Health Care in a New Administration

The first 90 days of the new administration have seen considerable activity surrounding health policy, both through direct policy actions and as downstream consequences of other policies. Several key issues may have far-reaching implications for emergency medicine. As emergency physicians, we must pay close attention to changes that may affect us, our patients, and our hospitals. This resident voice column explores several of these topics from the perspective of one newly entering the specialty.

Federal support for public health initiatives, including research, information dissemination, and treatment programs, is facing scrutiny and potential cuts under the Trump administration. Within days after inauguration, the new administration temporarily blocked the disbursement of many federal grants and loans, with exceptions for direct-aid programs like Medicare and Social Security. Additional directives and legal challenges led some to confusion and uncertainty, further influencing the services and funding that were available.¹ Public health experts were dismayed at the administration’s pause on external communication from federal agencies, including the Centers for Disease Control and Prevention, Department of Health and Human Services, the National Institutes for Health, and the Food and Drug Administration. Though temporary, the resulting unpredictability raised concern for researchers, federal agency employees, and the general public. Funding may prove an ongoing concern, as the administration proposes drastic reductions in grants for some medical research at hospitals and universities. At the time of this writing, some cuts are on hold following federal judges’ rulings. Whatever the outcome, there may be consequences for years to come.²

The overall direction of public health priorities, agency funding, and staffing and programmatic restrictions will be greatly influenced by the leadership of these federal agencies. Notable among them are the new Secretary of the Department of Health and Human Services, Robert F. Kennedy, Jr., and the new Administrator of the Centers for Medicare and Medicaid Services, Dr. Mehmet Oz. Both have backgrounds outside of traditional health policy roles and have been known for opinions that diverge from traditional medical consensus.^3,4 As part of his role, Secretary Kennedy will chair the Make America Healthy Again Commission established by President Trump. The Commission has outlined a focus on chronic diseases, however it has not fully addressed other crucial public health concerns, such as the ongoing measles outbreak, substance use, gun violence, and mental health services, all of which have implications for emergency medicine.⁵

Globally, President Trump ordered the United States to withdraw from the World Health Organization (WHO) via executive order. Because the United States has historically been the largest contributor in the WHO, withdrawal may have far-reaching implications on funding for WHO programs in lower-resourced countries. The United States may cede a large role in international governance and negotiations for global health programs. Experts warn that this could limit international cooperation on disease surveillance and emergency response, perhaps impacting disease transmission to and within the United States.⁶ Other global health organizations will also be affected by the cessation in federal funding, including the President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Agency for International Development (USAID), which imperils these programs’ abilities to provide critical services.⁷

Weakened public health and global health infrastructure could limit the country’s ability to respond effectively to future public health emergencies like disease outbreaks and disasters, placing further strain on emergency departments during crises.

Insurance and Access to Care

Compared to countries of similar size and wealth, the United States has the highest health care expenditures per capita. In 2023, the United States spent 4.9 trillion dollars, or 14,570 dollars per person. Nearly 40 percent funnels through the Medicare and Medicaid.⁸ Congress continues work on the federal budget, which may involve changes to these programs in order to reduce federal spending. To accomplish this, the administration has advocated for restructuring Medicaid into block grants, implementing per capita caps, or enacting work requirements on beneficiaries.⁹ These modifications may restrict eligibility and limit the benefits that patients may receive. There has also been promotion of Medicare Advantage plans, which could lead to narrower physician networks and additional prior authorization requirements compared to traditional Medicare.¹⁰ 

Even individuals with traditionally preferred insurance plans may see their preventive health benefits impacted. The Supreme Court has agreed to hear arguments from a Texas-based company that challenged the Affordable Care Act’s coverage of certain preventive services, which would remove requirements that private insurance must cover services like lung and colon cancer screenings, PrEP medications for HIV prevention, and behavioral counseling.^11,12

Medicare drug price negotiations will also remain an important area of focus. In a process that began under the Inflation Reduction Act in 2022, negotiations with drug companies for certain medications under Medicare Parts D and B aim to lower overall Medicare spending and reduce out-of-pocket drug costs for Medicare beneficiaries.¹³ The second round of price negotiations is underway, however the outcomes and direction of this and future rounds remain uncertain.

Regulations

Soon after taking office, President Trump issued a series of executive orders focused on immigration restrictions and increasing enforcement. Among these orders was a recission of a Biden Administration policy that protected against enforcement in “sensitive areas,” including hospitals and other health care facilities.¹⁴ Allowing Immigrations and Customs Enforcement (ICE) agents access to hospitals may intensify fear and reluctance among immigrants seeking care, even those who are lawfully residing in the United States. Health care systems and physicians may face challenges helping patients feel safe, protecting patient information, and establishing protocols to respond to potential encounters with ICE agents.

Carrying over from the first Trump administration, hospitals will be mandated to publish the prices they accept from insurers for all services , including medications, procedures, and imaging, in an emphasis on greater transparency in health care pricing overall.¹⁵ The goal is to empower patients to make informed decisions about their health care and to stimulate market-driven price reductions.¹⁶

The first Trump administration proposed tort reforms that advocated to cap non-economic damages in medical malpractice claims, shorten the statute of limitations for filing claims, and define protections for physicians following evidence-based guidelines. ¹⁷ Although these did not come to pass, it remains to be seen what may be proposed again.

Conclusion

As the second Trump administration continues to reshape health policy, there will be ongoing shifts in leadership, funding priorities, and regulatory approaches. The extent of these changes may have downstream ramifications on patients, resources at academic medical centers, and financial and legal implications on emergency physicians. As changes unfold, it is essential for emergency physicians to stay informed and engaged so that the needs of physicians and our patients are supported through advocacy.

 References

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