Medicare Advantage (MA) could benefit under Trump, Kennedy, Oz
With the nominations of Robert F. Kennedy Jr. as Health and Human Services Secretary and Mehmet Oz as Administrator of the Centers for Medicare and Medicaid Services (CMS), a slightly clearer picture has emerged as to what we can expect for healthcare policy and coverage. Admittedly, there is a lot still in question.
Kennedy likely focuses on his core concerns
If he does get confirmed, Kennedy is likely to focus on his passions of reforming the health regulatory agencies and bringing greater transparency to drug and food regulation. In addition, he wants to impact chronic disease in a big way. Kennedy is a known vaccine skeptic. Under him will serve Dr. Marty Makary as Commissioner of the Food and Drug Administration (FDA) and Dr. Dave Weldon, Director of the Centers for Disease Control and Prevention (CDC).
Both Makary and Weldon are known as far more mainstream in their views on health regulation and certain controversial issues as compared with Kennedy (although Weldon could be seen as a vaccine skeptic). No doubt, the three would make seismic changes at the regulatory agencies and for good reason. The FDA and CDC, along with the National Institutes of Health (NIH), badly needed reform. There is a virtual revolving door between regulated industries and the agencies, which has corrupted policy and oversight. The agencies need to be more accountable and transparent to the public. But Makary and Weldon likely temper Kennedy’s more radical approaches and views for the good. This is likely the case on Kennedy’s extreme vaccine skepticism.
Healthcare coverage influenced by tax cut extension and tight congressional control
I doubt Kennedy will get heavily involved in healthcare coverage issues. That will be left to the White House and Oz. Trump and VP partner JD Vance danced around healthcare coverage issues for the most part, but some of what they said reminded me of the 2017 Affordable Care Act (ACA) repeal and replace effort. Extending tax cuts will likely dictate much of what happens in healthcare and some funding and thus coverage in the Exchanges and Medicaid likely will be impacted. The tight margins in Congress may stop more aggressive overhauls of the programs.
Oz’s views on Medicaid and the Exchanges are a bit unknown. But given Trump’s earlier regulatory track record on Medicaid the Exchanges, we can expect a return to less generous marketing and outreach polices in the Exchanges as well as state-friendly Medicaid waivers involving coverage expansions and work requirements in Medicaid.
As a physician, Oz could take a direct interest in a lasting Medicare physician rate fix. This is badly needed as the decades of turmoil have led to the acquisition of physician practices by health plans, private equiaty firms, and health systems. In addition, primary care has eroded because of it.
The Land Of Oz may not be bad for Medicare Advantage (MA)
MA policy may be a bit clearer. Trump and conservative healthcare policy organizations are known to favor MA. Kennedy has little or no record on MA. Oz has also written positively about MA. There is some talk that the Trump administration could push MA as the default signup option for Medicare. The default option proposal could have some challenges in more rural areas of the country, but any proposal could exclude these areas.
In addition, we could see some regulatory relief for MA given the fondness for MA from Trump and Oz. MA plans have seen two years of (2024 and 2025) of negative rate trends due to low Star scores and a new risk adjustment model. Could the incoming administration forestall another negative year in 2026 due to Stars’ fallout and the last year of the phase-in of the risk model?
The Biden administration wants to propose further prior authorization in MA, among other reforms, before it leaves D.C. A Kennedy and OZ regime might rollback further proposals that hurt MA.
In the end, though, I do see further accountability measures going into effect even under an MA-friendly administration. Overpayments, risk adjustment, Star reform, marketing, and supplemental benefit concerns all resonate in CMS itself and in Congress. These likely continue in some form, in part to generate savings for tax cut extensions. There is a clear anti-corporate-welfare sentiment on Capitol Hill that will drive changes.
Oz on coverage in general
Betting odds suggest a Trump 47 not to emphasize coverage expansion or even broader healthcare reform. But Oz has been sympathetic to such proposals. Oz once co-penned an editorial that backed Medicare Advantage for All, where Medicare beneficiaries, those in employer coverage, and the uninsured would enroll in private plans. He criticized the traditional fee-for-service program as wasteful because it was centered on transaction payments.
Drug price sympathy
Oz, too, has raised issues about high drug prices and pharmacy benefit managers (PBMs). He also is no fan of Big Pharma. That could signal some sympathy for drug price reform. He favors permanent telehealth expansions and has invested in numerous digital health companies over the years. This means he may support artificial intelligence, remote monitoring, wearables, and digital therapeutics.
Health equity in question
Diversity and health equity could take a major hit under Trump 47 because of plans to overhaul government. That could lead to the elimination or pullback of health equity at CMS and within MA. At the same time, the health equity index in the Star program is slated to save the government money compared with the reward factor. So, could tax savings mean HEI in Star remains?
Healthcare competition
And Oz, Kennedy, and Trump could team up with congressional Democrats and Republicans on antitrust issues. While the popular perception is that Trump and the GOP will be friendly to Big Business, it is also true that many have a healthy distrust of big business and the anticompetitive nature of vertical integration in healthcare.
Leverage Makary on numerous healthcare reform issues
While Makary will be busy overhauling the FDA, the Trump administration should leverage Makary for overhaul healthcare policy. Makary has researched and written extensively about what is wrong with the healthcare system. He is an expert on medical debt, how hospitals operate, physician issues, transparency, and more. Even if coverage is not front and center in the administration (although it should be), Makary could be invaluable in formulating coherent strategies to reduce costs, improve outcomes, and reform the healthcare system.
#healthcare #trump #election2024 #healthcarereform #medicaid #exchanges #aca #obamacare #drugpricing #antitrust #fda #coverage
— Marc S. Ryan
