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As the Trump administration takes office, the U.S. healthcare system is facing important changes. On November 14, Trump announced the nominating of Robert Francis Kennedy Jr. as a secretary of Human and Health Services (HHS). With the Republican Party in control of Congress, many healthcare policies are expected to change, which will affect doctors, insurance companies, and patients. These changes could impact how healthcare is delivered, who has access to it, and how much it costs.
The Trump administration and the Grand Old Party (GOP) have plans to change healthcare in several key areas:
- Affordable Care Act (ACA) Reforms:
We heard some conflicting statements about the future of Obamacare, but Trump’s record from his first term suggests significant changes could be on the horizon, especially with Republican control of the House. One major change could involve the expiration of enhanced ACA subsidies passed under the Biden administration, which are set to end in late 2025. These subsidies significantly reduced premium payments, doubling enrolment in many areas, particularly Southern red states.
If not renewed, premiums could increase by an average of 79%, with enrolment expected to drop sharply from 22.8 million in 2025 to as low as 15.4 million by 2030. Extending these subsidies is estimated to cost $335 billion over 10 years but appears unlikely without Democratic control. Big changes to the ACA depend on whether Republicans keep control of the House. They might try to pay for tax cuts by cutting ACA subsidies and changing how Medicaid gets its funding, like their 2017 “repeal and replace” plan.
- Medicaid and Medicare Changes:
Under Robert Kennedy Jr.’s administration as Secretary of HHS, Medicaid could see significant changes. States may be granted waivers to impose stricter eligibility criteria, including work requirements, potentially reducing access for vulnerable populations. Medicaid funding might shift to block grants or per capita caps, limiting federal spending while giving states more control. Additionally, efforts to reverse Medicaid expansion under the ACA could gain momentum, particularly in Republican-led states, impacting millions of low-income individuals.
For Medicare, privatization could be a key focus, with an emphasis on promoting Medicare Advantage plans. Cost control measures may also be introduced, potentially altering coverage or payment models to address budgetary constraints. These changes could limit access to care for some beneficiaries and reshape how services are delivered. Given Kennedy’s controversial views on public health, these shifts may further complicate efforts to ensure equitable healthcare access, especially for at-risk populations.
- Lowering Drug Prices:
In 2025, the Trump administration is intensifying efforts to reduce prescription drug costs in the U.S. healthcare system. Focusing on market-driven strategies, the administration aims to foster competition, increase price transparency, and reduce regulatory barriers, while maintaining its opposition to Medicare negotiating drug prices directly. The administration is also addressing the role of Pharmacy Benefit Managers (PBMs), whose complex pricing structures have been criticized for inflating costs.
Reforms are being proposed to ensure savings are passed directly to consumers instead of middlemen. However, the administration’s refusal to allow Medicare to negotiate drug prices continues to draw criticism from advocates who argue it could yield substantial savings. Instead, the administration is exploring alternatives, such as tying Medicare prices to those in other countries.
- Simplifying Healthcare Rules:
Mehmet Oz has been nominated as the Administrator of the Center for Medicare & Medicaid Services (CMS), with a focus on chronic disease prevention. He aims to challenge the traditional healthcare system, likely advocating for innovative approaches to reduce chronic conditions and promoting alternative healthcare solutions. His appointment is expected to bring a shift towards preventive care strategies and a re-evaluation of current practices in Medicare and Medicaid programs.
He is also aimed to lower drug prices by exploring alternative methods, such as encouraging competition and reducing regulations. However, it opposed allowing Medicare to directly negotiate drug prices with pharmaceutical companies, which is a common strategy in other countries to reduce costs. Instead, the administration sought other ways to address high drug prices without involving Medicare in negotiations.
- Social Policy Changes:
In 2025, the Trump administration proposes “Project 2025” in U.S. healthcare, reflecting a shift toward conservative principles. The plan focuses on reducing federal involvement, fostering market competition, and implementing changes in areas such as gender-affirming care and reproductive health. A significant component of Project 2025 is restricting gender-affirming care, particularly for minors, by limiting access to medical treatments like hormone therapy and surgeries.
The administration argues these measures are necessary to protect children, but critics contend they undermine individual rights. Supporters praise Project 2025 as a return to traditional values and fiscal responsibility, while opponents argue it risks reducing access to critical healthcare services. As the plan unfolds, its impact on the healthcare landscape will be closely scrutinized.
The Impact on the Healthcare Industry:
These changes will affect healthcare in different ways:
- For Providers (Doctors, Hospitals): With new policies giving states more control over healthcare, doctors, and hospitals must adapt to varying rules and funding across the country. Each state will set its own guidelines for medical procedures, insurance requirements, and patient care, creating differences providers must navigate. Funding disparities may lead to resource-rich states offering better care, while others struggle with limited budgets. Providers will also face more administrative work to comply with state-specific requirements, adding to their workload. Adapting services to local needs and advocating for resources will be crucial, as these changes impact both the quality of care and access for patients.
- For Patients: Patients, especially those on Medicaid or using insurance through the Affordable Care Act (ACA), may see changes to their healthcare coverage. Some states might change eligibility rules for Medicaid, which could mean fewer people qualify for coverage. ACA insurance plans may also vary more between states, offering different benefits and costs depending on where a patient lives. These changes could make it harder for some patients to afford care, especially in states with reduced funding for healthcare programs. Patients may need to spend more time comparing plans, traveling for care, or managing higher out-of-pocket costs.
- For Insurance Companies: Insurance companies will face changes in how they are paid and the rules they must follow, as states gain more control over healthcare. Each state may set its own requirements for insurance coverage, benefits, and pricing, which companies must adapt to. This could mean adjusting their plans and policies to meet state-specific regulations. Payment structures may also change, impacting how insurers calculate premiums and reimburse providers. These shifts will likely force companies to rethink how they manage financial risks, such as balancing costs for high-risk patients with maintaining affordable premiums for others.
How Talisman Solutions Inc. Can Help ?
At Talisman Solutions Inc., we help healthcare organizations adjust to these changes. We specialize in improving billing, making sure organizations follow the rules, and using technology to make processes more efficient.
Conclusion
The healthcare policies under Trump and the GOP will bring both challenges and chances for change. Although there is some uncertainty, healthcare organizations can succeed by using new technologies, staying flexible, and being proactive. Talisman Solutions Inc. is here to help guide you through these changes and ensure your success.
Contact us today to learn how we can help you prepare for the future of healthcare policy.
