Gaming out Trump 2.0

May 29, 2024 | By Victoria Knight and Peter Sullivan

Axios Pro

Official Washington is starting to game out what a second Trump presidency would mean for health policy, with industry and conservative groups prioritizing options — including for if there’s a GOP sweep, Victoria and Peter report.

Why it matters: A Trump win would once again shock the system, bringing unpredictability and the possibility of cuts to federal health programs.

Inside the room: Several GOP lobbyists told Axios that client requests to help game out 2025 have intensified in the last six weeks, with more requests to connect to and build relationships with Trump world.

  1. The sessions are starting out with a review of how reconciliation works, said one lobbyist. Then, there’s gaming out how particular health policies could affect various industries.
  2. There also are plenty of questions about who may be tapped for a Trump administration, though K Street feels much more prepared on that front than in 2016.

The latest: A Republican administration and Congress would likely use reconciliation to extend the 2017 Trump tax cuts, but there is also discussion of bundling health care elements into one big package.

  1. House Majority Leader Steve Scalise has said that if Republicans are in control on all fronts, they want to take the Democratic “whole of government” approach to reconciliation, the way it was used in the Inflation Reduction Act, per one GOP lobbyist.
  2. Possible options include Medicare site neutral payments for hospitals, a crackdown on Medicare Advantage overpayments to insurers, or Medicaid cuts.
  3. All of those policies may be attractive because they could generate savings and help to offset the cost of a big legislative package.

It promises to be an exceedingly busy year regardless of the election outcome, with enhanced ACA subsidies due to expire along with the tax cuts and another showdown over raising or suspending the debt ceiling.

  1. There’s even the long shot prospect of a renewed push to repeal and replace the Affordable Care Act.

What they’re saying: “If Republicans run the tables in November, the margin of victory will be so narrow that repeal and replace is probably unrealistic, but I do think the IRA enhanced ACA credits are as good as dead,” said Dean Rosen, partner at Mehlman Consulting.

  1. GOP sources say there is more planning in Republican circles than there was in 2016, when the transition was more chaotic.

Reality check: It’s never certain what Trump will decide to focus on.

  1. One possibility is a “most-favored nation” policy to lower drug prices.
  2. Trump talked about that a lot in his first term but a last-minute push to finalize it was blocked in court.

“I think you’ll see him give that a lot of attention,” said Brian Blase, a former Trump health official and president of Paragon Health Institute, one of the Trump-aligned groups working on policy options.