Many are asking whether insurers, and specifically Medicare Advantage (MA), would do better under a Kamala Harris or Donald Trump administration. Well, the answer is not so easy. There are pros and cons for each. Further, some of this could be determined by the makeup of Congress as well.
But here is my quick take on the issue. I am sure we will be covering more of this as Election 2024 rolls on. The pros and cons are strictly from the standpoint of a health plan.
Trump Pros
- Under a Trump administration, private health plans would be safe from efforts to destroy them using Medicare for All and other grandiose schemes.
- In general, while there could be some light on antitrust matters, a Trump administration would scrutinize health plans less than a Harris one.
- Trump is known to favor an expansion of MA as a way to reduce costs and promote choice in the overall Medicare program.
- Health plans and pharmacy benefits managers (PBMs) might face less overall scrutiny.
Trump Cons
- Historically, Trump and his GOP compatriots have been anti-coverage expansion.
- Trump and Republicans could relook at repealing and replacing Obamacare in favor of Medicaid and uninsured coverage block grants to states. This would likely reduce coverage considerably. (Given his background, JD Vance could moderate some of this.)
- Even if the Affordable Care Act (ACA) is not attacked again, look for Trump and any GOP-controlled house to look to Medicaid for big savings (perhaps block grants just for Medicaid or related changes) because of the commitment on extending tax cuts as well as the promise not to impact Medicare.
- Trump, too, would rein in investments in the Exchange and favor restrictions on Medicaid expansion, including work requirements.
- Enhanced Exchange premium subsidies would die as of 1/1/2026.
Harris Pros
- Harris and Democrats are largely pro coverage expansion and healthcare investment.
- Harris would continue efforts to expand Medicaid and Exchanges.
- Harris would push extending or making permanent the Exchange enhanced premium subsidies.
Harris Cons
- While they claim to support MA, Harris and Democrats are far less enamored with the private program. They see it as over-reimbursed and would rather make investments in traditional Medicare fee-for-service (FFS). A major effort rein in MA overpayments would occur.
- At some points, Harris appeared to support Bernie Sanders’ pure form of Medicare for All without private insurance. At other points, her Medicare for All plan maintained private health plans to run parallel in the system (at least for a time) as long as they met strict requirements. VP nominee Tim Walz appears to be to the left of Harris on many healthcare issues. This also would worry health plans.
- Harris would continue efforts on the antitrust front, which could challenge providers, hospitals, plans, and PBMs alike.
Areas They May See Eye To Eye
- Despite Trump’s support for MA, given Medicare solvency issues it is likely that either administration would seek to rein in costs in the MA program. This could include looking closely at rates, risk adjustment, and overpayments; the Star program; and supplemental benefits
- Drug price reform could continue under either administration. Trump supported international reference pricing via rule for Part B drugs and said he would extend it to Part D in the future as well. Harris would likely seek to expand the number of drugs in the current Medicare drug price negotiation law and expand it to the commercial world.
#election2024 #harris #trump #healthcare #coverage #medicare #medicareadvantage #medicaid #managedcare #exchanges #obamacare #aca
— Marc S. Ryan
