Jr., a former Democrat and longtime anti-vaccine advocate.
But it also comes amid simmering Republican dissatisfaction with the coronavirus response and public health agencies’ guidance on vaccines, masks and closures. Congressional Republicans have proposed splitting the Centers for Disease Control and Prevention into two organizations, one for infectious diseases and one for chronic diseases. Republican committee leaders also propose restructuring the National Institutes of Health.
Such efforts could gain support from President Trump, who sought term limits for NIH leadership during his first administration.
Restructuring the Medicaid program under pressure
President Trump hasn’t said much about Medicaid, especially during this campaign, but this is another area where his first administration offers some clues. The administration will outline how states can implement work requirements in Medicaid plans; Approved 13 exemptions Expand them.
President Biden rescinded some of these authorizations, while others were later rescinded. Medicaid later rescinded the Trump-era guidance. But there remains an appetite among Republican leaders to put some kind of work requirement in the program. South Dakota is expected to vote on a bill establishing the requirements next month.
New waiver requests could come as Medicaid programs anticipate budget pressures and ballooning costs for popular new drugs.
Those programs are also still sorting out changes from the redetermination process in which states removed millions of people from Medicaid enrollment after the coronavirus emergency ended. There are early signs that millions of people switched to ACA plans, while sicker people with higher costs remained on Medicaid. This has led insurers to seek federal approval to fix premium rates for high-end enrollees, according to Medicaid programs reviewed by KFF.
Lowering drug prices
President Trump has long lamented the high prices Americans pay for prescription drugs and how other developed countries are “freeloading” at much lower prices. But he has abandoned his signature most-favored-nation proposal aimed at cutting costs, leaving a policy vacuum in this policy area.
Trump’s representatives say the main reason for this is the Inflation Control Act, which allows Medicare to directly negotiate certain drug prices. The former president will have to wrestle with how to implement his plans within the law or incite Congress to dismantle the law, which is unlikely.
Mr. Trump promised:Cancel all unused items It created a fund under the misnamed Inflation Control Act and watered down climate change requirements, but it distanced itself from health policy provisions, including a $2,000 co-pay for prescription drugs for Medicare enrollees.
But there are other ways he could attack the law and try to change the negotiation process.
Grogan urged Congress to overhaul Medicare Part D, the prescription drug program that could be abolished as more seniors enroll in private Medicare Advantage plans. Republican leaders also called for more transparency in negotiations between Medicare officials and drug companies.
Trump also made cracking down on pharmacy benefit managers a top priority in his first administration. Although he did not mention these proposals during his campaign, including the failure of a rule to eliminate kickbacks paid to PBMs, pharmaceutical industry leaders say he intends to return to these goals in his second administration. He seems convinced.
“We were encouraged by former President Trump’s support before going after intermediaries,” PhRMA CEO Stephen Uble said in a media briefing. this month.
reproductive rights
The former president still walks a line between boasting about forming the Supreme Court that overturned Roe v. Wade and insisting he would no longer restrict abortion rights. President Trump’s rhetoric has evolved this year as voters repeatedly say they don’t support state restrictions. He said he would veto a national ban if it reached the Oval Office.
But abortion rights advocates warn of countless other ways a future Trump presidency could curtail access to abortion and reproductive health care. We’ve seen some of it before: During his first term, the Department of Health and Human Services ordered some insurance companies to cover birth control for free to enrollees if it violates their religious beliefs. allowed them to opt out of the ACA’s requirements.
There’s also the specter that the Comstock Act, a 150-year-old law that hasn’t been enforced for decades, could be used to mail the abortion drug mifepristone. The majority of abortions. President Trump said this summer that he would not use Comstock to limit mifepristone, and his position is Abortion opponents’ voices of anger.
Comstock could emerge in the administration anyway, as more attorneys general are joining the original mifepristone case, which the Supreme Court sent back to a Texas district court. Missouri, Idaho, and Kansas are currently involved in the case, which is debating the legality of mailing mifepristone. I sharpened it.
Separately, President Trump vowed to protect access to in vitro fertilization and require insurance coverage of the procedure. The pledge comes after Democrats repeatedly attacked Republican lawmakers over abortion laws that inadvertently jeopardize access to in vitro fertilization.
Drug use and border policy
Trump has perhaps spoken in the most detail about his plans to control the opioid crisis, but most of his answers have to do with the justice system and border policy. his campaign website Pledges a naval embargo and military efforts to combat drug cartels and the death penalty for fentanyl traffickers. forever Places fentanyl in the highest category of controlled substances (Schedule I classification of fentanyl and related chemicals) Expires this year. )
President Trump also promised to expand economic support for people with addictions and their families caring for them. His proposals include paid leave for caregivers, as is current law, and public-private partnerships to create jobs for people in recovery.
Overdose deaths rose sharply in the final year of Trump’s presidency, and had been steadily increasing in previous years. Trump blamed the recent setbacks on the coronavirus pandemic and Biden’s border policies.
“Until the coronavirus hit, we were doing very well in fighting addiction,” he said during a debate with Biden.
Except for gender-affirming care.
One issue Trump has used to galvanize his base is gender-affirming care for minors. The former president promised to “end the gender insanity of the left” and ban federal funding for reassignment surgeries. On his website, he promises to issue an executive order on his first day in office “directing all federal agencies to discontinue all programs that promote the concept of gender and gender reassignment, regardless of age.”
President Trump has also repeatedly falsely claimed that children are undergoing reassignment surgeries at schools without their parents’ permission. There’s no evidence that that happened. All major medical associations recommend parental consent for surgeries on minors, including gender-affirming surgeries. very rare.
Gender-affirming care for minors often includes psychiatric care and therapy. The state’s restrictions on this type of care and the use of hormone blockers will soon be brought before the Tennessee Supreme Court. defend the ban In December.
