WASHINGTON — Seven months before the presidential election, President Donald Trump's health care priorities remain murky at best. But one thing is certain: the second Trump administration will make its own assessment of many of the important issues that voters care most about.
The former president has vacillated over issues such as the federal ban on abortion, the potential repeal of the Affordable Care Act, and ways to reduce drug costs, which has left voters largely supportive of President Biden's approach to these issues. I'm having a hard time narrowing down the message that resonates with me. Most Americans support federal protections for abortion, and more than half view Obamacare favorably. The majority also supports government negotiations on drug prices, but many do not believe Biden is defending that policy.
But while President Trump's message on abortion and insurance has shifted in recent months, Medicare bargaining power could work in his favor as he revives his first-term efforts to reform drug pricing. There is. Former officials, many of whom have spoken privately to the campaign, say Mr. Trump has no intention of abolishing Mr. Biden's signature drug pricing plan, but rather tweaking it to make it his own.
STAT spoke with six former officials and people close to President Trump's orbit who emphasized the president's interest in restructuring Medicare drug pricing policy and entering the ACA market, but the new He downplayed the threat of “repeal and replace.”
Theo Merkel, a former White House health adviser and now a senior fellow at the Paragon Health Institute, said: “He is 100% correct that the ACA costs more and has fewer outcomes than its authors intended.” Ta. “We have an opportunity to say, 'We're not going to repeal the ACA, but we're going to give people options other than the ACA.'”
Merkel and others warned that the Trump campaign is still in the early stages of developing its health policy agenda and that her team has few confirmed health advisers. Trump, as he has throughout his presidency, often speaks directly to voters based on recent conversations, he said. He spoke mostly on condition of anonymity because he didn't want to seem out of step with the former president's evolving message.
“Usually Mr. Trump himself is his best agent and spokesperson,” one former official said.
But President Trump heard from senior think tankers, veterans of his first administration, former White House aides and health and human services officials who now work at Paragon, the America First Institute, the Heritage Foundation and others. ing.
Some of these informal advisers have previously touted a plan to base the price of certain U.S. drugs on much lower prices in a basket of comparable countries, a model known as the most-favored-nation approach. Mr. Trump announced the plan by executive order in the final months of his presidency, but Mr. Biden rescinded the plan.
“He was very attached to the MFN for a long time,” said one policy expert and former official. “It's this visceral feeling that Americans are being lied to.”
But reviving that approach could run into obstacles of the Republicans' own making. In the Medicare bargaining plan passed as part of the Anti-Inflation Act, lawmakers introduced quality-adjusted life years into the program, a pricing metric that many patients and experts say is discriminatory, especially for people with disabilities. prohibited to use. Many countries classified under the most-favored-nation model incorporate her QALYs into price negotiations with pharmaceutical companies.
But that doesn't make it impossible, experts told STAT. President Trump could try to implement this model with Medicare Part B drugs, which were the original focus of Trump's plan, with no price negotiations for another two years.
While it would be difficult to remake the IRA into a preferential nation model, experts say it is a much more likely approach than simply withdrawing the negotiation plan, as former HHS official and Heritage Foundation president Roger Severino suggested earlier this year. I have a house too. Even if Republicans win both the House and Senate in the November elections, the majority will likely be slim, and the caucus could easily split over fights to repeal laws already popular with voters. there's a possibility that.
Abolish or improve?
President Trump is already facing a messaging problem with his comments on Obamacare, as Republicans have made it clear they don't want to repeat the embarrassingly long fight to repeal Obamacare.
The former president said in November that he is “seriously considering alternatives” to the Affordable Care Act if he is elected to a second term. But he has avoided repeating those words amid a flurry of messaging from the Biden campaign about the law's popularity and record-high enrollment in the ACA marketplaces.
“Donald Trump was one vote away from repealing the Affordable Care Act,” Biden wrote on X in March. “Now he's determined to try again, and is running to 'end' it and cut Medicare and Social Security in the meantime.”
Days later, President Trump said in a post on his social media platform, Trust Social, that he was “not running to end the ACA” and that he was running to make it “better, stronger, and much less expensive.” He said he is running to make it “to the cost.'' “We're going to make the ACA much better than it is now,” he said in a video post, repeating the reversal from early April.
President Trump has not disclosed details of his plan, but former officials and advisers have said that Trump's first-term short-term plans (called “junk plans” by Democrats) and the It points to efforts to abolish the insurance premium deduction that had been used to participate in the program. The Biden administration has canceled short-term plans and injected more subsidies into the market.
Conservative policy experts and President Trump's surrogates argue that these subsidies, which currently go to the vast majority of insured people, artificially inflate perceptions of the law's success and lead to a surge in enrollment. while claiming that Americans lack access to quality, sustainable insurance.
Instead of a full-scale repeal fight, those around Mr. Trump, such as former Louisiana Gov. Bobby Jindal, have argued that instead of a full-scale repeal fight, they would “implement conservative reforms that increase the likelihood of additional reforms,” while also It is pursuing a “radical gradualist strategy” of abolishing “parts”.
Find the right abortion message
Trump also faces the challenge of communicating his stance on abortion in a way that appeals to a majority of voters.
While many Republicans believe in restricting abortion, voters have repeatedly come to the ballot box to decry the state's restrictive bans and push for stronger protections. Trump himself has flipped on the issue, even though he regularly takes credit for the Supreme Court's decision that overturned Roe v. Wade. And while he appeared earlier this year to support federal restrictions with certain exceptions, he instead emphasized that abortion rights issues should be left to each state.
More recently, President Trump and the Arizona Republican Party have struggled to distance themselves from Arizona's abortion ban in the wake of a state court ruling that Trump declared went “overreach.”
His stance on this issue risks infuriating his supporters.
“He's going to be under pressure from inside and outside.” [more] “It's a socially conservative policy, especially given his statements about leaving abortion to the states,” said one former health official.
Those involved in conservative policy discussions said that's not the position Mr. Trump wants to be in right now. This could be another reason why he is focused on lowering health care costs, an issue that could have broader public support.
“He's playing the hits,” said one former official.
