When it comes to health policy,President Donald Trump made it his mission to undo many measures his predecessor put in place.
President-elect Joe Biden is expected to do the same.
In their four years in office, the Trump administration made sweeping changes that affected the Affordable Care Act, Medicaid, abortion, and transgender rights, in many cases reversing the efforts of the Obama administration. Most of the measures were done through executive orders and regulation since it was tough to get any bills through Congress, particularly after the Democrats took control of the House after the 2018 midterm elections.
Biden’s health officials will likely be active, as well, but it will take time for all their actions to take effect.
“They don’t have a massive eraser pen. They’ve got to go through the rule-making process,” said Allison Orris, a former Obama administration official, and counsel with Manatt Health, a professional services firm. “They are going to have to think about what comes first, second, and third and be realistic about timing.”
Plus, the Biden administration may opt to keep and continue several Trump administration efforts, including shifting to value-based care, rather than paying doctors for every visit and procedure, and increasing access to telehealth, said Ian Spatz, senior adviser at Manatt.
The two administrations also share common views on some measures to lower drug pricing, including basing Medicare payments on the cost of prescription medications in other countries and importing drugs from abroad. But Trump officials have not actually put these proposals in place.
However, where the two administrations will differ significantly is messaging, Spatz said. While Trump focused on dismantling the Affordable Care Act, Biden will emphasize expanding the law and access to health coverage.
Here are seven Trump health care measures the incoming Biden administration is expected to reverse.
The Trump administration took the historic step in early 2018 ofallowing states to require certain Medicaid recipients to work in order to receive benefits. Eight states have received approval, seven have pending requests, and four had their waivers set aside in court, according to the Kaiser Family Foundation. However, work requirements are not in effect in any state currently.
The Supreme Court will decide on November 20 whether to consider a case challenging work requirements in Arkansas and New Hampshire.
Biden’s Health and Human Services secretary would be able to unwind the approvals, but it is a complicated task, said Joan Alker, executive director of the Center for Children and Families at Georgetown University. The secretary would have to determine whether to withdraw permission for the entire waiver or just certain features.
Several of these waivers included other provisions that could make it harder for low-income Americans to retain 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 reverse waiver approvals, it isn’t typical. More common is setting new guidelines for when a waiver comes up for renewal and for new applications.
Short-term health plans
One executive order Trump repeatedly points to is expanding short-term health plans, which typically have lower premiums, but provide less comprehensive coverage and don’t have to adhere to the Affordable Care Act’s protections for people with pre-existing conditions. The President has touted them as a less expensive alternative to Obamacare.
In 2018, the administration allowed Americans to purchase these plans for just under a year, reversing the Obama administration’s move that restricted their durations to only three months.
“The short-term plans have important symbolic significance because they restrict coverage to people with pre-existing conditions, which was a prominent political issue in the campaign,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.
Affordable Care Act funding cuts
In its first year in office, the Trump administration slashed funds to promote Obamacare open enrollment and to assist consumers with selecting plans by 90% and 84%, respectively. Many Affordable Care Act advocates point to a lack of advertising as a reason why sign-ups have slipped in recent years.