Congressional Republicans eyeing deep Medicaid cuts in first 100 days
House and Senate Republican leaders are considering up to $5.7 trillion in spending cuts to offset the cost of the extension of tax cuts that disproportionately go to the highest earners. Almost $2.3 trillion in these cuts would come from Medicaid due to block granting and work requirements reducing the number of enrollees and the care they are able to access. It also envisions cutting $151 billion from spending related to the Affordable Care Act, including $46 billion in cuts to premium tax cuts. These cuts would likely worsen health outcomes by reducing patient access to care. Additionally, these cuts would disproportionately harm rural hospitals.
Trump rolls back Biden health policy through executive orders
On day one, President Trump canceled multiple Biden health actions, including regulations aimed at lowering health care costs, to coronavirus outreach, Affordable Care Act expansions, and protections against gender-based discrimination. Trump rescinded Biden’s executive order that led to longer enrollment periods for Affordable Care Act plans in most states and extra funding for the third parties that help people enroll in ACA insurance. Trump also rescinded an executive order that prompted the Center for Medicare and Medicaid Innovation to create three drug pricing experiments that haven’t gotten fully off the ground yet. He also rescinded a a 2022 policy against discriminating against people on the basis of sexual or gender identity that ordered support for LGBTQ+ students and instructed officials to end programs promoting so-called conversion therapy both domestically and internationally.
New Administration leadership comes into focus
The new Trump Administration has announced a number of key health personnel throughout the federal government, including:
HHS Secretary - Robert F. Kennedy, Jr.
- Chief of Staff – Heather Flick
- HHS Deputy Secretary – Jim O’Neill
CMS Administrator – Dr. Mehmet Oz
- Chief of Staff – Stephanie Carlton
- Chief Operating Office – John Brooks
- Director for the Center on Medicare – Chris Klomp
- Director for the Center on Medicare and Medicaid Innovation – Abe Sutton
FDA Director – Dr. Marty Makary
CDC Director – Former Rep. Dave Weldon
Surgeon General – Dr. Janette Nesheiwat
NIH Director - Dr. Jay Bhattacharya
Congressional appropriations remain in a holding pattern as funding deadline approaches
Current funding for FY25, which started on October 1, was extended to March 12 as the result of a late December budget deal. However, congressional appropriators have been unable to begin the bipartisan and bicameral negotiations needed to pass the 12 appropriations bills due to House and Senate leadership having not agreed on the total nondefense discretionary spending allocation. Appropriations staff typically require three to four weeks to draft, review, introduce, and pass an omnibus bill, making the true deadline for action closer than it appears.
Separately, the House Appropriations Committee has solidified Labor-HHS roster. Chairman Robert Aderholt (R-AL) and Ranking Member Rosa DeLauro (D-CT) will keep their leadership positions, with Rep. Julia Letlow (R-LA) serving as Vice Chair. There will be three new Republican Members and one new Democratic Member: Representatives Jake Ellzey (R-TX), Stephanie Bice (R-OK), Riley Moore (R-WV), and Madeline Dean (D-PA). Representatives Juan Ciscomani (R-AZ) and Chuck Edwards (R-NC) have rolled off.
Supreme Court agrees to hear Braidwood
The Supreme Court has agreed to hear Braidwood v. Becerra, which challenges the constitutionality of the ACA’s preventative services provisions, which require most commercial health insurance plans, and by extension Medicaid expansion enrollees, to provide recommended preventive services without patient cost sharing. The plaintiffs argue that the no-cost preventative care provisions are unconstitutional because the United State Preventative Service Task Force (USPSTF) is unconstitutionally appointed. AcademyHealth has proudly and continually worked with our peer organizations in drafting and submitting multiple amicus briefs supporting the work of the USPSTF and expert convenings generating evidence-based recommendations for policymakers. Learn more about it on our blog here.
CMS released an updated RFI on reforming data use agreements
Last year, CMS proposed a new data access policy and fee structure that would dramatically limit access to their data due to concerns. At the time, AcademyHealth's advocacy campaign successfully demonstrated to CMS that research stakeholders are ready to address patient data privacy concerns while maintaining vital research. Consequently, CMS has delayed proposals to consider stakeholder feedback. You can read more about this campaign here. CMS has introduced a new request for information with additional questions for CMS data users here. This RFI is open until April 15.
Bipartisan interest in breaking up health care conglomerates
A new bipartisan bill by Senators Elizabeth Warren (D-MA) and Josh Hawley (R-MO) would require UnitedHealth Group, CVS Health and Cigna to each sell their pharmacies within three years. The legislation would prohibit companies that own drug middlemen or health insurers from also owning pharmacy businesses. It is the most aggressive legislative effort in recent years to target those drug middlemen, known as pharmacy benefit managers, or P.B.M.s — companies hired by employers and government programs to oversee their prescription drug benefits.
What we’re reading
A new Gallup poll finds that Americans’ views of US health care quality is at the lowest level in 24 years. The current 44 percent of U.S. adults who say the quality of healthcare is excellent (11 percent) or good (33 percent) is down by a total of 10 percentage points since 2020 after steadily eroding each year. As has been the case throughout the 24-year trend, Americans rate healthcare coverage in the U.S. even more negatively than they rate quality. Just 28 percent say coverage is excellent or good, four points lower than the average since 2001 and well below the 41 percent high point in 2012. In addition to registering subpar ratings of the quality and coverage of healthcare in the U.S., few Americans -- 19 percent -- say they are satisfied with its cost.
The Senate Budget Committee released a bipartisan report on how private equity firms prioritize profits over patients, jeopardizing care and eroding hospitals’ financial wealth. AcademyHealth brought leading experts to the Committee during its investigation to provide evidence and insights, and their work is cited throughout this document.
The American Journal of Psychiatry has a new study on the implications of telemental expansion and health disparities. They find that the increase in telehealth has worsened existing disparities, with groups that use telemental care being disproportionately people in higher-income brackets, living in cities, with steady employment and more education. As Congress is considering telehealth expansions, AcademyHealth’s Fall Health Policy Fellow Sasha Zabelski argued that more federal research on effectiveness and delivery is critical for the platforms to live up to their promise.
New research published by Mullens et al in the Annals of Surgery looked into timely access to high-quality and affordable surgical care in the US, finding that nearly 1 in 3 Americans lack that access. They found that key drivers were affordability due to being underinsured or uninsured. Patients with insufficient access were disproportionately likely to be more rural, lower income, and of Hispanic ethnicity.
In the first admission cycle since the Supreme Court restricted race-conscious admissions, more Black and Hispanic students applied to medical schools than last year, but the number who actually enrolled dropped by more 10 percent, according to data from the Association of American Medical Colleges. This data seems to validate the concerns of those who feared the June 2023 decision would lead to less diverse medical school classes and ultimately a less diverse medical workforce, harming efforts to end the country’s deeply rooted racial health disparities.
Patient groups are raising the alarm about limited coverage for prosthetics as insurers often claim they are not medically necessary. Fewer than half of people with limb loss have been prescribed a prosthesis, according to a report by AHRQ. People who need surgery to replace a joint typically don't encounter similar coverage roadblocks.
An investigation by the Marshall Project found that across the country, hospitals are dispensing medications to patients in labor, only to report them to child welfare authorities when they or their newborns test positive for those very same substances on subsequent drug tests. The positive tests are triggered by medications routinely prescribed to millions of birthing patients in the U.S. every year. The drugs include morphine or fentanyl for epidurals or other pain relief, anxiety medications, and two different blood pressure meds prescribed for C-sections. Despite these warnings, hospitals often lack policies requiring providers to review a patient’s records to see what medications they received before reporting them to authorities. Mandatory reporting laws protect doctors from liability for reports made “in good faith,” even if they turn out to be wrong. And toxicologists and doctors say many doctors lack the time and expertise needed to adequately interpret drug test results.