Trump and Harris on health care: Policy experts make their predictions

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Past policy, current trends and future predictions all are part of the efforts to forecast what’s coming in the next four years under former president Donald Trump or Vice President Kamala Harris.

Five experts from Berkeley Research Group LLC (BRG), a global business consulting firm, presented their analyses Oct. 15 in an online panel discussion about a broad range of issues in current American health care.

In his introduction, Managing Director Thomas O’Neil III cited the recent comments of J.P. Morgan Chase CEO Jamie Dimon, who noted the continuing Russian war in Ukraine and the conflict between Israel and Hamas and Hezbollah create risks for the economy.

“I raise that because we can read tea leaves for the next hour together, but there's always the possibility of a superseding event that will change the entire path for all of us,” O’Neil said.

Corporate governance

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Harris and President Joe Biden implemented the Corporate Transparency Act of 2022, which requires business entities to disclose ownership interests to the Financial Crimes Enforcement Network of the U.S. Department of Treasury. The federal Securities and Exchange Commission has been activist in the last several years, but a Trump administration could seek to unwind that, he said.

“And then when we think about health care, the Medicare Advantage program in particular has been under unprecedented pressures,” O’Neil said. “There are some who are opining that its demise is inevitable, and others who wish to focus on access, affordability, and the ability to tailor personal health care solutions for beneficiaries. Those will all undoubtedly be in play, depending on what happens in a few weeks.”

Fraud enforcement has been fairly rigorous in the past three years, particularly against abuses that happened due to COVID-19. A Trump administration could engage in more regulatory flexibility and looser enforcement standards for the Anti-Kickback and False Claims Act measures, O’Neil said.

Medicare and value-based care

No matter who wins the White House, the next president’s cabinet and key administrators will determine the direction of the U.S. Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare and Medicaid Innovation (CMMI), said BRG Managing Director Patrick Dooley.

It is unclear if there would be an opportunity to repeal the Affordable Care Act, although a Trump administration and allies in Congress probably would seek to undermine aspects of it. A Harris administration likely would continue Biden’s efforts to expand Medicaid, while a Trump administration probably would continue efforts to increase work requirements or make potential cuts, Dooley said.

Under Harris, CMMI likely would continue developing new payment models. In his first term, Trump largely left alone CMMI, but recently its activities have drawn attention from Congressional Republicans, Dooley said.

Regarding consolidation in health care, Harris opposed it as attorney general of California. In his first term, Trump focused on price transparency, choice and competition, but he has been more friendly to business, so a second term policy is unclear, Dooley said.

Primary care

As for primary care, Dooley predicted the Harris administration likely would continue CMS’ Making Care Primary model that launched in eight states this year, and there likely would be support for the Primary Care AHEAD model. That is the States Advancing All-Payer Health Equity Approaches and Development Model that will operate 2024 through 2034.

The CMMI primary care models of the last decade “all kind of build off one or the other,” and those likely would continue under Harris, Dooley said. It’s less clear what would happen under the Trump administration, he said.

There is a goal to have all Medicare beneficiaries under an accountable care relationship by 2030. Achieving that goal will depend on who serves as the CMS administrator and director of CMMI, Dooley said.

“I think the other challenge both for the primary care as well as getting all Medicare beneficiaries under an accountable care relationship is the ability to encourage providers to participate in them,” Dooley said. “So the ongoing challenge with these primary care models has been that the savings that are generated through reductions in total cost of care are often not greater than the investments that are needed in things like care management programs and other things like that.”

The challenge, then, is not just an administrative one, but one of incentives, because most of the accountable care programs are voluntary. When providers want to participate in the programs, that leads to additional Medicare enrollees being in an accountable care relationship, Dooley said.

AI rules

Regarding use of artificial intelligence (AI) in health care, there may not be as much daylight between the candidates as one might imagine, said BRG Managing Director Amy Reeder Worley. Both have focused on supply side AI, which deals with initiatives that drive innovation for better health care for patients, physicians and other providers, and for payers, she said.

“I would say both Vice President Harris and President Trump are optimistic about AI's promises to help more than it hurts, and if you look at what they've done in their pasts, honestly, the biggest difference that I'm seeing is how they talk about AI regulation, as opposed to exactly what the detailed differences would be,” Worley said.

As a tech-savvy Californian, Harris has been pragmatic, saying it is a “false choice that suggests we can either protect the public interest or advance innovation," Worley said. Trump and Republicans have called to repeal Biden’s executive order on AI, saying it hinders innovation, and a new executive order would be “rooted in free speech and human flourishing,” she said.

Drug pricing

The next president will receive the baton of implementing Biden’s Inflation Reduction Act, including the Medicare drug price negotiation program, said BRG Managing Director John Barkett.

Harris likely would build on the Biden administration’s efforts, probably supporting $35 price caps on insulin for all populations, not just Medicare, and a $2,000 cap on out-of-pocket spending for pharmacy drugs, Barkett said.

There has been hoopla about Medicare drug price negotiations hurting drug development and innovation. But the talks deal with drugs that have been on the market at least nine years, Barkett said. The next president will have to look at other populations and other types of drugs if they want to make a broader impact than the IRA, he said. That could include drugs new on the market, or expensive cell and gene therapies.

Meanwhile, the Trump campaign has disavowed the idea of paying drug prices based on those in other countries, Barkett said. He also has disavowed the Project 2025 program of policies compiled by the same people Trump would be talking to as president, said Barkett, a former Biden staffer.

“And so I think we can't totally rule out the idea that a Trump administration would revisit one of the most talked about policies of drug pricing reform in his in his first administration,” he said.

Health care workforce

Neither candidate has made the health care workforce a talking point in the campaign, Barkett said.

Harris has supported the Medicare expansion of home care and maternal health and mental health, with a $100 million announcement to grow the health care workforce, he said.

“But one gets the sense that a Harris administration would continue to take the issue in a serious manner, try to find monies where they could and continue to bridge the gap while listening to the evidence on where the keenest shortages are and trying to direct resources there,” Barkett said about Harris.

He added he cannot recall Trump talking about the health care workforce as an issue. Project 2025 generally has words like “evaluate and streamline workforce development programs and then focusing on evidence-based outcomes,” Barkett said.

“So, you know, seems reasonable enough to look at these programs, make sure that they're working and then invest there,” Barkett said. “If you polled 100 policy analysts and ask them, which administration would likely spend more on workforce? They would suggest it would be the Harris administration versus the Trump administration.”

In general, the Trump administration likely would support reforms that lead to lower federal and state spending on Medicaid. That in turn likely would make it harder to show up to serve those populations, Barkett said, noting the workforce implications generally don’t get discussed with those policy discussions.

FDA policy

The campaigns have at least one common ideal regarding Food and Drug Administration (FDA) policy. Harris and the Project 2025 program both support reforming the practice of generic drug “parking.” The practice involves pharmaceuticals having exclusive license to make generic drugs, but if they don’t exercise that, it can stop production by other companies, said BRG Managing Director Daniel E. Troy, who served as legal counsel to FDA.

Both candidates could allow Federal Trade Commission (FTC) involvement in FDA matters on drug patents – Trump’s vice presidential pic, Sen. J.D. Vance (R-Ohio), has been complimentary of FTC Chair Lina Khan, Troy said.

“There's no love lost between both big pharma and either campaign these days,” Troy said. “Once upon a time, you could pretty reliably, you know, count on the Republican members in Congress to stick up for Big Pharma. That is not the case anymore.”

The Biden-Harris administration has struggled to articulate and follow a consistent approach to tobacco and vaping policies. Meanwhile, a Trump administration could create a role for Robert F. Kennedy Jr. – “an incredible wildcard” – who has questioned the Prescription Drug User Fee and is known to have issues with vaccines, Troy said.

Meanwhile, Trump has said he won’t ban mifepristone, although the Project 2025 program has suggested that.

“But of course, one of the ironies of our incredibly polarized age is, Trump has made the Republican Party more liberal when it comes to abortion and abortion access than anybody would have ever conceived – pun intended – of the Republican Party being, you know, eight, 10, 12 years ago,” Troy said.