Health care and Trump 2.0: Disruption ahead

There is no precedent to what the U.S. could see in health care under a second Trump presidency, an industry expert said.

Paul H. Keckley is managing editor of The Keckley Report, a health care policy analyst and advisor to health care organizations. He gave a preview of what the incoming Trump administration could mean for the U.S. health care system during a recent webinar.

President-elect Donald Trump and the 119^th Congress have a short window of time to enact any change, Keckley said. That’s because it will probably take until April for the Senate to confirm Trump’s nominees to lead key agencies and then Congress will turn its attention to the 2026 midterm elections.

“They have a short window to do a lot of stuff because the activities of 2025 will be the Campaign 2026 narrative,” he said. “That means there’s not a lot of big legislation they can pass – not just because they have a narrow margin in both houses but because it’s hard to pass big legislation.”

But executive orders from the White House and administrative directives from agency heads can bring about some changes in health care without Congress passing legislation, Keckley said.

He predicted Trump would start by changing “the low hanging fruit” – issues that could be enacted quickly through executive orders or administrative rulings by federal agencies. These orders and rulings might be challenged in the court “but at least would set the agenda for a minimum of two years if not four.”

Low hanging fruit, Keckley said, includes issues that would have populist appeal.

An intent 'to clean house'

“I think what’s interesting about the Trump administration and Trump health care team is disruption is raw meat – they like it. They believe the health care system is deceptive, somewhat corrupt, certainly a system of cronies. So Trump’s avowed intent is to clean house – he’s putting in a different set of cronies.”

Keckley noted that Trump’s nominees in four of the top five health care positions are physicians. “But none of those has a day job seeing patients.  All of them have been in private sector activities, all of them have been in some of the political antivax rhetoric of the past four years. It has been interesting to see him assemble this team, which has as its true north ‘we’re going to shake things up.’”

He said he believes Trump will revisit a proposal to remove the ban on expanding the number of physician-owned hospitals in the U.S. The Affordable Care Act prohibited any physician from building or owning a hospital and limited the growth of any physician-owned hospital that was already in operation.

Commissions expected to be named

“Trump will take the position that we need competition and hospitals don’t have the right to control that. And that will obviously be challenged. We’ll see a list of reviews, we expect some commissions to be named to study the issue.”

Keckley predicted Trump will appoint commissions to examine several aspects of the U.S. health care system.

“Commissions and task forces are great ways to say ‘I’m working on something’ without having to do anything. You appoint some folks, you create a commission, you give them some legislative staffers and they produce a report typically too late to do much about it in the current election cycle but you can say, ‘Look what we did.’”

Commissions could possibly examine the impact of hospital consolidation on health care costs, the approval process for new prescription drugs and the structure of the health insurance industry, Keckley said.

“For the past four years, we have been in a period where the wind and the momentum were at the back of the insurance industry and a lot of headwind faced the provider side. But Trump will take the position of ‘I can open the insurance market for you but I will allow for some short-term policies,’” he said.

Keckley predicted the Trump administration will push to provide a private option for veterans’ health care, much like how Medicare Advantage created a private option for senior health care.

As for Medicare Advantage, Keckley predicted the Trump administration will provide incentives for MA carriers to make more zero-premium policies available in the marketplace.

The first Trump presidency came on the heels of the ACA’s enactment. Keckley looked at what a second Trump administration will mean for the health care law.

“The ACA did a lot of things that Trump promised to get rid of when he first came into office,” Keckley said. “But he found that there was more about the ACA that people liked than what they disliked – things such as coverage for those with pre-existing conditions, coverage for those under 26.”

But Trump 2.0 will allow “every governor and every agency in health care in the federal government to enact changes which, at worst, end up in court but still draw attention to their intent to fix a problem, with the only caveat to that being whoever comes into the role next time can throw it out.

“There is no precedent to what we will see in the next 18 months.”

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].