RFK Jr. fuels uncertainty on policies from Medicare to abortion

Hartford Courant – Sunday, November 17, 2024
By Tribune News Service

WASHINGTON — Robert F. Kennedy Jr.’s selection to serve as President-elect Donald Trump’s top health official is prompting questions from policy watchers over how the pick will handle the range of key health policies that would fall under his purview.

Kennedy, an environmental lawyer and leading vaccine skeptic, has been vocal on his positions against food additives and immunization recommendations. But the nominee for secretary of the Department of Health and Human Services has been relatively quiet on many of the other issues he would oversee while leading 13 supporting agencies and more than 80,000 federal employees.

The pick’s position on the Medicare agency’s drug price negotiations under the Inflation Reduction Act is unclear, as are his thoughts on the Food and Drug Administration’s defense of the safety of the abortion pill mifepristone, which has been subject to litigation from doctors and Republican-led states that want to see it restricted.

Analysts are divided on what Kennedy’s leadership could mean for the $800 billion Medicaid program, as well as the continuation of the Affordable Care Act.

The position the agency takes on these issues is likely to be influenced less so by Kennedy’s personal positions, analysts say, as they watch for the wider group of leaders Trump and Kennedy bring in to inform the administration’s domestic policy priorities.

The HHS secretary’s role is “almost more about the message it sends, or the messaging that he or she delivers, and not necessarily so much about the fine points of policy,” said Matt Salo, former executive director of the National Association of Medicaid Directors.

—Medicare, ACA

Kennedy, if confirmed, is likely to focus mainly on issues related to science and evidence, with less attention on the Centers for Medicare & Medicaid Services, according to Richard Hughes, an attorney at Epstein Becker & Green, P.C., in Washington, D.C.

Despite previous GOP efforts to repeal and replace the Affordable Care Act, “there’s so much popularity around coverage expansions that it would be really hard to see a rollback of any of the commercial coverage requirements,” in the ACA, Hughes said.

Patient advocacy group Families USA “will be at the barricades to defend the core commitments of Medicaid, Medicare, the Affordable Care Act,” the group’s director, Anthony Wright, said in a statement shortly after the election.

Trump and Kennedy could also try to overturn, repeal, or remake the IRA’s Medicare drug price negotiations that set “fair prices” for drugs provided under the program, using international reference pricing instead of direct negotiations, Hughes said.

Anna Kaltenboeck, who helped write the drug pricing provisions of the IRA and now serves as director of ATI Advisory’s Prescription Drug Reimbursement Practice, said Kennedy’s position to “stop the revolving door between industry and government” could “influence his disposition towards negotiation.”

But in the short term, Kaltenboeck expects the negotiation timeline to move forward as planned. The CMS has already announced the negotiated prices for the first 10 selected drugs, and under the IRA’s provisions must select the next round by Feb. 1.

“The law is fairly prescriptive,” Kaltenboeck said, but added the administration “might revisit how it approaches implementation.”

—Medicaid

Medicaid could be in the crosshairs under Kennedy’s leadership, analysts say.

“It’s an easy target” when Congress and the administration is looking to lower costs, Hughes said. The GOP previously tried cutting Medicaid through “per capita caps,” or block grants that proved unpopular because they could increase state costs.

Jeff Hutt, spokesman for the Make American Healthy Again PAC, said he never discussed with Kennedy plans for the Medicaid program, which covers more than 72 million of the nation’s most financially needy patients. “But discussions regarding other entitlement programs leads me to believe that he has no intention of cutting Medicaid. If anything, I think he would want to reform and re-regulate the program,” he said in an emailed statement.

Marc Samuels, founder and CEO of consulting firm ADVI Health, said if Kennedy’s “focus remains on other areas, he may defer to his CMS Administrator for Medicaid policy decisions.”

In that scenario, we could see an effort from the Trump administration to “cut Medicaid — whether through reduced enrollment or payment changes,” which “would likely have downstream impacts on patient access and provider reimbursement,” Samuels said.

Salo, now the founder and CEO of Salo Health Strategies, said to expect that work requirements for Medicaid beneficiaries will “be back at the forefront of a lot of conversations in a lot of states in Medicaid over the next four years.”

Work requirements for Medicaid beneficiaries could be imposed administratively through the CMS or legislatively through Congress, Hughes said.

—Abortion

As secretary, Kennedy would also face the ongoing litigation involving the abortion pill, as well as other issues related to reproductive health.

He has gone back and forth on his views on abortion regulation, but said in a June 14 post on X that “abortion should be legal up until a certain number of weeks, and restricted thereafter.”

Policy analysts have said they expect federal guidance on emergency abortion care and expanded privacy protections to be withdrawn under a second Trump administration. Trump has argued the issue of abortion regulation should be left to states.

I. Glenn Cohen, a bioethics and health law professor at Harvard University, said the FDA and Department of Justice under the second Trump administration may also withdraw its support of mifepristone in ongoing litigation, where Republican-led states recently intervened.

The FDA and DOJ under President Joe Biden defended the decision to make “changes that significantly improved access to medical abortion,” and a “Trump FDA/DOJ may go in the opposite direction,” Cohen said.

On Nov. 11, Michael Bloomberg, the majority owner of the Bloomberg media company, published an opinion column critical of appointing Kennedy to a role in the Trump administration.

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