How Congress may approach healthcare reform under Trump
Feb 5, 2025
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In a deep dive into healthcare reform, Andrew Schwab, a seasoned health policy expert and founder of Platform Government Strategies, shares insights on the shifting landscape under Trump. He discusses the potential for Medicaid cuts and the establishment of the Department of Government Efficiency. Schwab also explores bipartisan opportunities in areas like Medicare adjustments and chronic care, while examining the impact of recent executive orders on healthcare. The conversation provides a thorough understanding of legislative priorities amidst the political whirlwind.
The Republican Party is actively pursuing Medicaid reform and potential cuts, significantly impacting state budgets and healthcare funding.
Despite partisan divides, there are bipartisan opportunities focused on pharmacy benefit manager reforms and enhancing Medicare payment systems.
Deep dives
Legislative Priorities and Potential Cuts
The Republican Party is prioritizing Medicaid reform and has plans to implement per capita caps, which could significantly affect state budgeting and healthcare funding. Legislative proposals include possible cuts to Medicaid and the rollback of enhanced tax credits under the Affordable Care Act. The recent disclosure of a list highlighting potential spending cuts serves as a strategic tool for Republican leadership to align their members and prepare them for the consequences of these cuts on their constituents. This proactive approach aims to foster transparency and adherence to President Trump's policy agenda amidst a narrow majority in Congress.
Challenges and Opportunities for Bipartisanship
Despite significant partisan divides, certain healthcare issues may lend themselves to bipartisan support, particularly around pharmacy benefit manager (PBM) reforms and Medicare payment adjustments. Key figures within Congress, such as Congressman Buddy Carter and Senator Mike Crapo, are advocating for these reforms, presenting opportunities for collaboration between parties. However, much of this potential action hinges on the completion of the current reconciliation process, making it a topic for consideration in the latter half of 2025 and heading into 2026. The focus on improving the functionality of Medicare Advantage also suggests a willingness to pursue bipartisan solutions post-reconciliation.
Impact of Regulatory Changes and Government Efficiency Initiatives
The newly established Department of Government Efficiency (DOGE) could influence healthcare policy, particularly regarding the oversight of Medicare and Medicaid regulations. There is uncertainty surrounding the new administration's plans for previous regulatory proposals, including those affecting Medicare Advantage, which are currently under review during a regulatory freeze. Additionally, the potential for covering anti-obesity medications under Medicare is in question, as this would require extensive financial resources, leading to speculation on its prioritization by House Republicans. The evolving regulatory landscape will likely shape healthcare policies and funding in the coming weeks, indicating a fluid yet pivotal moment for the sector.
With the election over and President Donald Trump officially inaugurated, all eyes in healthcare are turning toward how the sector might change. But as the first two weeks of his second term showed, keeping up with Trump’s actions—and their ramifications—requires full-time focus.
In this episode, Fierce Healthcare’s Noah Tong speaks with health policy expert Andrew Schwab to help us break through the noise on Capitol Hill and better understand Republicans’ upcoming legislative priorities. Schwab is founder and CEO of health policy and advocacy firm Platform Government Strategies. Schwab gives his thoughts on the likelihood of Medicaid cuts in a reconciliation bill, his views on the Department of Government Efficiency (or DOGE) and potential areas of bipartisan agreement.