Insights

On November 14, President-elect Trump named Robert F. Kennedy, Jr. to lead the Department of Health and Human Services (HHS).  So what will it mean if Kennedy becomes the administrator of HHS? 

In the 2024 U.S. presidential race, Robert F. Kennedy, Jr. introduced a health care platform aimed at reshaping the nation’s health policies under the banner of “Make America Healthy Again.” RFK, Jr.’s approach to health care is rooted in his longstanding commitment to environmental activism and public health advocacy, and a deep skepticism of the pharmaceutical industry.  

Let’s explore the key components of RFK Jr.’s “Make America Healthy Again” plan, and whether those components will succeed or fail.   

Universal Health care Access 

A core tenet of Kennedy’s platform is the commitment to provide universal health care—ensuring that every American has access to affordable medical services, regardless of income or employment status. Knowing how hard it was to pass the Affordable Care Act (ACA), it is extremely doubtful that RFK, Jr. could influence Congress to develop legislation on universal health care. His plans have been criticized by both the right and the left as leading to higher taxes, ballooning federal deficits, or overburdened state governments, particularly without a clear plan for how to pay for such reforms. 

Focusing on Prevention and Holistic Health 

Kennedy’s plan emphasizes a different approach to health care, focusing on preventive measures and lifestyle changes to reduce the incidence of chronic disease (rather than traditional medicine).  His plan emphasizes better nutrition, mental health services, exercise, and education on lifestyle choices as well as integrating alternative therapies such as acupuncture, naturopathy, psychedelics, and holistic treatments.   

While some are welcoming the inclusion of additional types of health care, there is great concern in the scientific community that integrating these into the health care system could potentially result in patients choosing ineffective or even harmful treatments over scientifically-backed medical care.   

In addition, Kennedy is known for his anti-vaccine rhetoric, which raises concerns about how his stance on alternative medicine might affect the broader public health landscape. Critics are concerned Kennedy could encourage the spread of misinformation and harm public health.   

While portions of his ideas are likely to be adopted as they are already in play (better nutrition, increased access to mental health), expect great resistance from Congress, the feeral agencies, and the scientific community over scientifically unproven ideas.   

Reducing Industry Influence on Health Care  

RFK, Jr. has been one of the most vocal critics of the pharmaceutical industry, particularly its influence on health care policies and practices.  Kennedy proposes sweeping reforms to the Food and Drug Administration (FDA), the Centers for Disease Control (CDC), the National Institutes of Health (NIH), and the US Department of Agriculture (USDA).  Kennedy feels these agencies have become “sock puppets for the industries they are supposed to regulate.”   While some proposals in his plan such as greater transparency at the FDA on drug and vaccine approvals could achieve bipartisan support, he will find great bureaucratic and Congressional resistance to his proposals to “fire everyone at the FDA,” implement reference pricing at CMS, or “immediately replace 600 NIH employees.”    

Environmental Health Focus 

Kennedy’s platform connects public health with environmental policy, acknowledging that many diseases are exacerbated or caused by environmental factors like pollution, pesticide, or chemical exposure.  While Kennedy may receive some support regarding banning chemical additives from food, many of his other policies (like taking fluoride out of drinking water and promoting raw milk) will receive significant push back.   

While the Make America Healthy Again Plan aims to address many critical issues in the U.S. health care system, these potential downsides highlight the challenges of balancing cost, access, quality of care, and government involvement. The effectiveness of the plan will largely depend on the specifics of his policies and how they are implemented. 

With the 2024 elections in the rear-view mirror, let’s talk “health care extenders.”  Umm, what’s that, what are they, what’s the outlook?  We are glad you asked! 

Health Care Extenders 

“Health care extenders” is an inside-baseball term in Washington, DC for health care-related policies that are set to expire at the end of December.   Absent Congress (or in some cases, the administration) taking up these provisions in the next few weeks, parts of the Medicare or Medicaid statute will expire, leaving critical programs in the lurch. 

But Wait, I’ve Heard This Before 

Yes, you’re right, you remember.  Health care extenders, and the anxiety that comes along with temporary policymaking, is not new.  Many of these provisions were extended earlier in March 2024.  In fact, some of these temporary policies started as far back as 2003 – I’m looking at you GPCI floor – and have been perennially extended ever since. 

So What’s on This Year’s List 

With so many extenders lingering out there, we wanted to make sure you had Congress’ “shopping list” at the ready.  (Yes, we have holiday shopping on our mind.  Maybe it’s retail therapy after this past election cycle?) 

Expiring: 12.20.2024  

• Pediatric Disease Priority Review Voucher Program  
• Programs related to autism and other developmental diseases  

Expiring: 12.31.2024  

• Teaching Health Center Graduate Medical Education (THC GME) Program  

• National Health Service Corps (NHSC) Program  

• Special Diabetes Program (SDP)  

• Special Diabetes Program for Indians (SDPI)   

• COVID-19 Telehealth Flexibilities    

• Moratorium on disproportionate hospital share cuts  

• Community Health Center Program  

• Acute Hospital Care at Home Program 

• Medicare Low-Volume Hospital Adjustment  

• Medicare Dependent Hospital  

• Add-on payments for ambulance services  

• Work Geographic Index Floor Under Medicare  

• Sexual Risk Avoidance Education Program  

• Personal Responsibility Education Program  

• Waiving in-person visits to prescribe controlled substances (this is a pending rule at DEA)

• Emergency Medical Services for Children State Partnership Program  

• Bring Education & Awareness to Encourage the Use of Mental Health & SUD Services/Health Care Professionals 

• Mental Health Programs Among the Health Professional Workforce 

What’s the Outlook 

Now that you have the list, you probably want to know what’s gonna happen.  There’s good news and bad news.  Let’s go with the bad news first.  Bad news is that savvy Congressional committee staff are always scrutinizing these policies to see which ones really need to be extended and which ones don’t.  So the adage of – always on a list, always extended – doesn’t hold true for extenders.  Good news is that lawmakers on both sides of the aisle and both sides of the Capitol support  extending these provisions. 

We expect Congressional action on these provisions in December, likely tied to a much larger piece of legislation that must go through before Congress closes out this session.  The big question is how long will they be extended this time?  Part of that answer depends on Congressional mood when members come back.  We see 2 scenarios.  The first scenario is that Congress extends the policies for a handful of months – maybe end of March – just to get by for a few weeks and not run up a big price tag on how much spending Congress would have to approve.  Extending tiny policies, even for a few months, is expensive.  The second scenario is a “clear the deck” scenario where Congress extends the policies through 2025 so that the new administration and new Congress have more time to either tend to other non-health care-related business (like tax reform) or to dig in on these provisions and make more thoughtful decisions on policy (like telehealth). 

So there you have it.  Let the lame duck sausage-making begin! 

As health care costs climb and the population ages, policymakers face ongoing pressure to limit spending while expanding access to care, especially for vulnerable and underserved populations. 

Economic Stability 

Every aspect of our nation’s health care system, from physicians to nurses, the drug and device industries to insurers (private and public), shares in the commitment to deliver care to the people in our communities. In this effort, America’s hospitals serve a unique role on the frontlines of our nation’s health care system, serving all who come through their doors—regardless of ability to pay. Yet, given their unique roles as economic engines in their communities and the dollars required to fund daily operations, hospitals are increasingly being put in the crosshairs of those seeking quick fixes to save scarce health care funds. 

In Search of Dollars 

When it comes to hospitals, there has been growing interest among policymakers in “site neutrality” proposals that would seek to level the cost and reimbursement for various services that can be provided in variety of settings, including hospital outpatient departments (HOPDs), ambulatory surgical centers (ASCs), and physician offices. Dating back to the Bipartisan Budget Act of 2015, there has been a movement within Medicare, supported by both legislation and regulation, toward equalizing payments for clinical visits at off-campus HOPDs and all other services provided at off-campus HOPDs—with a few exceptions. While off-campus HOPDs that billed Medicare before November 2, 2015, were exempted from these changes, the camel’s nose was now under the tent, and interest in expanding on these ideas has only grown in recent years.  

While the years following have brought more noise than action, in 2023, the House revisited the issue and passed with broad support the Lower Costs, More Transparency Act, which included a provision that would equalize Medicare reimbursement for physician-administered drugs between physician offices and all off-campus HOPDs, including those which were previously exempt from these changes. 

In November 2024, Sens. Bill Cassidy (R-LA) and Maggie Hassan (D-NH) released a “Lowering Health Costs for Seniors Framework,” which proposes establish site-neutral payments for common outpatient procedures across HOPDs, ASCs, and physician offices.  The framework also proposes to re-invest the subsequent Medicare savings into low-volume rural and urban safety net hospitals. Even though the framework has yet to be introduced as formal legislation, the release of the paper signals further bipartisan interest in enacting site-neutral payments. 

The Whole Picture 

What site-neutral proposals can miss is that attempting to equate the services provided in a hospital with those delivered in an office setting is not an easy apples-to-apples comparison—especially when considering the overhead costs required to support a hospital instead of a physician’s office. In addition, the patients served by hospitals are more likely to come from lesser-served areas, are more likely to have more limited resources, and are often sicker and have more comorbidities than those who often seek care in the office setting.  

Financial Realities  

Hospitals appear to outside observers to be “where the money is.”  That may be true—to a point. But one should not mistake capital for being flush with dispensable cash.  If site neutral proposals become law, hospitals could be faced with reimbursement cuts for services—especially when those payments fail to fully account for the costs of maintaining a hospital. 

With the capital expenses and infrastructure costs that come with being a hospital, it is essential to note that Medicare does not fully cover the costs that hospitals incur in caring for patients, paying only an average of 82 cents for every dollar of hospital care provided to Medicare patients.  

All-Comers 

Where site-neutrality proposals can miss the mark is that there is nothing site-neutral about the commitment that our hospitals have made to take all comers. Free-standing centers and offices simply are not neutral when it comes to whom they extend care, whereas such facilities can turn away those who they might see as a financial liability. That is not a criticism as much as it is a recognition of reality. 

What’s Next 

As a new administration and Congress converge on Washington in 2025, we expect renewed interest in moving health care legislation and, with it, policymakers’ perennial search for pay-fors to offset the costs of any new initiatives. Until site-neutrality proposals are willing to consider what “neutrality” would mean—not only in dollars but also in our hospitals’ commitment to the community and caring for all—they will fall short of recognizing the commitment and responsibility hospitals take on in our communities.