Today’s edition leads with thoughts on the final election results before diving into our typical Read on Washington. Despite a flurry of campaign promises and rhetoric, much remains unknown about the implications for our field and mission. However, one thing remains certain: we, as researchers and advocates, have an essential role in informing and influencing decision-making. Below are some thoughts from AcademyHealth’s advocacy team on supporting that role.
Agency Leadership
The incoming Trump Administration intends to nominate Robert F. Kennedy, Jr. to lead the Department of Health and Human Services. Mr. Kennedy has long questioned the value of federal health research and the processes through which it is implemented. Dr. Mehmet Oz has been tapped to head the Centers for Medicare and Medicaid Services and has called for the repeal of the ACA in the past. Leadership choices for other agencies, including AHRQ, NIH, HRSA, FDA, and CDC, have not been formally announced.
Personnel matters and the challenges that the research and public health ecosystem will face in the upcoming Congress and Administration are daunting, but AcademyHealth and our membership are well-positioned as honest brokers of high-quality and actionable evidence. This is the time for our entire field to be proactive in our outreach and communicate the rigorous, life-saving, and cost-effective work we do daily.
Funding for the Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Quality (AHRQ) was caught up in efforts to limit health research funding by the House of Representatives Appropriations Committee in FY24 and FY25 (read more here and here) when they attempted to zero out all funding for it. In both instances, AcademyHealth led the Friends of AHRQ in educating congressional offices about the importance of AHRQ and health services research and successfully increased funding for this research from a long-term and flat $338 million in FY22 to $369 million in FY24. Our historic success in supporting the Agency comes down to the strength of our coalition.
For FY25, we successfully coordinated 171 national organizations – representing researchers, patients, providers, nurses, hospitals, health systems, universities, insurers, think tanks, and more – to call for AHRQ to be fully funded (read more here). The breadth and depth of this coalition set it apart from nearly all other requests appropriators receive for HHS funding, and it opens doors even to offices that were not inclined to support our field. Through these conversations, we have created new congressional champions in both parties and chambers, and this bipartisan support is as critical this year as it will be next.
Although AHRQ remains threatened, AcademyHealth is encouraged by bipartisan support for the Agency. At a time when rural constituents are raising the alarm about hospital closures, AHRQ and health services researchers are providing the evidence policymakers need to ensure that patients are still able to access health care equitably. AcademyHealth will continue working with members of Congress and their staff to raise the visibility and promote the value of AHRQ and its life-saving health services research.
To join the Friends of AHRQ, email us here.
Health Equity
Health services research is fundamentally the science of determining what works, for whom, at what cost, under what circumstances, and with what tradeoffs. Supporting better health outcomes for all, regardless of where they live, their gender, race, ethnicity, or socioeconomic background, is inseparable from our work. We were dismayed to see hostility towards DEI initiatives and health equity work during the campaign and remain deeply concerned about the degree of hostility that will seep into policymaking. We will tirelessly make the case for this research to stay a priority. Health disparities and barriers to care for countless millions of Americans do not go away because we stop funding investigations into them.
Public Health and Vaccines
The new Trump Administration has been deeply skeptical about existing public health infrastructure and well-studied public health interventions such as vaccine efficacy and fluoridation in water. They may attempt to fundamentally restructure public health agencies, from the NIH to the CDC to AHRQ. AcademyHealth supports exploring new and innovative strategies to deliver equitable and high-value care but believes any changes should have a firm grounding in evidence and appropriate input from researchers, patients, and the healthcare workforce. These federal research programs are the crown jewels of innovation worldwide. AcademyHealth will continue to advocate for sufficient, stable research funding to ensure research and public health infrastructure’s ability to respond to America’s needs.
Women’s Health Care
The Trump Administration is expected to pursue policies that further restrict access to abortion care, which has accelerated on a state level in the wake of Dobbs. These restrictions may include limited access to medication, legal threats to hospitals and health systems, and/or nationwide abortion bans. Women’s health clinics and clinicians could face continued pressure on their ability to stay open and serve their patients, with a potential increase in healthcare deserts for underserved populations. There are also possible restrictions for in vitro fertilization and other family planning care. AcademyHealth will continue to lead research communities studying the implications of reproductive health care policy changes.
Medicaid
The Republican Congress and the Trump Administration are considering significant changes to Medicaid, but there is a great deal of uncertainty about how high of a priority reforms will be and what they will entail. Reporting is already coming out about potentially turning the program into a block grant or instituting work requirements, both of which are intended to reduce spending on the program by reducing access to it by current patients. It is also unclear if the Trump Administration would continue to approve existing waivers. If confirmed, Robert F. Kennedy Jr.’s priorities on Medicaid remain uncertain. He has previously supported block grants but may defer to CMS for specific reform priorities.
President-elect Donald Trump’s economic advisers and congressional Republicans have also begun preliminary discussions about making significant changes to Medicaid, food stamps, and other federal safety net programs. These discussions center on Trump’s 2017 tax cut bill, large portions of which will expire at the end of 2025. Extending these tax cuts would cost $4 trillion over the next decade and require significant spending cuts to avoid large increases in the deficit.
The Affordable Care Act
While the first Trump Administration centered on repealing the Affordable Care Act as a top healthcare priority, the ACA has received far less negative attention during this year’s election. While there is still a risk that Republicans could repeal many elements of the ACA through simple majority votes in budget reconciliation, a full repeal seems unlikely. We expect challenges to preventative health services, Medicaid expansion support, and critical ACA subsidies that provide care to millions of patients but may be allowed to expire at the end of 2025.
In the 2017 attempts to repeal the ACA, the Patient-Centered Outcomes Research Institute (PCORI) and the Center for Medicare and Medicaid Innovation (CMMI) were at significant risk as their authorizations were interwoven with the ACA. Since then, PCORI has received standalone authorization through 2029, which provides some independence from ACA repeal efforts. Retiring House Energy and Commerce Chair Cathy McMorris Rodgers (R-WA) has been critical about the value of CMMI; however, potential incoming chair Brett Guthrie (R-KY) has applauded CMMI’s work on sickle cell patients and has indicated support for expanding the program. As Congress evaluates CMMI, our field must continue supporting innovative federal research.
AcademyHealth will continue to seek out every opportunity to promote the value of health services research to policymakers, using both longstanding bipartisan and bicameral relations and identifying new champions. We need our community and champions to speak out and boldly advocate for the importance of research. If you are already a member, thank you. If not, consider joining us by becoming a member and supporting our advocacy efforts. We are stronger together, always.
And now, your Read on what else is happening in Washington.
Congress debates whether to move on to another end-of-the-year omnibus or punt to next year.
Federal funding runs out on December 20, and there is significant uncertainty about whether this Congress will pass a full-year funding bill or push it to 2025, when Republicans will have more control of the process. Speaker Mike Johnson has been pushing for a short-term continuing resolution into next year to allow for a more significant Republican imprint on government funding, while Democratic Members and the White House call for finishing up all business of this Congress before it is over. Expectations are that an end-of-the-year omnibus will likely have higher funding for research priorities than an omnibus would if it were passed in February or March. It typically takes several weeks to negotiate, draft, and review an omnibus bill, which means the clock is ticking.
Congressional leadership comes into focus
Final decisions as to who will be leading in Congress and its committees remain to be finalized. We expect the Senate Majority Leader to be Sen. John Thune, with Sen. Chuck Schumer leading the Democratic minority. On the Senate HELP Committee, we expect Senators Bernie Sanders (I-VT) and Bill Cassidy (R-LA) to switch positions as chair and ranking member. Additionally, we expect something similar to happen in Senate Finance with Senators Ron Wyden (D-OR) and Mike Crapo (R-ID). The Senate Appropriations Committee is also expected to shift among current leaders, with Senators Patty Murray (D-WA) and Susan Collins (R-ME) switching the chair and ranking member positions, and Labor-HHS Subcommittee Senators Tammy Baldwin (D-WI) and Shelley Moore Capito (R-MS).
In the House, the Energy and Commerce Committee will be shaken up. Current Chairwoman Cathy McMorris Rodgers (R-WA) and Ranking Member Anna Eshoo (D-CA) did not run for reelection. Republican Reps. Bob Latta (R-OH) and Brett Guthrie (R-KY) are racing for the chairmanship. Notably, active Republican Committee Members Michael Burgess (R-TX) and Larry Bucshon (R-IN) also retired. The House Appropriations Committee remains the same with Chairman Tom Cole (R-OK) and Ranking Member Rosa DeLauro (D-CT).
DEA and HHS extend telehealth flexibilities until the end of 2025
The Drug Enforcement Administration and the HHS are extending providers' flexibility to prescribe controlled substances via telehealth for another year. The temporary extension marks the third time regulators have prolonged the pandemic-era flexibilities, allowing providers to prescribe some controlled medications without conducting an in-person evaluation.
Surgeon General releases a report on disparities in reducing smoking
Surgeon General Vivek Murthy released a report on the existing disparities in reducing tobacco-related disease and death. The report found a 70 percent decrease in tobacco smokers since 1965, and reports of deaths from secondhand smoking have dropped by half since 2006. However, decreases have been unequal, as 27.1% of American Indian and Alaska Native people reported being current cigarette smokers. That's more than double the 13.3% of white participants and nearly double the 14.4% of Black Americans who reported being current smokers. Additionally, smoking among Americans living in poverty was more than twice as common compared to those not living in poverty, the report found. In 2020, 20.2% of those making under $35,000 a year were reportedly current cigarette smokers, compared to 6.2% of those making $100,000 or more yearly. It is unclear if the Trump Administration will continue anti-smoking programs, as during the campaign, Trump promised to “save” vaping after meeting with vaping lobbyists.
What we are reading
The Commonwealth Fund released its most recent report examining health systems' performance in access to care, care process, administrative efficiency, equity, and health outcomes across 10 countries. This most recent report accounted for changes during the COVID-19 pandemic and included multiple equity dimensions, including gender, discrimination, and rural versus nonrural measures. The U.S. continues to be in a class by itself in the underperformance of its healthcare sector. While the other nine countries differ in the details of their systems and their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic healthcare needs, including universal coverage.
Pew released a study that found that 76 percent of Americans express a great deal or fair amount of confidence in scientists to act in the public’s best interests. Confidence ratings have moved slightly higher in the last year, marking a shift away from the decline in trust seen during the COVID-19 pandemic. Overall, 45% of U.S. adults describe research scientists as good communicators. A slightly larger share (52%) say this phrase does not describe research scientists well. It is not enough for us to support promising research and sound evidence; we have to be able to communicate it to a broad audience in an accessible, timely, and patient manner.
Health systems, led by Mass General Brigham, have announced a new collaborative to allow providers to compare the efficacy of AI products. The Healthcare AI Challenge Collaborative will allow participating clinicians to test the latest AI offerings in simulated clinical settings. Clinicians will pit models against each other in head-to-head competition and produce public rankings of the commercial tools by the end of the year. Participating health systems say that comparing AI products directly is overdue.
If you found this post helpful or interesting, join AcademyHealth for regular access to the Read on Washington and countless other benefits! Membership funds our advocacy work at AcademyHealth.