The incoming Trump administration has posted an outline of its healthcare agenda on its transition website. There is no mention of drug pricing or what the administration might do about frequent price increases, such as Mylan’s EpiPen practice, that critics say are unsubstantiated and unethical. During the campaign, Trump’s official platform called for a change to let Medicare negotiate drug prices and for the re-importation of lower cost drugs from abroad—ideas that swim upstream against typical GOP positions.
“I am not surprised by the absence of attention to drug pricing,” says David Howard, an associate professor of health policy and management at Emory University in Atlanta. “This isn’t a big issue for Republicans, and it is not like there were coherent proposals for reducing drug prices on either side [of the presidential campaign].”
The few details provided in today’s post seem directly in line with Republican orthodoxy. Most are related to the president-elect’s promise to repeal and replace the Affordable Care Act. Health savings accounts will be part of the mix, the site says. People will also be able to purchase insurance across state lines, even though the states will be in charge of regulating their markets. A scholar at the American Enterprise Institute wrote earlier this year that “one should not expect interstate sales to significantly reduce the cost of health insurance.”
The outline also calls for the reintroduction of “high risk pools” for people whom insurers would deem too expensive to cover under regular plans. Such pools existed before the ACA, which replaced them by abolishing the exclusion of patients with pre-existing conditions. In a report this summer, the Kaiser Family Foundation said the pre-ACA pools run by the states “likely covered just a fraction of the number of people with pre-existing conditions who lacked insurance, due in part to design features that limited enrollment.”
The site promises to “modernize” Medicare and “maximize flexibility” for state Medicaid programs to experiment with coverage. The latter is likely a description of the long-held GOP belief in giving states block grants instead of entitlements, which could cap the number of people Medicaid programs could cover. As for modernizing Medicare, the catch-all phrase could mean anything from reform to privatization. It doesn’t necessarily allude to drug-price negotiation. In fact, the 2003 law signed by President George W. Bush that created the Part D prescription drug benefit was known in shorthand as the “Medicare Modernization Act” and explicitly forbade Medicare from price negotiations.
The Trump website also says the administration will seek to protect “individual conscience” in healthcare and “innocent human life from conception to natural death,” putting in question how far the administration will go to curtail reproductive rights, contraception, and abortion practice. Trump will also immediately fill a Supreme Court seat, which could quickly bring the Roe v. Wade law up for review.