The changing operating environment

Healthcare was not a primary focus during the 2024 election campaign, overshadowed by issues like the economy and immigration, Trebes and Palmer said.

Palmer noted that, while there was little detailed health policy discussed, some hints were given, such as House Speaker Mike Johnson's (R-La.) brief mention of wanting to repeal the Affordable Care Act (ACA) and Vice President-elect JD Vance's idea of separating people with pre-existing conditions into high-risk pools.

However, Palmer emphasized that the best way to predict future policies is to look at Trump's first term, though there have been some notable changes in the operating environment since then. Trebes highlighted some of those significant changes between Trump's first term and what can be expected in his second term.

In addition, public trust and engagement with institutions have also evolved, and there have been changes in policymaking and the legal environment, such as Supreme Court rulings that have expanded presidential power and the use of budget reconciliation for significant legislation like the Inflation Reduction Act.

The role of key appointments

One of the critical factors that will shape healthcare policy in the next administration is the appointment of leaders to key federal agencies. Woods emphasized the importance of who will be in charge of agencies like HHS, FDA, CDC, and the Federal Trade Commission.

After the episode was released, Trump nominated Robert F. Kennedy Jr. to be secretary of HHS, whom Trebes and Palmer noted has a number of controversial views on vaccines and public health.

Healthcare leaders need to pay close attention to the names being considered for these key positions, as their relationships with Trump and their ability to influence his decisions will be crucial, Trebes and Palmer said.

Trebes advised that healthcare leaders monitor these developments and engage with their advocacy teams to influence their senators' decisions on these appointments.

"There is a role for healthcare leaders to be paying attention to the names that are getting passed around because I think … this will be a very personality dependent administration and how these leaders get along with Trump will matter a lot in how the leaders he picks are able to convince him to go one way or another," Trebes said.

She also stressed the importance of having a consistent organizational stance on public health issues and supporting healthcare workers in navigating the complexities of varying guidelines and potential misinformation.

The ACA, Medicaid, and Medicare

The ACA is likely to face challenges under the new administration, Trebes and Palmer said. Palmer noted that a full repeal and replace, even with a Republican trifecta in Congress, is probably unlikely.

"I honestly don't necessarily think that repeal and replace is likely to happen because I don't know that Republicans in the House and Senate have the political appetite to attempt it again" like they did during Trump's first term, Palmer said, adding that Trump's approval ratings in his first term were among their lowest during the attempts to repeal and replace the ACA.

"It wouldn't shock me if some people attempt a repeal and replace thing, but I just don't know that Republicans necessarily can agree on what to replace the ACA with," he added.

While a full repeal and replace effort may not be politically feasible, there could be attempts to undermine the ACA through measures like reducing funding for navigators and cost-sharing reduction subsidies.

The expiration of enhanced ACA subsidies, which have significantly increased enrollment and affordability, is another critical issue. Without these subsidies, premiums could rise, leading to a decrease in enrollment and increased instability in the marketplace.

Medicaid is also expected to see changes, particularly with the potential reintroduction of work requirements and potential shifts to block grant funding.

These changes could lead to increased administrative burdens and variation in coverage across states, Trebes and Palmer said. Medicare, particularly Medicare Advantage, may experience a more favorable climate under the new administration, but the future of drug price negotiations remains uncertain.

Abortion and reproductive health

Abortion access was a major issue in the 2024 election and will continue to be a contentious topic, Trebes and Palmer said. The likelihood of a national abortion ban is low due to the political hurdles involved, but the patchwork of state laws will persist.

Healthcare leaders must navigate the complexities of varying state regulations and the potential impact on workforce and patient care.

Trebes noted that states "do not exist in a vacuum. People move between states … Organizations operate across state lines. And so there are a number of other aspects to the abortion access question."

Trebes specifically mentioned prescribing across state lines through telehealth and mifepristone access through the mail as two key aspects of reproductive care.

Trebes and Palmer also noted the lawsuit brought before the Supreme Court over the summer challenging mifepristone was ultimately rejected by the court as they found the plaintiffs lacked standing. However, Trebes and Palmer said, if a plaintiff with better standing comes in, it's possible the Trump administration would not want to defend the same lawsuit.

It's also possible the Trump administration would want to change guidance related to the Emergency Medical Treatment and Labor Act (EMTALA). Trebes noted the Biden administration released guidance clarifying how EMTALA affected pregnancy complications and emergencies, which the Trump administration may elect to change.

Trebes added that ultimately, while there are "a lot of really extreme things that are chaotic and very salient right now that probably will affect the structure of the future," there are "some big shifts in what care utilization and morbidity looks like under the surface, what payer-provider partnerships look like, [and] what the treatment portfolio we have available as we shift from more procedures to more drugs."

As a result, healthcare leaders should make sure they "don't lose sight of your need to focus on adapting to those in the midst of all of this policy change," Trebes said.

Join us for a discussion about the state of the healthcare industry heading into 2025. We will unpack what leaders should know about the biggest trends in the industry — from the shifts upending care utilization to the impact of the new administration on health policy. Then we will dig into what the future holds for health system strategy in a world of constant disruption, rising costs, and evolving patient demand. Finally, we’ll explore the cross-industry power dynamics shaping provider networks, pharmacy competition, and harnessing shared healthcare data.