The 2024 election is nearing the corner and has major implications for the healthcare industry, from abortion to drug pricing.
During the Reuters Total Health Conference held in Chicago on Tuesday, Ceci Connolly, CEO of the Alliance of Community Health Plans, shared five things she thinks the healthcare industry should know about the upcoming election.
1. The election is “Trump’s to lose”
Former President Donald Trump started this election with the advantage, but this shifted when President Joe Biden dropped out of the race and Vice President Kamala Harris became the Democratic nominee. Currently, Harris has a lot of momentum, but what really matters from now until the election is “the way that Trump behaves,” Connolly said.
“He is, in fact, an almost larger-than-life player on our political stage, if you will,” she said. “And he is so dominant, both positively and negatively, that it will likely come down to him. At the moment, I would say the race is tied dead even, no doubt about it. Ignore the national polls. They mean absolutely nothing. If you are a junkie, you can look at the polling in those seven swing states. Those are the only ones that matter.”
2. A divided government might be good for healthcare
It’s possible that the House may flip from Republican to Democrat and that the Senate may flip from Democrat to Republican this election. This means the U.S. will likely continue to have a divided government, which could actually be good for healthcare because it means less happens, according to Connolly.
“If you’re in business, what you don’t like is the unpredictability and the uncertainty and the constant change that we are often going through when it comes to regulation and laws with respect to healthcare and the health sector,” she said. “So this notion of divided government truly is the way the founding fathers designed it. It’s checks and balances.”
Connolly added that if the Democrats take control of the House, there could be an extension on the enhanced subsidies for people buying their health coverage on the Affordable Care Act Marketplaces. These enhanced subsidies are currently slated to expire at the end of 2025, and if they do, there will be a major increase in the number of uninsured in the U.S., Connolly said. This could lead to more people receiving care at the emergency room, which they probably won’t be able to pay for and providers will go uncompensated.
3. The courts are the new “playing field” for health policy
In a recent ruling, the Supreme Court overturned the Chevron deference. In the past, federal agencies like CMS and the FDA were given the flexibility to “interpret statutes and issue more detailed regulations,” Connolly said.
In the short term, not much is going to happen due to this ruling, but there are important implications long term.
“People are really kind of looking out in the landscape and they’re thinking about, ‘Well, which regulation are we going to challenge, saying that’s not what Congress meant when it passed that law and we think it should be changed?’” Connolly said. “So there’s going to be time, and I’m going to forecast to you that the biggest players in any industry — healthcare or any other industry — with the deepest pockets are the ones that will spend to start challenging individual regulations that they don’t like, but that’s going to be a slow and a very, very expensive process.”
This means policymaking will have to be looked at differently. Courts are doing a lot of the policymaking now, and “many players are court shopping for where they think they will find a ruling that applies,” Connolly argued.
4. Congress may act on telehealth, PBMs and patent reform during lame duck
Regardless of who wins the election, there will be a lot of turnover in the federal government. That means those who are currently in power will likely try to get some policies “across the finish line” during the lame duck period (the period between the election and inauguration).
For example, Covid-19 telehealth flexibilities — which are set to expire at the end of the year — are likely to be extended. However, they probably won’t be made permanent yet because Congress is looking for more data on whether virtual care actually creates savings or not.
There has also been bipartisan support for addressing pharmacy benefit managers, with bills in both the House and the Senate.
“Americans are so fed up with drug costs, and the politicians know that, and they hear it when they go home all the time from their constituents,” Connolly said. “And so there is bipartisan sentiment in Washington that more should be done when it comes to drug pricing.”
Similarly, there could be some legislation targeting pharmaceutical companies’ use of patent thickets. This is when there is an overlapping set of patent rights, delaying more affordable drugs from entering the market. Connolly gave the example of GLP-1s, which currently have market exclusivity for 19 years.
5. Harris and Trump actually have some similarities in healthcare
Putting abortion aside, Harris and Trump aren’t as different as many may think when it comes to healthcare, Connolly declared. Neither candidate is particularly passionate about healthcare and neither has an extensive record in health policy. In addition, issues like the economy and immigration will likely take precedence when one of them takes office.
However, there are some exceptions to this, Connolly noted. On drug pricing, she predicts that Trump will try to “out-do” the Biden administration because “he understands what a populist issue that is, and he wants to be able to claim that he’s done something even bigger, grander, greater when it comes to making drugs more affordable.” The Biden administration has also used its regulatory power to expand Medicaid coverage.
“I don’t think that you would see that in Trump too,” Connolly said. “I think it would be a very different approach to Medicaid in as much as the Feds play a role.”
Photo: MarianVejcik, Getty Images
