Insights

As the political landscape has shifted with the 2024 election, health care policies are among the most significant issues that could be upended when the new Trump administration takes control in January.  Under President Joe Biden, the Department of Health and Human Services (HHS) finalized several health care rules, that from their perspective, expand access to care, reduce drug costs, and protect vulnerable populations.  However, many of these regulations may be on the chopping block come January.   

Here’s a closer look at three key Biden health care rules that could be changed with President Donald Trump’s return to office: 

The Skilled Nursing Facility (SNF) Staffing Rule  

One of the major, and most controversial, health care initiatives from the Biden administration was a push to improve staffing standards in SNFs. The Centers for Medicare and Medicaid Services (CMS) finalized a rule in April 2024 that raised minimum staffing requirements for nursing homes, The rule set higher minimum standards for direct-care staff—such as registered nurses (RNs), licensed practical nurses (LPNs), and nurse aides— including that nursing homes must provide a minimum of 3.5 hours of care per resident per day from certified nurse aides (CNAs), including 0.5 hours from a direct registered nurse (RN).  The rule also requires SNFs to have an RN onsite 24 hours a day, seven days a week.   

Nursing home associations argued that the increased staffing requirements would lead to higher operational costs and potentially force some facilities to close or reduce services.  

With Trump’s returns to office, he may direct his administration to roll back or rescind this rule. Trump’s 1st administration was known pulling back rules that increases operational costs for health care facilities – and this rule fits that category.   

Medicare Drug Pricing Negotiations 

One of the signature achievements of the Biden administration was the passage of the Inflation Reduction Act (IRA), which included provisions to allow the federal government to negotiate the prices of certain prescription drugs under Medicare. The law empowered Medicare to negotiate prices for a limited set of high-cost drugs.  Under the IRA, the government negotiated the price of the ten most expensive drugs to Medicare, and proposed to expand this list further.  This policy was touted as a major step to curbing the out-of-control growth of prescription drug costs for America’s seniors and those with disabilities.   

However, the incoming Trump administration likely views these reforms as a step too far, potentially undermining free-market principles in the pharmaceutical industry. Trump’s administration previously opposed similar drug pricing negotiations.  HHS, under Trump, could push to dismantle the provisions of the IRA, either by defunding the program, limiting its scope, or repealing the law entirely. 

ACA Coverage for Dreamers 

One of the more controversial aspects of the Biden administration’s health care policies has been its expansion of coverage under the Affordable Care Act (ACA) to include undocumented immigrants brought to the U.S. as children, also known as “Dreamers.”  The Biden administration opened up health insurance marketplaces to DACA (Deferred Action for Childhood Arrivals) recipients, allowing them to access subsidies and qualify for Medicaid in some states. The policy was designed to ensure that Dreamers, many of whom are essential workers, have access to affordable health care.  

Even with a lot of support from immigrant advocates, this policy has been the subject of heated debate. Critics argue that it represents a costly expansion of government programs that could incentivize illegal immigration and further strain public health resources. The Trump administration will almost certainly reverse this policy, pushing to end ACA coverage for Dreamers and restoring stricter immigration-related requirements for health insurance. Given Trump’s stance on immigration during his first term, a rollback of health coverage access for undocumented immigrants would likely be a priority. 

You can be sure we are closely tracking all the incoming policy decisions of the Trump Administration.  With health care being one of the most important and personal issues to millions of Americans, the policies adopted in the coming years will continue to shape the future of health care in the U.S. 

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!