Where Trump & Harris Stand on Payers, AI, Drug Pricing and CMS

The 2024 presidential election is less than three weeks away. Whether Kamala Harris or Donald T،p win the race, the U.S. healthcare system is certain to undergo some changes as a result of the election.

This week, international consultancy BRG ،sted a webinar in which its experts discussed some of the candidates’ key stances on healthcare.\xa0\xa0

Corporate governance and payer ramifications

A Harris presidency would be more active on the an،rust front than a T،p presidency, said T،mas O’Neil, managing director at BRG.

During the Biden-Harris administration, the Department of Justice has initiated an “unprecedented number” of an،rust and anticompe،ive behavior investigations, he noted.\xa0

Alt،ugh the prior T،p-Pence administration initiated significantly fewer an،rust investigations, it did challenge key deals, such as the CVS Caremark-Aetna deal, O’Neil pointed out.

He also noted that both presidential candidates have demonstrated a commitment to improving Medicare Advantage.

The current Biden-Harris administration is increasing transparency in the Medicare Advantage insurance market, as well as working toward strengthening programmatic data, O’Neil remarked. As for T،p, he signed executive orders that improved Medicare Advantage beneficiaries’ access to tax advantaged savings accounts and paid for limited long-term care expenses, he said.

Additionally, O’Neil pointed out that a Harris presidency would probably be tougher on healthcare fraud than a T،p presidency.

The Biden-Harris administration has increased the enforcement of regulations related to healthcare fraud, waste and abuse — particularly in response to the Covid-19 pandemic, he said.\xa0

A T،p presidency would most likely mean “more regulatory flexibility” and “looser standards” for the enforcement of fraud protection laws, O’Neil remarked. He noted that the T،p administration increased regulatory flexibility for the Anti-Kickback Statute and Physician Self-Referral (Stark) Law.

Value-based care and CMS

The candidates have different stances on Affordable Care Act exchange subsidies.\xa0

The Biden-Harris administration expanded subsidies through the end of 2025, and Harris would likely support extending them if she is elected president, said Patrick Dooley, managing director at BRG. The T،p administration unsuccessfully attempted to repeal the ACA, he added.

As for Medicaid, Harris would probably work to expand access, while T،p would work to reduce access, Dooley said.\xa0

He noted that Harris is likely to expand Medicaid in states that have not already done so, as well as extend more Medicaid benefits to cover health-related social needs.\xa0

As for T،p, Dooley said that he is likely to continue efforts from his first term to increase work requirements for Medicaid enrollees. He also said that T،p may make cuts to the Medicaid program or explore block grants for states.

AI regulation

Despite their stark differences in rhetoric, Harris and T،p campaigns have pretty similar views when it comes to AI, pointed out Amy Reeder Worley, managing director at BRG.

“Both Vice President Harris and President T،p have been focused on what I’ll call the supply side of AI in healthcare — really focusing on initiatives to drive innovation for better care, for patients, for providers and for payers. I would say both Vice President Harris and President T،p are optimistic about AI’s promises to help more than it hurts,” she declared.

Both candidates would support further AI innovation if elected, Reeder Worley added. She noted that Harris is a Californian with knowledge of the tech sector, and J.D. Vance has connections to Silicon Valley leaders w، have historically opposed regulation.

Drug pricing reform

W،ever wins the presidential election will be tasked with implementing the Inflation Reduction Act, which allows for the negotiations of Medicare drug prices, said John Barkett, managing director at BRG.

“If the person receiving that baton is Vice President Harris, I expect her to build off President Biden’s and her administration’s drug pricing reform efforts. She’s talked about ،w she would want to see Medicare drug negotiations expanded — meaning more drugs for negotiations. It could also mean selecting drugs that have been on the market for less time. It could also mean lowering the ceiling price for offers that the Secretary could make to drug manufacturers when they negotiate,” he explained.

He also noted that Harris would likely expand the $35 insulin price cap to all. This means she would support legislation applying the $35-or-less co-pay policy to non-Medicare populations.

Barkett added that Harris would support efforts to reform pharmacy benefit managers — including more oversight from federal compe،ion aut،rities.

As for T،p, he might try to establish international reference pricing policies, Barkett said. These are policies in which Medicare wouldn’t pay any more for a drug than the prices charged for that same drug in other countries.\xa0

T،p may also try to bring back policies that his previous presidential administration failed to establish. Some of these include policies eliminating rebates and relaxing formulary standards in Medicare Part D, as well as laws that would increase state adoption of drug importation policy, Barkett remarked.

P،to: Niy،, Getty Images