Federal Outlook
What a Donald Trump Presidency Means for Health Care
After months of speculation, the American people have voted that they hate Joe Biden in sunglasses and his love of ice cream by electing Donald Trump to be the 47th president of the United States.
While border security and Trumps DOJ pick are getting all the headlines, lets jump into how this could affect health care in America.
Healthcare Privatization/De-Regulation
President-elect Trump loves de-regulation as much as he loves tariffs. Like in his first term, Trump will look to further deregulate and further privatize the health care sector. During his first term Trump and the Republican party tried to repeal and replace Obamacare but failed due to then Senator John McCain most dramatic thumbs down vote. I would not be shocked if Trump and republicans looked again to repeal Obamacare, which House Speaker Mike Johnson noted to in an interview before the election. I will also note that Trump has not noted what his new health care plan would be. Famously in the debate with Harris, Trump said he had the “concept of a plan”.
Most likely we should expect that Trump and the GOP party will look to expand privatization of Medicare by aggressively promoting Medicare Advantage. Conservatives argue that Medicare beneficiaries are better off in Advantage plans, which offer more benefits than the traditional, government-run program. Critics say increasing insurers’ control of the program would trap consumers in health plans that are costlier to taxpayers, expose seniors to high prior authorization requirements, and have at times left the sickest patients high and dry when they decide to drop certain medical coverage. In 2023, Medicare Advantage plans cost the government and taxpayers about 6% — or $27 billion — more than original Medicare, though some research shows they provide better care.
Advantage plans have also been less likely to cover home-based/long term care services, leaving many patients without the option. A recent report by the Senate Permanent Subcommittee on Investigations found that Medicare Advantage plans had high denial rates for care in institutions where patients go after hospital stays. For the largest insurers, the rejection rates for such care were between about three and 16 times their denial rates for all services in 2022. In traditional Medicare, hospitals and nursing homes determine who gets such services. Trump’s campaign said he would prioritize home care benefits and support unpaid family caregivers through tax credits and reduced red tape. He did not explicitly note what red tape he would reduce and how he would look to prioritize home care benefits.
Trump said on the campaign trail that he wants to protect seniors by “shifting resources back to at-home Senior Care,” addressing disincentives that contribute to workforce shortages, and supporting unpaid family caregivers through tax credits. But he didn’t say exactly how he aims to shift resources back to at-home care.
Medicaid Changes
A key part of Trumps presidential campaign was his goal to cut government spending across the board. Medicaid is the third-largest program in the federal budget, accounting for $616 billion of spending in 2023, according to the Congressional Budget Office. Trump campaigned on a promise not to make cuts to the two largest programs: Social Security and Medicare. That makes Medicaid the “obvious place” for Republicans to raise revenue to finance their agenda, said Larry Levitt, executive vice president for health policy at KFF. Cuts would likely result in fewer and fewer households being covered.
Trump and the GOP could also look to curtain Medicaid enrollment by implementing working requirements, as he did in his first term. Additionally, Republicans may try to cap federal Medicaid spending allocated to states, experts said. The federal government matches a portion — generally 50% or more — of states’ Medicaid spending. That dollar sum is uncapped. Republicans may try to covert Medicaid to a block grant, whereby a fixed amount of money is provided annually to each state, or institute a per-capita cap, whereby benefits are limited for each Medicaid enrollee.
Trump has signaled that he wants to roll back most of Bidens executive actions, which could include the Medicare 80/20 rule. This would be a huge win for providers who would be immensely impacted by the rule that would require 80% of repayment rates to go directly to wages.
RFK Jr.
RFK Jr. being nominated to be Secretary of Health and Human Services was not on my bingo card for 2024. RFK Jr. joined Trumps team in the final months of the election and pledged that if he is confirmed he would work to “Make America Healthy Again”. RFK Jr. is an interesting person to put it mildly. The son of Robert F Kennedy, RFK Jr. has called for getting ultra-processed foods out of school lunches as part of a goal to reduce the incidence of diet-related chronic diseases and ban hundreds of food additives and chemicals, such as food dyes. He has also called for the removal of fluoride in public water, has promoted use of raw milk, and is a known vaccine skeptic, who has pushed false medical claims that vaccines are linked to autism. So, he is kind of all over the board.
If confirmed, RFK Jr. would oversea CMS, has not made his feelings public (which is honestly shocking) on long-term care. It is not known if he would push CMS to expand home-based care access or if he would look to cut government services. All we can expect is that if he is confirmed, something will change in a major way.
State Recap
Compromise Economic Development Package Signed By Governor Healey: Includes Nurse Licensure Compact Provision
After months of speculation, the long awaited economic development package has been passed and signed by Governor Healy. This comes after the legislature failed to produce a compromised package by the end of session in June. Most importantly to the home-based care sector, the package includes a provision that would add Massachusetts to the Nurse Licensure Compact (NLC). The NLC, which HCA has supported for years, would allow nurses from other states to practice in Massachusetts, increasing the pool of potential nurse candidates for unfilled home-based care nurse positions. Massachusetts was the only state in the New England Region not to be apart/pass legislation to be a part of the NLC. HCA heavily advocated to conference committee members about the importance of the nurse compact provision being included in any final package. The package also includes language that would create a pathway in Massachusetts for physicians previously authorized to practice medicine outside the United States to practice in an underserved region of the Commonwealth.
Outside of the NLC provision, the package authorizes $3.96 billion in capital programs, according to a three-page summary. That includes another $500 million over the next 10 years for the life sciences industry, renewing state support that dates back to the Patrick administration. The new language increases the annual tax credit authorization for the cornerstone industry from $30 million to $40 million, and adds health equity, biosecurity, digital health and artificial intelligence to the Life Sciences Center’s mission. The package is also loaded the bill with significant policy riders, including reforms to clear the way for development of a soccer stadium on a parcel of land in Everett, and language requiring ticket sellers to clearly disclose prices online and bans the use of automated ticket purchasing software, tools that opponents say drive up prices in the secondary market.
After waiting six day, Governor Healey signed off on nearly the entirety of the 319-page bill and returned only one section dealing with automobile insurance with an amendment.
Fiscal Year ‘26 Planning Kicks Off At Dec. 2 Revenue Hearing
While fiscal year ’26 doesn’t actually start until July 1, 2025, state’s financial managers are going to kick off their budget-writing work on Monday, Dec. 2 with the annual consensus revenue hearing. Legislative leadership and Finance Secretary Matthew Gorzkowicz haven’t announced what experts will be asked to testify on the future budget, but it usually includes representatives from the Department of Revenue, Treasury, Mass. Taxpayers Foundation, and others.
Following the hearing, the trio will have to agree on a state tax revenue estimate for fiscal 2026 by Jan. 15. That estimate serves as a key building block for budget proposals that Gov. Maura Healey will unveil by Jan. 22, followed by a House budget proposal in April and a Senate plan in May.
Most officials on Beacon Hill expect fiscal 2026 will be a challenging budget year, as non-surtax collections have softened and spending demands mount. Gorzkowicz told the Local Government Advisory Commission this month that the Healey administration “think[s] that there’ll be continued challenges going into FY ’26 and we expect that it’ll be another tight year in terms of trying to balance the budget.” The same state law that requires agreement on a consensus revenue number also dictates that the consensus revenue agreement “shall be included in a joint resolution and placed before the members of the general court for their consideration.
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