A Hot Take: The Impact of a Trump Win on U.S. Health Care

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[This article was originally published by our sister publication, Managed Healthcare Executive]

Immigration, the economy, and character of the candidates dominated the presidential election that former president Donald Trump won handily last week. Health care issues stayed largely in the background, with the exception of abortion and, over the final weekend, some statements made by Robert F. Kennedy Jr. about fluoridation.

“With no big health reform debate to command the attention of the nation and no big health proposal from either candidate, this is not a ‘health care election,’” Drew Altman, president and CEO of KFF, wrote in mid-October.

But now that Trump has won and the Republicans have gained control of the Senate (the House is still in doubt), attention is turning to how the new administration might reshape federal health care policies and programs and revisit long-held predicates of public health priorities and policies.

The futures of the Affordable Care Act (ACA), the signature achievement of the Obama administration, and the Inflation Reduction Act (IRA), the signature health care achievement of the Biden administration, are now cloudier than they would have been in a Harris administration, although that may less true for the IRA than the ACA. One near-term issue is the enhanced ACA premium subsidies that greatly reduced the premium cost of individual coverage purchased on the ACA exchanges. Congress must decide next year whether to continue them or not.

In the final week of the campaign, Republican House Speaker Mike Johnson made a remark in an exchange at one campaign event that seemed to suggest he was in favor of replacing the ACA. Several days later in an interview, he said that was a misinterpretation.

“We are laser-focused on improving health care, as we are every area. We need higher quality care in many parts of the country, we need greater access, we need lower costs,” Johnson said.

Johnson, a Louisiana Republican, referenced the GOP Doctors Caucus as a source of healthcare ideas. In the current Congress, the caucus consists of 16 Republican physicians, pharmacists, and dentists and is chaired by Rep. Andrew Harris, Maryland’s only Republican congressman, and an obstetric anesthesiologist.

In the Senate, Sen. Bill Cassidy, a gastroenterologist, is expected to play a prominent role in the development of any healthcare legislation. He is expected to chair the Committee on Health, Education, Labor and Pensions (HELP), a position currently held by Sen. Bernie Sanders, the progressive independent from Vermont.

Lindsay Bealor Greenleaf, J.D., MBA, vice president and a state and federal health policy expert for ADVI Health, said in an interview today that the Republicans have moved on from outright repeal of the ACA.

"It is way too entrenched," she said. She foresees, though, curtailment of federal spending on the program, which might include a trimming of premium subsidies and more flexible benefit design.

Any influence that Cassidy and Harris may have on Trump administration changes to the ACA may pale in comparison to the disruptive, attention-grabbing role of Kennedy if Trump follows through on statements he made on the campaign trail.

“I am going to let him go wild on health. I am going to let him go wild on the food. I am going to let him go wild on medicine,” Trump said about Kennedy at his campaign Madison Square Garden rally on Oct. 27.

In a video call with his supporters early last week, Kennedy said Trump had promised him “control of the public health agencies, which are HHS and its subagencies, CDC, FDA, NIH, and few others and then also USDA.” Trump campaign officials pushed back against a promise and cabinet position for Kennedy.

In an interview conducted in a townhall format on NewsNation townhall, a cable television network, Kennedy said Trump had asked him “to reorganize” the federal agencies that deal with human health, including the CDC, NIH, the FDA, and as well as some agencies in the USDA.

Regardless of his exact role, Kennedy seems positioned to be a high-profile figure in the Trump administration. In the NewsNation townhall, Kennedy said Trump had asked him to clear up the corruption, end the conflicts of interest, and, “return these agencies to their rich tradition of gold-standard, empirically based, evidence-based science” and to “measurably reduce chronic disease in our children in two years.”

"I think it is the hot topic to watch," Greenleaf said of Kennedy's role in the administration. The Trump-Kennedy relationship is new and one that health care interest groups and policy experts are still trying to figure out. A position requiring Senate confirmation may be out of the question, she noted, but even having a role in the White House Kennedy could be significant. Kennedy might be put in charge of a commission or committee investigating the causes of chronic disease, particularly among children, she said.

Kennedy, who endorsed Trump in August after suspending his own independent bid to become president, is championing a “Make America Healthy Again,” or MAHA, campaign that plays off of Trump’s Make America Great Again slogan and movement. On his MAHA website, Kennedy says the goal is to rid public health agencies of the pharmaceutical industry influence, ban food additives and change policies to reduce ultraprocessed food. The website has merchandise for sale, including a $35 embroidered baseball cap that says "Make America Healthy Again."

On Nov. 2, Kennedy caused a stir with a social media post that revived fluoridation of public water supplies as a controversy. On the first day of a Trump administration, the White House would advise U.S​. water systems to remove fluoride from the public water supply, Kennedy wrote.

“Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease,” his post said. Public health and dental organizations have defended fluoridation as important to oral health.

Patrick Cooney of The Federal Group, who has decades of Washington, D.C. experience as a lobbyist and as a congressional staff earlier in his career, noted that the power has swung back and forth between Democrats and Republicans for several elections. The 2024 result highlights that the "public continues to want significant change in the economy to impact their daily lives," Cooney said.

"Over the next several months the new Trump Administration and the 119th Congress will get on with the business of governing," Cooney said, "As that happens, we will have a clearer picture of where health care regulation, cost, and access to care issues will head."