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Diagnosing the health (policy) of our nation: The impact of November’s elections

As the nation processes the results of the US November general elections, the implications for federal health policy loom large. Healthcare stakeholders are eager to understand how the evolving political landscape will shape market access, regulatory priorities, and patient outcomes. This article unpacks key takeaways from the discussion, focusing on the winning scenario and strategies to prepare for the shifting health policy landscape.

The winning scenario: Full GOP control under Trump

Ahead of the election, four possible scenarios were on the table, each carrying significant implications for healthcare policy. The actual outcome—a Trump presidency coupled with full Republican control—sets the stage for potentially transformative healthcare policy changes. Let’s explore the key legislative and regulatory priorities and their implications.

Legislative priorities

Reforming the ACA

Although repealing the ACA may not be a sure-fire objective compared to 2017, President-elect Trump and House of Representatives Speaker Mike Johnson have indicated that significant reforms are on the table. This could include reducing Medicaid funding through block grants or per capita caps, which would limit federal funding and reduce eligibility for coverage.

Medicaid block grants

Under this funding model, states would receive fixed sums for Medicaid programs, removing guarantees for individual coverage. This change could drastically increase the uninsured rate, especially among low-income populations.

Public health funding cuts

Federal health agencies like the Centers for Disease Control and Prevention (CDC) may face significant budget reductions, impacting public health initiatives.

Regulatory priorities

Greater flexibility for plans

Medicare Advantage and Part D programs may see increased plan management autonomy, potentially at the expense of beneficiary protections.

Drug pricing strategies

While full IRA repeal is unlikely, adjustments to its implementation may affect Medicare price negotiations and patient affordability measures.

How to prepare for the changing landscape

For healthcare stakeholders, the winning scenario demands strategic adjustments to remain resilient and focused on driving patient access. Here are actionable steps to navigate the anticipated policy shifts effectively:

Strategic planning for 2025
As we await formal policy announcements, organizations should assess how legislative and regulatory changes could influence market dynamics. Analyze potential impacts on payer strategies, patient access, and reimbursement models to refine commercial and policy priorities.
Deepen partnerships with patient organizations
Patient advocacy groups play a crucial role in shaping policy discussions. Collaborate closely to amplify shared priorities and ensure that patient needs remain central to legislative and regulatory decisions.
Adapt payer engagement strategies
Changes to Medicaid funding or ACA provisions may shift coverage dynamics. Proactively refine value messaging to align with evolving payer requirements and ensure continued access to essential therapies.
Revamp patient support programs
Prepare to address financial and access challenges that patients may face under new policy frameworks. Model potential shifts in program funding and structure robust support mechanisms to mitigate barriers.
Monitor state-level trends
While federal policy garners attention, state governments continue to enact significant healthcare reforms, from drug pricing regulations to prior authorization and step therapy legislation. Stay informed about these developments and their potential ripple effects on the market.

The November elections have ushered in a new era for health policy, marked by uncertainty and opportunity. With the incoming Trump administration and full GOP control poised to enact significant reforms, stakeholders must remain agile and proactive in adapting to this evolving environment. By aligning strategies with anticipated policy changes and fostering partnerships with key players, healthcare leaders can ensure patients retain access to the care they need, even in times of political and regulatory transformation.

Understanding the implications of health policy shifts isn’t just about staying informed—it’s about preparing to drive meaningful change.

Prepare your patient support program for IRA's impact

The Part D benefit redesign — as part of the Inflation Reduction Act (IRA) — is almost here. Are you doing enough to prepare your patient support program for it? Start planning now to ensure your organization is ready for these significant changes.