During their four years in office, the Trump administration made sweeping changes that affected affordable care, Medicaid, abortion and transgender rights law, in many cases reversing the administration’s efforts. Obama. Most of the action was taken through executive orders and regulations, as it was difficult to get bills through Congress, especially after Democrats took control of the House after the midterm elections from 2018.
Biden’s health officials will likely be active as well, but it will take time for all of their actions to take effect.
“They don’t have a massive eraser pen. They have to go through the rule-making process,” said Allison Orris, a former Obama administration official and a consultant to Manatt Health, a professional services firm. “They’re going to have to think about what comes first, second and third and be realistic about the timing.”
Additionally, the Biden administration may choose to maintain and continue several of the Trump administration’s efforts, including the shift to value-based care, rather than paying doctors for every visit and procedure, and improving access to telehealth, said Ian Spatz, senior advisor at Manatt.
The two jurisdictions also share common views on some measures to reduce drug prices, including basing Medicare payments on the cost of prescription drugs in other countries and importing drugs from overseas. But Trump officials haven’t actually put these proposals in place.
However, where the two administrations will differ significantly is messaging, Spatz said. While Trump has focused on dismantling the Affordable Care Act, Biden will focus on expanding the law and access to health coverage.
Here are seven Trump healthcare measures the incoming Biden administration should reverse.
Work requirements
The Trump administration took a historic step in early 2018 by allowing states to require certain Medicaid recipients to work for benefits. Eight states have received approval, seven have pending applications and four have had their waivers overturned in court, according to the Kaiser Family Foundation. However, the work requirements are not in effect in any state at this time.
The Supreme Court will decide on Nov. 20 whether it should consider a case challenging work requirements in Arkansas and New Hampshire.
Biden’s Health and Human Services secretary would be able to withdraw the approvals, but it’s a complicated task, said Joan Alker, executive director of the Center for Children and Families at Georgetown University. The secretary should consider whether to revoke the authorization for the entire waiver or only for certain features.
Several of these waivers included other provisions that could make it more difficult for low-income Americans to maintain Medicaid coverage, such as lockouts for non-payment of premiums.
And just before Election Day, the Trump administration approved Georgia’s waiver that will allow the state to replace the federal Obamacare exchange, healthcare.gov, with a private platform.
While secretaries have the power to revoke override approvals, this is not typical. It is more common to set new guidelines for when a waiver occurs for renewal and for new applications.
Short term health plans
An executive order that Trump repeatedly points out is the expansion of short-term health plans, which typically have lower premiums but offer less comprehensive coverage and do not have to adhere to the protections of the Affordable Care Act. for people with pre-existing illnesses. The president touted them as a cheaper alternative to Obamacare.
In 2018, the administration allowed Americans to buy these plans for just under a year, overturning the Obama administration’s decision to limit their duration to just three months.
“The short-term plans have important symbolic significance as they limit coverage to people with pre-existing conditions, which was a high political issue in the campaign,” said Larry Levitt, executive vice president of policy at health at the Kaiser Family Foundation.
Affordable Care Act funding cuts
In its first year in office, the Trump administration cut funds to promote the open listing of Obamacare and to help consumers choose 90% and 84% plans, respectively. Many supporters of the Affordable Care Act say the lack of publicity is one of the reasons enrollments have fallen in recent years.
Trump officials have also reduced the open registration period for the federal exchange to six weeks, half of what it was before.
And during the pandemic, the president refused to open a special enrollment period to allow the uninsured to choose policies – despite requests from insurers and even several Republican governors to do so.
The Biden administration is expected to reverse all these measures to reduce Obamacare.
Referral restriction for Title X abortion
Biden has vowed to revoke the Trump administration’s rule banning federally funded health care providers in the Title X family planning program from referring patients for abortions.
Title X serves about 4 million people a year, according to the Department of Health and Human Services. It funds projects that provide resources such as contraception, breast and cervical cancer screening, and prevention education and screening for sexually transmitted diseases and HIV – but not abortions.
Last year, HHS banned health care providers participating in the program from discussing abortion with female patients or offering abortion referrals, resulting in multiple challenges in federal courts, resulting in blockages on the rule.
In July 2019, the 9th US Circuit Court of Appeals upheld the court’s earlier ruling that the rule should go into effect despite the ongoing challenge against it. The following month, the court dismissed Planned Parenthood’s request to overturn its order, prompting the organization to withdraw from the program.
The impact of the entry into force of the rule has been striking. About 900 clinics dropped out of the program in early 2020, according to a report by reproductive rights group Power to Decide, citing examples of more limited and more expensive services. Additionally, after HHS opted to reallocate abandoned Title X funds to other remaining participants, a report from the Kaiser Family Foundation revealed gaps in the new coverage.
The American Medical Association, the leading industry group for physicians, last month asked the Supreme Court to block the rule, citing conflicting rulings after the 4th Circuit Court of Appeals upheld the blocking of a lower court on the rule in September.
Mexico City Politics
Biden has vowed to overturn the so-called Mexico City Policy, a funding ban for foreign nonprofits that perform or promote abortions, which Trump reinstated and extended during his tenure.
The Trump administration reinstated the measure – which previously only impacted family planning assistance – in 2017 through a presidential memorandum and extended it to all global health funding applicable to states – United within the framework of the “Protecting Life in Global Health Assistance” program.
According to the Government Accountability Office, an independent, non-partisan agency that works for Congress.
In September, the Trump administration put forward a proposed regulatory rule to further expand the ban, which already encompasses global health subsidies and cooperative agreements, to apply to contracts. 60-day rule comment period ended on Friday.
Based on data from 2013 to 2015, global health funding provided through contracts could account for nearly 40% of all funding affected by the extended rule, said Jen Kates, vice president at the time. Senior and Director of Global Health and HIV Policy at Kaiser. .
Originally implemented by the Reagan administration, the policy was quashed by Democratic presidents and reinstated by Republican presidents, last retracted by the Obama administration in 2009. Even during the Obama years, US law prohibited the direct funding of abortion services. But the NGOs that performed the procedure were allowed to receive US funding for other programs, including those related to access to contraception and postabortion care.
Funding for family planning
The Biden administration is also expected to reinstate a directive that states cannot prohibit Medicaid funds from going to qualified providers who separately provide abortions, such as Planned Parenthood. Medicaid funding does not cover abortions except in cases of rape, incest, or when a woman’s life is in danger, due to the Hyde Amendment of 1976.
In 2018, HHS issued a letter to state directors of Medicaid rescinding a 2016 Obama administration directive from April 2016, which warned that cuts to family planning service providers would violate federal law. Trump also signed a bill in 2017 allowing states to withhold federal money from organizations that provide abortion services, including Planned Parenthood.
LGBTQ regulations
The Trump administration has been particularly hostile towards transgender Americans. Among its most criticized measures was an effort earlier this year to roll back an Obama-era regulation banning discrimination in healthcare against transgender patients. A federal judge blocked the repeal this summer, ruling it violated a recent Supreme Court ruling.
Biden’s website specifically refers to the effort and says it will “stand up for the rights of all people – regardless of sex, sexual orientation, gender identity – to have access to health care. quality health, affordable and without discrimination. ”
Biden’s LGBTQ policy plan also says he will work to expand funding for mental health services for LGBTQ Americans and that his administration plans to automatically enroll low-income LGBTQ people in the public option, once it is created if they live in rural areas in states that have not developed Medicaid.
