The Washington DC-based principal of a national advisory and advocacy firm gives an overview of Donald Trump's plans for healthcare and an outlook on other healthcare policies if the Republican nominee wins the presidency.
This is an excerpt from How the 2016 Election Will Affect the Future Landscape of Healthcare Payment and Policy, a HealthLeaders Media webcast on how the election will impact healthcare policy. Nicholas Manetto is a principal at FaegreBD, a division of the law firm Faegre Baker Daniels LLP.
The full webcast includes Ilisa Halpern Paul, president of the District Policy Group, which is part of Drinker, Biddle & Reath, who discusses the outlook under a Democratic victory. This transcript has been edited for length and clarity.
Nicholas Manetto: For Republican Donald Trump, primary health policy discussion has been around repealing the Affordable Care Act. That is very much in line with national Republican orthodoxy, and it's been a core point for the last six or so years.
Trump is very different from [Hillary] Clinton. This is not just in their differences on policy issues, but really his lack of focus on healthcare throughout his career. This is, of course, as you know, his first run for elected office, and his business interests have not really focused in the healthcare arena, as compared to Secretary Clinton, who has had a sizable focus on health going back to her early career in Washington.
Beyond repealing the ACA, there's not a lot of detail in his agenda. It largely consists of a core set of Republican principals that have been in the arena for some time.
These include points around changing the tax code to incent the use, affordability, and access to Health Savings Accounts, as well as some insurance regulatory reform to broaden the markets for insurance products, and you also see a longstanding staple around turning Medicaid into a Block Grant program to give the states more flexibility in how they design their programs.
There are two areas where you do see some disagreement from the typical Republican agenda. Those come in the area of prescription drugs, where you see Donald Trump being pro-allowing Medicare to negotiate directly for prices of drugs rather than letting the Part D plan work with the pharmacy benefit managers to do that as they have done for decades since the MMA [Managed Medical Assistance] was enacted.
You also see Trump expressing support for drug reimportation. This is a hot topic that we saw in the lead-up to the Medicare prescription drug bill earlier in 2003–2004, when you had a lot of seniors purchasing drugs from pharmacies located outside the border to address cost concerns. Now, you're having Trump say he would support some of those efforts as a way to address the rising costs of prescription drugs.
You see this sort of mesh of longstanding Republican principals for the most part, with a few of these outliers that sort of reflect the Trump populist appeal.
So, the agenda, in summary, is longstanding ACA repeal-and-replace, but not very detailed, with a few of these outliers. Especially when you talk about price sensitivity and transparency, those are going to be sensitive areas, especially in the eyes of the biopharmaceutical stakeholders.
For a long time, the assumption has been that a Trump administration would cede the bulk of their health policy agenda to leaders in the Republican congress; folks like Speaker Paul Ryan, who has developed a very comprehensive health policy agenda under the A Better Way heading.
However, the more recent and continued tensions between Trump and Speaker Ryan will raise questions about what exactly this relationship might look like, if it comes about.
On the insurance side, a Better Way includes a lot of policies like tax incentives to help individuals purchase insurance, trading various interstate compacts and insurance pools like "high risk" pools, and use of association health plans, all to try to drive private sector uptake of insurance and access to insurance.
We'll see a lot of policies focused on HSAs, such as allowing spouses to make more catch-up contributions and expanding access to populations that can use the HSAs, including programs like Tricare, and even in the Indian Health Service.
While repeal of the ACA is fundamental to the Better Way agenda, you do see recognition of some of the more popular reforms, like allowing people to stay on their parents' plan through age 26 and protecting folks with preexisting conditions from being taken off a plan or prevented from purchasing insurance.
You don't see any open debate with anyone saying that these should be undone, but you do see some calls in the Ryan agenda for changing the age rating ratio from 3:1 to 5:1 as a way to address healthcare pricing.