In advance of the Republican convention, the Trump campaign posted their second-term agenda – Fighting for You. The campaign opted not to launch a detailed policy platform. Rather, they released a bulleted list of “core priorities” organized by policy category, including seven healthcare-related goals:
- Cut prescription drug prices
- Put patients and doctors back in charge of our healthcare system
- Lower healthcare insurance premiums
- End surprise billing
- Cover all pre-existing conditions
- Protect Social Security and Medicare
- Protect our veterans and provide world-class healthcare and services
Not surprisingly, while some praised the brevity of the agenda, others were critical of the lack of details. On the one hand, it is easy for voters to review this list and understand the President’s objectives. On the other hand, the goals are so broad that it is likely both political parties could agree on them – but have very different ideas about what each one means, and even more different ideas for how to effect change.
As with last week’s post on the Biden health care platform, our primary interest here is to decipher what President Trump’s agenda for a second term could mean for the future of employer-sponsored health care. As we reflect back on the current term, it appears the President and Republicans have largely moved on from their unsuccessful legislative bid to repeal and replace the Affordable Care Act -- although they continue to support a lawsuit heading for the Supreme Court that seeks to kill the law. While the divided government of the past two years has precluded major legislative changes, the President has used the “power of the pen” to sign Executive Orders and advance numerous regulatory proposals (some prompted by the COVID-19 pandemic) aimed at supporting telehealth; easing restrictions on health savings accounts; promoting association health plans; lowering drug costs; and improving healthcare cost transparency.
Here are the biggest open issues we see should the President win a second term:
- If not the ACA, then what? The Supreme Court is scheduled to hear oral arguments on California v. Texas immediately following the election. In 2016, the Republican platform was repeal and replace – but what will happen if the ACA is struck down during a second Trump administration is a huge unknown. We note that preserving protections for people with preexisting conditions – currently guaranteed by the ACA -- is on his list of core priorities.
- What about access to care for the growing number of uninsured? Unfortunately, a number of workers lost their employment based health insurance during the pandemic. The President’s policy list is silent on this issue. Uncompensated care is ultimately very costly as other payers, mainly commercial plans, end up paying for the shortfall.
- What does “patients and providers back in charge” mean? Reading between the lines, this could be another way of promoting the idea of competition and price transparency. However, the reality is that doctors and hospitals have a very powerful voice in Washington, and their agenda is not necessarily aligned with patients’ priorities and best interests. Quality and value must be in the forefront of this objective.
- Will employers and their plan members benefit or pay more as a result of these policy goals? It’s hard to tell who would benefit and who would pay. There is always a delicate balance between the reimbursement for services under Medicare and Medicaid and the under commercial plans supported by employers. As a general rule, actions that lower spending on public health programs tend to drive up cost in employer plans.
One thing we learned from the 2016 Presidential election is not to assume anything, despite the plethora of polling data. With another two months still to go until the election, a lot can happen to change momentum one way or the other. In other words, it’s too soon to say what employers should do to prepare for health policy changes – but in the meantime we will continue to share our thoughts and observations with you.