Healthcare

President-elect Trump’s healthcare priorities for his upcoming term reflect a tension between competing policy interests. From a public health perspective, his “Make America Healthy Again” approach seeks to disrupt how federal agencies work with industry stakeholders and evaluate food and medicine safety.

With respect to programs like Medicare and Medicaid, Congress is poised to potentially enact significant changes that bolster certain aspects, such as Medicare Advantage, while reducing federal spending on others, such as Medicaid. Abortion and access to certain medications and services like IVF will also remain a hot topic over the next administration.

Make America Healthy Again: President-Elect Trump announced that he would nominate Robert F. Kennedy Jr. as Secretary of the Department of Health and Human Services (HHS).

If confirmed, RFK Jr. has said he will focus on addressing chronic diseases by implementing a “Make America Healthy Again” (MAHA) platform. MAHA is wide-ranging, but it primarily focuses on external inputs that enter the body, things like food, water, vaccines, and other environmental factors like air, and how those things affect (or arguably lead to) diseases such as autism, attention-deficit/hyperactivity disorder, sleep disorders, infertility rates, diabetes, and obesity. MAHA advocates are concerned about how various industries, including food and drug companies, have not been (in RFK Jr.’s view) appropriately regulated by federal agencies like the U.S. Food and Drug Administration (FDA). He has promised to replace staff within federal agencies who he deems to be too sympathetic to large food and drug companies and install staff with similar views on these issues.

President-Elect Trump continued this trend of putting forward critics and skeptics of various establishments in leadership positions for other HHS agencies, including:

• Dr. Marty Makary, a Johns Hopkins surgeon and critic of the Biden Administration’s response to COVID-19 as FDA Commissioner;
• Former Rep. Dave Weldon (R-FL), a doctor and an Army veteran who served on the Labor and HHS Appropriations Subcommittee for Centers for Disease Control and Prevention (CDC) Director;
• Dr. Janette Nesheiwat, a Fox News medical contributor and director of a network of urgent care centers as Surgeon General.

These and other officials will be in charge of reforming the operations of the FDA, CDC, and the National Institutes of Health (NIH). 

Budget Reconciliation: On one hand, President-Elect Trump promised not to touch Medicare and Social Security during his presidential campaign. But on the other hand, his party’s unification of Congress and the White House gives them an opportunity to unilaterally extend expiring individual tax cuts originally included in the Tax Cuts and Jobs Act of 2017 (TCJA), and to lower the corporate tax rate through a privileged “budget reconciliation” bill. Lower federal taxes mean less government revenue, and CBO has estimated that extending the TCJA provisions could increase deficits by $5 trillion or more. Budget hawks who are already concerned about ballooning federal debt and ongoing deficits will seek other avenues to reduce federal spending, and spending on healthcare – particularly within the Medicaid program and for Affordable Care Act (ACA) premium tax subsidies – is already a prime target. It also remains to be seen whether significant reductions to providers furnishing services to Medicare beneficiaries through, for example, implementing “site-neutral” payments for outpatient services delivered at hospital outpatient departments (HOPDs) will be considered a Medicare “cut” if the suite of benefits covered by Medicare is not itself altered.

Overseeing many of these decisions with respect to Medicare and Medicaid – programs that collectively cover more than 150 million Americans – will be Dr. Mehmet Oz, who President-Elect Trump announced he will put forward as Centers for Medicare & Medicaid Services (CMS) Administrator. Dr. Oz is a heart surgeon, professor, author, and television personality who has expressed strong support for Medicare Advantage in the past. He has also supported making Medicare telehealth flexibilities that allow all beneficiaries to receive care in their homes permanently, and he has invested in health wearables, remote monitoring, and other digital therapeutics. According to a statement from the President-elect, Dr. Oz will be tasked with decreasing the rates of chronic diseases and “will also cut waste and fraud” within CMS.

Medicare’s ability to negotiate the price of prescription drugs, which was passed under the Inflation Reduction Act, will also likely be reassessed.