The Trump administration is remaking the healthcare policy landscape with major implications for providers, payers and health IT firms.

Those changes include drastic overhauls to the Department of Health and Human Services, the agency now under the purview of Secretary Robert F. Kennedy Jr., and responsible for dictating payment rates for doctors and providing health coverage to tens of millions of Americans. Approximately 1 in 4 employees in the HHS have been laid off, pushed to retire early or encouraged to take a buyout.

More downsizing may be forthcoming. A leaked budget document shows the Trump administration aims to slash HHS spending by one-third.

More changes are coming from the new CMS Administrator Dr. Mehmet Oz. A former television personality, Oz has promised to scrutinize Medicare Advantage plans after Democrats raised concerns about his previous advocacy for the program. But so far, the Trump administration has proposed favorable policy for MA plans, including a dramatic rate increase.

Medicaid could see major revisions too. The safety-net insurance program could be the target of cuts after congressional Republicans proposed a federal budget that could reduce funding for the program.

Healthcare Dive is closely covering the changes in healthcare under the Trump administration. Keep tabs on the latest major developments using this tracker:

Mehmet Oz, MD, faced questions about everything from Medicaid funding to the products on his TV talk show as he met before senators Friday.

Mehmet Oz, MD, faced tough questions before the Senate Finance Committee Friday. Oz has been nominated to lead the Centers for Medicare & Medicaid Services and the post requires Senate approval.

Oz, President Donald Trump’s nominee to lead the Centers for Medicare & Medicaid Services, made his case before the Senate Finance Committee Friday. The Senate must confirm Oz to lead the CMS, which touches the lives of 160 million Americans.

A cardiothoracic surgeon, Oz found fame through his frequent appearances on Oprah Winfrey’s talk show, and he later had his own talk show for more than a decade. During his introductory remarks, Oz may have become the first Cabinet nominee to tout his Emmy Awards in his bid for Senate confirmation. He also ran for the U.S. Senate in Pennsylvania, losing to U.S. Sen. John Fetterman, D-Pa.

There doesn’t appear to be much drama about Oz’s confirmation. The Senate narrowly voted to confirm Robert F. Kennedy Jr. to lead the U.S. Department of Health & Human Services, which oversees CMS. The Senate has confirmed virtually all of Trump’s nominees, although the White House withdrew Dave Weldon’s nomination to lead the CDC Thursday when it became clear he didn’t have the votes.

Sen. Bill Cassidy, a Louisiana Republican and a physician, said during the hearing that he expects Oz to be confirmed. Republicans hold the majority in the Senate.

Still, Oz faced tough questions on topics including potential cuts to Medicaid, the Medicare Advantage program, prior authorization, and his talk show.

Medicaid

Oz faced questions about whether he would oppose cuts to the Medicaid program, and he didn’t give Democratic senators assurance that he would fight against reductions.

Sen. Ron Wyden, an Oregon Democrat who is the ranking Democrat on the committee, asked Oz if he would fight against Medicaid cuts and insisted on a “yes” or “no” answer.

Wyden asked, “Will you agree to oppose cuts in the Medicaid program?”

In response, Oz said, “I cherish Medicaid, and I’ve worked within the Medicaid environment quite extensively.”

When Wyden pressed again for a “yes” or “no,” Oz said, “I want to make sure that the patients today and in the future, have resources to protect them if they get ill. The way you protect Medicaid is by making sure that it’s viable at every level.” Wyden then asked the record to reflect that Oz wouldn’t answer yes or no.

Sen. Maggie Hassan, a Democrat from New Hampshire, pointed to a Congressional Budget Office analysis that a Republican spending plan could result in millions of people losing Medicaid coverage and asked Oz about it. Hassan asked Oz how many children losing health insurance would be acceptable.

“I don’t want children losing health insurance,” Oz said.

Hassan responded, “Well, then you’re going to need to reject the Republican budget plan.”

Healthcare leaders have worried about the prospect of Medicaid cuts. While Trump has said he won’t cut Medicaid benefits, he and GOP lawmakers have said they want to weed out fraud in the program. House Republicans have also pushed a spending plan that would raise the possibility of reduced funding for Medicaid.

Medicare Advantage

Democratic and Republican senators asked Oz about Medicare Advantage programs, generating some interesting responses. Oz has spoken favorably about Medicare Advantage in the past, but he offered some concerns about the program.

In response to questions from Cassidy, Oz said, “We’re actually, apparently paying more for Medicare Advantage than we’re paying for regular Medicare. So it’s upside down.”

Oz said that he would like to look at “the up-coding that’s going on, that’s happening systemically in many systems, in many programs, to make sure that people are being appropriately paid for taking care of sick patients, but not for patients who aren’t ill.”

Oz also suggested that another way of reducing spending would be to allow Americans to obtain multi-year agreements with Medicare Advantage plans, as opposed to signing annual agreements.

“That would save some of the money that the brokers are taking out of the middle. Some brokers do a great job. Some don’t,” Oz said.

More than 30 million Americans, representing more than half of all those on Medicare, are members of Medicare Advantage plans. Hospitals have been increasingly critical of Medicare Advantage plans, saying they are too often denying or delaying claims.

Prior authorization

This is another area of interest from both Democratic and Republican lawmakers. Oz was asked about what he would do to ease headaches with prior authorization, a process requiring physicians and hospitals to gain approval from insurance companies for treatments, procedures and medications.

Oz said it’s one of the most frequent complaints he hears from physicians and says there’s room to make the process better.

“This issue of pre-authorization is a pox on the system,” Oz said. “We spend 12% of the healthcare budget on administrative costs. Pre-authorization is misused in some settings.”

Insurers have said prior authorization is a necessary tool to control costs and avoid unnecessary expenses, and Oz said, “There needs to be a mechanism to confirm that procedures are worthwhile.”

Oz said that there are about 15,000 procedures that could require prior authorization, and he noted that different insurance companies have different requirements for procedures that need pre-approval. He said he’d like to see the number of procedures requiring prior authorization narrowed down to about 1,000.

Responding to questions from Cassidy about prior authorization, Oz said, “We’re spending money, wasting money, trying to do a process that should be automated.”

Oz said he’d like to see more automation on a much smaller number of procedures requiring pre-approval. He said the authorization process should be similar to a consumer using a credit card and finding out almost immediately if the transaction can be done.

More hospitals and insurers are utilizing AI-powered technology in handling prior authorization requests. Healthcare leaders have said AI could help reduce headaches in the process, but hospital leaders say insurers are using AI tools to deny or at least delay reimbursements.

His talk show

Some of the most pointed questions concerned Oz’s long-running talk show, which he ended when he decided to run for the Senate in 2022.

Hassan asked about some of the weight loss supplements that he touted on his show, including green coffee extract. She asked if Oz would confirm that it’s not a miraculous drug for weight loss.

“I never said that that medication was a miracle weight loss drug,” Oz said. When Hassan pressed if it was fraudulently marketed and that it’s not a miraculous weight loss drug, Oz said, “Yes.”

Oz said he wasn’t paid to promote supplements on his show. “I take great pride in the research we did at the time to identify which of these worked and which ones didn’t,” he said.

Hassan indicated she wasn’t satisfied with Oz’s responses. “It seems to me, you are still unwilling to take accountability for your promotion of unproven snake oil remedies to millions of your viewers, and that’s really concerning,” she said.

Scientists criticized Oz for pushing remedies for weight loss on his show. In a 2014 study, researchers said they found “believable evidence” for only a third of the recommendations on “The Dr. Oz Show.”

Hospital payments

Sen. Sheldon Whitehouse, a Democrat from Rhode Island, implored Oz to look at the differences in reimbursements for hospitals in different states.

Pointing to his state, Whitehouse said hospitals in Rhode Island receive substantially less than hospitals in neighboring Massachusetts.

“As a doctor, I think you pretty well understand that if you’ve got two hospital facilities that are less than an hour apart from each other and that are in the same regional healthcare market, and one is paid 26% less than the other, you have created a massive and harmful distortion,” Whitehouse said.

Oz said he understood the problem and pledged to try to address the situation if he’s confirmed. Whitehouse said he hoped that would happen. The senator provided one of the more humorous moments in the hearing when he said, “I’m going to be on you like a ferret to get this fixed.”

Oz also said he’d discussed the situation with Sen. Bernie Sanders of Vermont, which receives even smaller reimbursements.

“I think there are opportunities to revisit that,” Sanders said.

Other takeaways

In his opening statement, Oz said that he wants to “empower beneficiaries with better tools and more transparency.” He also cited Trump’s executive order on price transparency.

He also said that he wants to incentivize doctors and providers to provide better care with technology. He touted the potential of AI to help clinicians. “Artificial intelligence can liberate doctors and nurses from paperwork so they can focus more on the patient,” Oz said.

Oz also pledged to use more high-tech tools to reduce waste and extend the life of the Medicare trust fund.

He also talked about the importance of tackling obesity and encouraging Americans to eat better and get more exercise.

Sen. Mike Crapo, R-Idaho, the chairman of the Senate Finance Committee, opened the hearing with praise for Oz.

“Your background and experiences bring a fresh perspective to the role of CMS administrator,” Crapo said. “As an accomplished physician, you have first-hand experience, not only with the bureaucratic nature of federal government payment programs, but also the impact of chronic disease.”

Wyden also asked if Oz plans to protect patient privacy in light of Elon Musk’s Department of Government Efficiency examining CMS in the midst of its review of federal programs.

Oz said he hasn’t talked with Kennedy or anyone in the Trump administration about DOGE’s work. He said he expects to learn more if he wins Senate approval.

“So I intend to spend my first precious few weeks in the agency, if confirmed, speaking to the staff, raising morale, getting people excited, and addressing what’s going on with DOGE,” Oz said. “I will know a lot more if I’m confirmed.”

In the wake of President-elect Donald Trump announcing that he wants Robert F. Kennedy Jr. to lead the U.S. Department of Health & Human Services, many critics focused on his well-documented vaccine skepticism.

President-elect Donald Trump wants Robert F. Kennedy Jr. to lead the U.S. Department of Health & Human Services, a prospect that has alarmed public health leaders.

Kennedy has routinely spread vaccine misinformation, including citing debunked studies linking vaccines to autism, critics say. Healthcare leaders worry that Kennedy would discourage the use and development of vaccines, and undermine public confidence in their safety, if he leads the nation’s health department. Opponents of Kennedy’s nomination to lead HHS called Trump’s choice “dangerous” and “disastrous.”

But in the days since Trump has nominated Kennedy for the post, more healthcare leaders have pointed out Kennedy’s lack of qualifications to lead an agency that affects the health and welfare of all Americans. The health department oversees Medicare and Medicaid programs, along with the Food and Drug Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, the chief source of research funding, and a host of other agencies.

Ezekiel Emanuel, MD, a former White House adviser for health policy under President Barack Obama, told MSNBC that Kennedy is “unqualified for the job.”

Emanuel, the vice provost for global initiatives at the University of Pennsylvania, said putting someone without a scientific or medical background in charge of a health agency with a $1.7 trillion budget is a bad combination.

“He doesn’t have management experience,” Emanuel said on MSNBC. “He doesn’t understand how science is done. He doesn’t understand how the federal government evaluates various studies. He can’t actually look at a research paper and look at the data and draw conclusions.”

Emanuel doesn’t discount that some of Kennedy’s views are worthy of support, including a focus on chronic diseases and a need for more oversight of highly processed foods. He also said Kennedy is correct in drawing attention to conflict-of-interest issues in evaluating the safety of drugs, medical devices, and food.

But he said Kennedy’s worthwhile views on some health issues are undercut by Kennedy’s public statements against vaccines, “one of the greatest inventions humans have ever had.”

“It’s estimated we’ve saved 154 million people from vaccines in just the last 50 years, in the United States alone,” Emanuel said.

Read more: What another Trump presidency could mean for public health

‘Absolutely terrifying’

Kathleen Sebelius, who led the U.S. Health Department under President Obama, told MSNBC that the prospect of Kennedy leading the agency “is absolutely terrifying and people should understand how serious it is.”

“This is life or death,” said Sebelius, the former Kansas governor. “The HHS affects people from birth to their grave and is intimately connected with every state in the country. So this could be very dangerous. I think it’s totally disqualifying for anyone who seeks to lead the major health agency in this country and one of the leaders in the world to just unequivocally say there is no safe and effective vaccine.”

Kennedy said on a podcast “there’s no vaccine that is safe and effective,” as the Associated Press reported.

In an interview with MSNBC, Kennedy said he wasn’t going to get rid of vaccines.

“I’m not going to take away anybody’s vaccines,” Kennedy said. “If vaccines are working for someone, I’m not going to take them away.”

Still, Kennedy’s pledge hasn’t assuaged the concerns of his critics.

Emanuel said on MSNBC that he’s concerned Kennedy won’t approve vaccines, or won’t certify them so they can be reimbursed by insurance companies. He’s also worried Kennedy will put a chill in drug companies developing new vaccines to deal with infectious diseases.

Certainly, Kennedy has supporters. U.S. Sen. Bill Cassidy, R-La., a physician who will head the Senate Health, Education, Labor and Pensions Committee next year, spoke positively about Kennedy’s nomination last week. U.S. Sen. Rand Paul, R-Ky., another physician, praised Trump’s nomination of Kennedy.

Tommy Thompson, who led HHS under President George W. Bush, told The Milwaukee Journal-Sentinel that he supported Kennedy as the department’s next leader. Thompson acknowledged concerns about vaccines, but he lauded Kennedy’s focus on chronic diseases and processed foods. He said he thought Kennedy could “reform the department.”

“He’s on the right subjects that I started when I was secretary, so I’m all for it,” he said.

Another former HHS secretary, Donna Shalala, opposes Kennedy’s nomination. Shalala, who led the department under President Clinton’s administration, wrote on X that Trump’s nomination of Kennedy was “shocking.”

“Kennedy is an unqualified, know nothing,” Shalala wrote. “He is dangerous to the health and well being of every American.”

‘Threaten countless lives’

Geeta Nayyar, MD, wrote about misinformation in healthcare in her book, “Dead Wrong,” and briefly mentioned Kennedy in that work. In a post on LinkedIn, Nayyar said she worried that Kennedy will bring vaccine conspiracies to the mainstream. She noted that Kennedy was included in the “Disinformation Dozen” that spread the bulk of vaccine misinformation online.

“He was so dangerous from the fringes. What can he accomplish from a position of power? That’s unclear. But we already know how much damage he can do simply by sowing doubt in vaccines,” Nayyar wrote in her post.

Uché Blackstock, MD, founder and CEO of Advancing Health Equity, wrote on LinkedIn that the nomination of Kennedy is “a direct threat to the integrity of public health.”

Blackstock wrote that she is especially concerned that Kennedy’s misinformation about vaccines would weaken trust in public health and disproportionately harm vulnerable groups, including Black communities and other minority groups.

“Public health leadership must champion science and equity, working to build trust rather than sow doubt,” she wrote. “The stakes could not be higher: we need leaders who will protect, not endanger, the health of communities. RFK Jr.’s track record demonstrates a clear opposition to these principles.”

Richard Besser, MD, former acting CDC director and the current president of the Robert Wood Johnson Foundation, has spoken out against Kennedy’s nomination. In a post on LinkedIn, he said his concerns aren’t based on partisan views.

“Indeed, the reason to oppose Robert F. Kennedy Jr.’s nomination is not because of his politics, or even the politics and priorities of the incoming Trump administration,” Besser wrote. “If he’s permitted to use Health and Human Services as his soapbox to promote dangerous and unfounded conspiracies, Kennedy will literally threaten countless lives across America.”

The Senate must confirm the HHS secretary and it’s still unclear if Kennedy will win approval from a majority of the Senate. Some public health leaders express doubt that Kennedy will be confirmed.

Protect Our Care, a healthcare advocacy group, is pressing senators to reject Kennedy’s nomination and targeting vulnerable Republicans, Politico reported.

Brad Woodhouse, executive director of Protect Our Care, said in a statement, “RFK Jr. is deeply unqualified, deeply unserious, and deeply dangerous. This nomination would be a joke if it wasn’t so deadly serious and every United States Senator who cares about the health of their constituents should oppose it.”

Nayyar said healthcare leaders need to be prepared for “science denial at the helm of HHS.”

“A head of HHS who casts doubt on vaccines, guts federal health agencies, and diverts resources from infectious disease prevention (have we already forgotten the 1 million+ Americans who died during the pandemic?) is not going to make our jobs any easier. But it does make our jobs — and our responsibility to stand up for science — even more important,” Nayyar wrote.

President-elect Donald Trump has announced his nomination of Robert F. Kennedy, Jr for HHS Secretary.1 Kennedy, a prominent antivaccine activist and former independent presidential candidate, would oversee significant aspects of the nation’s public health policy. His controversial stances—ranging from opposition to vaccines and water fluoridation to support for alternative treatments like hydroxychloroquine—signal potential upheavals in long-standing public health initiatives.

Kennedy’s nomination marks a departure from traditional HHS candidates, with Trump opting for a figure who has publicly criticized federal health agencies. His views have drawn criticism from scientists and lawmakers, including Senate Finance Committee Chair Ron Wyden (D, Oregon), who called Kennedy’s positions “disturbing” and signaled intense scrutiny during the confirmation process.

Although Kennedy has pledged reforms to the FDA and HHS, and advocated tying drug prices to European standards, his broader health policy agenda remains uncertain, particularly regarding issues like the Affordable Care Act and Medicaid. So far, Kennedy’s nomination appears to reflect his strong stances on the key aspects of health he’s broadcasted and Trump’s unorthodox approach, setting the stage for contentious Senate hearings.

Kennedy’s nomination marks a departure from traditional HHS candidates, with Trump opting for a figure who has publicly criticized federal health agencies. Image Credit: ภัทรชัย รัตนชัยวงค์ – stock.adobe.com

1. Food and Nutrition

Trump has promised that Kennedy’s leadership will focus on combating chemicals, pollutants, and additives that he claims contribute to chronic disease in the US.1 Kennedy is known for touting healthier diets, discouraging seed oils and pesticide-heavy agriculture, and advocating for raw milk, despite health risks associated with unpasteurized dairy.2 His potential influence on dietary recommendations would likely face challenges in balancing industry interests with public health goals.

On Fox & Friends, Kennedy explained that improving food quality in the US is “easy to fix,” citing that many ingredients used in foods are not permitted in European countries.3 “The reason for that is corruption,” he said. “The food industry and big agriculture producers control the FDA, and so they’re not worried public health; they’re worried about advancing the mercantile interests of those corporations.”

2. Ending the Chronic Disease Epidemic

Ending the chronic disease epidemic was a prominent platform of Kennedy’s previous independent presidential campaign. Now, as part of Trump’s administration, he plans “to see measurable results in 2 years,” at the president-elect’s request.4 Kennedy has brought up concerns about the role chronic disease played in the US mortality rate during the COVID-19 pandemic, comparing it with that of other nations and blaming the lack of efficiency of the CDC. He often underscores that the prevalence of chronic diseases, such as diabetes and autism, among others, was much lower when he was younger, and now, “we have the sickest children in the world.”

“When I was a kid, the autism rate among American children, and in 70-year-old men today in my generation, is 1 in 10,000,” Kennedy said on Fox & Friends. “In my children’s generation, it’s 1 in every 34 kids, in every 22 boys.” However, he fails to acknowledge that the reason for this is unknown, and there are various factors that could contribute to this increase. Although autism may have been documented by fringe psychiatrists in the early 1900s, it wasn’t recognized as a disorder or included in Diagnostic and Statistical Manual of Mental Disorders-III until the 1980s.5

Kennedy has used personal anecdotes frequently while speaking about the current state of health in the country by comparing it with his perspective of growing up.3 Although it’s true that current health care spending is at an all-time high,6 especially vs his uncle President John F. Kennedy’s time in office, Kennedy has repeatedly made claims about fixing this based primarily on experience bias, lacking the nuance in considering other possible factors.

3. FDA Policies, Alternative Health Treatments

Kennedy is critical of the FDA’s approach, especially regarding its regulation of alternative treatments like psychedelics, stem cells, and certain supplements.2 He described the FDA as resistant to health innovations and claimed that the “FDA’s war on public health is about to end,” according to a post from his X account from October. He wrote that employees involved in what he described as a “corrupt system” should preserve their records and prepare to be ousted.

While Kennedy’s rhetoric has questioned FDA-approved products, spanning antidepressants—connecting the increase in the treatment’s use with the country’s rise in mass shootings—to vaccines, experts argue that substantial changes would be difficult. The FDA’s lengthy longstanding framework involves rulemaking processes and extensive collaboration, making the reality of these changes ripe with significant legal and procedural hurdles.

4. Vaccination Policies

Kennedy is an outspoken vaccine skeptic, claiming that no vaccine is entirely safe and effective and linking vaccines to autism—a claim disproven by scientific research.2 He suggests reviewing vaccine safety and informing the public more comprehensively. He’s assured that those who want to be vaccinated will still be able to do so, stating that his stance is “you oughta know the safety profile and the risk profile and the efficacy of that vaccine, and that’s it.”7

However, experts worry that his influence could erode vaccine coverage and heighten the risk of preventable diseases.2 While leading HHS, which includes the FDA and CDC, he might push for changes, although federal structures and regulatory practices make rapid adjustments challenging.

5. Fluoridation of Drinking Water

Kennedy opposes adding fluoride to drinking water, arguing that it’s an unnecessary and ineffective way to deliver the mineral, now available in toothpaste.2 He asserts that high fluoride levels may harm children’s IQ, although the CDC and expert panels maintain there’s no convincing evidence of adverse effects from community water fluoridation. However, this policy is primarily a state and local decision.

The Future of Health Policy Is Still Undetermined

Kennedy’s positions reflect a broader skepticism of established medical and scientific consensus, drawing concern from experts who warn that his influence could weaken public trust in health recommendations.2 Despite Republicans controlling both houses of Congress with the incoming term, Kennedy’s health initiatives will likely warrant scrutiny in a Senate confirmation hearing.1

The fate of the Affordable Care Act, Medicare drug price negotiations, 340B reform, pharmacy benefit manager transparency, or other legislative priorities is still uncertain. Although Trump has historically employed extensive efforts to dismantle the Affordable Care Act, he’s offered little clarification on his plans for federal health policies in his new term.8 Yet, Kennedy has provided even less insight into his position on these components, leaving many questions about the country’s future health policies unanswered at this time.

References

1. Mattina C. Trump announces RFK Jr as HHS Secretary pick. AJMC®. November 14, 2024. Accessed November 15, 2024. https://www.ajmc.com/view/trump-announces-rfk-jr-as-hhs-secretary-pick

2. Miller K. Trump is praising RFK Jr.’s Make American Health Again’ plan. Scientists are worried. Fortune Well. November 13, 2024. Accessed November 15, 2024. https://fortune.com/well/article/rfk-jr-maha-plan-health-policies-trump/

3. Fox & Friends #MAHA. Kennedy MAHA. October 31, 2024. Accessed November 15, 2024. https://www.mahanow.org/fox-friends-maha-video

4. President Trump has asked me to do three things. Kennedy MAHA. November 12, 2024. Accessed November 15, 2024. https://www.mahanow.org/three-things-video

5. Rosen NE, Lord C, Volkmar FR. The diagnosis of autism: from Kanner to DSM-III to DSM-5 and Beyond. J Autism Dev Disord. 2021;51(12):4253-4270. doi:10.1007/s10803-021-04904-1

6. Grossi G. US health spending hits $4.8 trillion, insurance coverage peaks in 2023 projections. AJMC. June 12, 2024. Accessed November 15, 2024. https://www.ajmc.com/view/us-health-spending-hits-4-8-trillion-insurance-coverage-peaks-in-2023-projection

7. My take on vaccines. Kennedy MAHA. October 16, 2024. Accessed November 15, 2024. https://www.mahanow.org/take-on-vaccines-video

8. Grossi G. Harris defends ACA while Trump calls for “much better” health plan during debate. AJMC. September 11, 2024. Accessed November 15, 2024. https://www.ajmc.com/view/harris-defends-aca-while-trump-calls-for-much-better-healthc-plan-during-debate

Photo by Helena Lopes: via pexels

During a second Trump administration, president-elect Donald Trump and a Republican-backed Congress are expected to limit abortion access and cut spending for Medicaid and the Affordable Care Act (ACA), health policy experts from the nonpartisan KFF said Friday.

On a Zoom call, the topic was “What a Second Trump Administration May Mean for Health Care.” Here’s a recording and transcript. On the call, KFF’s policy experts warned that the incoming administration may do the following:

Limit access to contraception via medication

Begin strict enforcement of the Emergency Medical Treatment and Labor Act (EMTALA), thus restraining care for pregnant people in distress.

Scrap or curtail Medicare’s new drug-price negotiations program,

Let the enhanced subsidies expire at the end of 2025 for millions enrolled in ACA plans under Obamacare,

End U.S. cooperation with other nations on global health initiatives and on any response to another pandemic.

Many of these issues will depend on who is appointed to lead the federal Department of Health and Human Services, the Food and Drug Administration and other agencies, and what role Robert F. Kennedy Jr., will have in setting policy, the experts said.

Keep in mind that Larry Levitt, KFF’s executive vice president for health policy, warned, “There’s a lot of tea-leaf reading in trying to anticipate what might happen.”

“We know there will be a big debate coming on taxes, and I fully expect health care to be a big part of that debate,” he added. “Trump has said Medicare, Social Security and Defense (Department) cuts are off the table with Republicans looking for spending reductions to help pay for tax cuts.”

For health policy, a fork in the road

The election represented a “fork in the road for health policy,” Levitt added. That means more emphasis on deregulation than under the Biden administration, and for health care, less federal spending and less transparency, he said.

“That means the math is inescapable,” Levitt noted, explaining that cuts are coming in spending for Medicaid and the ACA. “Medicaid is the next biggest chunk of money after those other programs, and if there is pressure to cut spending to finance tax cuts, then Medicaid will have a big target.”

In the past, Trump, conservative groups and Republicans in Congress have endorsed plans to cut Medicaid spending by making block grants to states or per-capita caps or by slashing federal matching payments for the ACA and Medicaid expansion, Levitt commented.

One big question is what a Trump administration may do about the prescription drug-price negotiations, which began last year, as we reported here. “Trump has been a long-time critic of the drug industry, but offered no specific policies in the campaign,” Levitt said. “It’s a big question of whether he will continue drug-price negotiations in Medicare or seek to repeal or weaken it.”

Questions on ACA subsidies

Trump and Congressional Republicans also could let the ACA’s premium tax-credit subsidies expire after next year. If they do, the result will be big increases in out-of-pocket and premium costs, lower enrollment in ACA plans and more uninsured Americans, he predicted.

It’s also possible, however, that health insurers, hospitals and physicians will want the subsidies to continue because they boost health insurance enrollment, Levitt said. “The ACA is working quite well right now, and insurers do not want to see the enhanced financial aid expire and reduce enrollment,” he commented. “I think the Trump administration is perceived as business-friendly. Cuts in health care would certainly not be perceived as friendly to the health care industry.”

Cynthia Cox, KFF’s vice president and director of the program on the ACA, added that Obamacare marketplaces have doubled the number of people enrolled from about 11 million four years ago to 21 million today. “That’s driven by these enhanced subsidies, primarily, but also because the Biden administration has taken other steps to boost outreach and marketing and enrollment assistance programs,” she said.

Restrictions on abortion

On the issue of limiting abortion access, Alina Salganicoff, KFF’s senior vice president and director for women’s health policy, said mifepristone, one of two drugs used for medication abortions, is a target for those who oppose abortion.

In June, the U.S. Supreme Court ruled unanimously to preserve access to the drug, as Mark Sherman reported for the Associated Press. The medication was used in almost two-thirds of all abortions in the United States last year, and the case could restrict access to mifepristone across the country, including in states where abortion remains legal, he added.

“That case is still live,” Salganicoff explained. Even though the Supreme Court said the groups challenging the use of the drug did not have standing, there are changes the FDA could make in the second Trump administration, she added. “We don’t know whether they’re going to actually review the approval, but I will tell you that it is likely that they will revisit the conditions in which medication abortions, which now account for nearly two-thirds of all abortions in this country, can be provided,” she said.

In addition, health care providers using telehealth approve about one in five abortions in the United States today, Salganicoff said. After a telehealth visit with a provider, the pills are mailed under provisions the Biden administration approved, she explained. The result is no in-person visit is needed. “We do anticipate that’s going to be a target,” she added.

What’s more, about one in 10 abortions are done using pills mailed to people in states where abortion is banned from states that have shield laws protecting their use, she said. Under this FDA protocol, it’s legal to do so. “But, clearly this is going to be a target at the FDA,” she warned.

Looming cuts for Medicaid

On the issue of Medicaid spending, Levitt said, there are questions about whether cuts will come in the form of reductions in federal matching payments to the 40 states that have expanded enrollment in Medicaid or for the 10 states that have not expanded Medicaid, including Georgia. If Trump or Congresses used block grants or per-capita caps to fund Medicaid, every state would be affected, he explained. In turn, every state could cut Medicaid spending, leading to reductions in coverage and benefits, he added. Both block grants (meaning a set amount for each state) and per-capita caps (meaning a set amount for each enrollee), Trump and Congress could limit federal Medicaid spending.

Robin Rudowitz, KFF’s vice president and director of the Program on Medicaid and the Uninsured, commented that changes in spending for the ACA also could affect whether the remaining 10 states expand Medicaid and would affect the waivers that some states, such as Georgia, use to enroll residents in Medicaid without expanding enrollment more broadly.

What’s ahead for the CDC and WHO

One of the questions the KFF experts addressed was related to public health. Levitt noted that if Kennedy has a prominent role in the administration, there is a potential for misinformation. “We turn to the government for reliable data, public health and scientific information, and there’s the potential now for the government to be not only not an effective source for health information, but in fact, an accelerant for misinformation,” he warned. He asked Jennifer Kates, KFF’s senior vice president and director of global health and HIV policy to address that issue and the changes that Trump could make at the federal Centers for Disease Control and Prevention.

“First of all, the new administration is going to appoint a CDC director, and that appointment itself is very important, because that person will likely share the views of the incoming administration,” she said. Under a new law, the Senate will confirm the CDC director in 2025, as Joyce Frieden reported for MedPage Today.

“We could expect a de-emphasis, or change in the view of what is considered evidence and in how the CDC provides recommendations on public health measures,” she added. “There’s a lot of discretion that the new administration is going to have to decide what role it wants [the] CDC to play.”

Another possibility is that during a second Trump administration, federal officials could begin the process of taking the United States out of the World Health Organization, as the first Trump administration attempted to do but ran out of time, Cates said. “I would fully expect the second Trump administration to try to do that again,” she added. Also, the incoming administration is likely not to agree to an international agreement to strengthen efforts to prevent, prepare for and respond to a pandemic, as the WHO has proposed, she noted.