In the next four years, block grants and work requirements could be back on the table for Medicaid. The Trump administration could revive skinny insurance plans restricted by the Obama and Biden regimes. And the government could crack down on price transparency, while slashing regulations in other areas like staffing mandates for nursing homes.
Those are some predictions from former HHS Secretary Tom Price, the first leader of the massive health department during President-elect Donald Trump’s first term.
Price, an orthopedic surgeon and former congressional representative from Georgia, served as HHS secretary for most of 2017 before resigning amid a scandal over his use of taxpayer dollars to pay for private flights.
He joined Healthcare Dive for a wide-ranging interview on Trump’s second term, including how the president-elect’s immigration policies intersect with staffing issues and how “transparency, competition and choices” will serve as the guiding light of the administration in regulating — or, more likely, deregulating — the healthcare industry.
Price also discussed how the Department of Government Efficiency could shape Trump’s healthcare policies, and shared leadership advice for the president-elect’s controversial pick to head up the HHS: noted vaccine skeptic and conspiracy theorist Robert F. Kennedy Jr.
Editor’s note: This interview has been edited for clarity and brevity.
HEALTHCARE DIVE: What do you think the HHS’ main priorities will be Trump’s second time around?
TOM PRICE: The campaign laid out their three guiding principles on healthcare: transparency, competition and choices. If you think about whatever issue of interest one might have, those are the goalposts you should look at.
Transparency, whether it’s on the payer side or the provider side — giving patients more information about both I think will be a priority. Competition is clearly something that the president-elect holds dearly and strongly believes that with greater competition and greater efficiency, lower costs can occur. And then choices — he has always been strongly in favor of having patients be the ones selecting the mode of treatment, method of treatment and by whom.
You mentioned transparency. Do you expect the Trump administration to crack down on entities violating price transparency regulations?
I wouldn’t be surprised at all. I also wouldn’t be surprised if they marry it with the efforts of DOGE, with the AI activity that can occur and the use of large data to be able to give folks more information on whatever it might be that they’re interested in. I think there’s going to be an umbrella over everything in the government about saving resources. If you look at that in healthcare, the transparency rules will be championed again.
How big of a role do you think DOGE — essentially a presidential advisory entity without real power from Congress — will play in healthcare?
It’s going to be interesting to see how it plays out. As you mentioned it doesn’t have an official role, for a variety of reasons. I think DOGE will mostly be setting the tone and the tenor of what the departments should look at in terms of efficiencies and savings.
I wouldn’t be surprised if they — setting guidelines is too strong a word, but if DOGE lays out goals for spending and programs that should be looked at in terms of their organization and breadth, and making suggestions about gaining efficiency.
I think they’ll have some effect. I don’t know how long it’ll last, and I don’t know how deep it’ll go.
Republicans appears to be zeroing in on Medicaid for cuts. There’s been talk of block grants or per-capita spending caps. There’s been talk of reviving work requirements. What’s the likelihood of these controversial policies being enacted?
If you think about how to reform Medicaid in ways that would be helpful to both patients and folks providing care, greater flexibility and choices for Medicaid recipients to be able to utilize different types of coverage vehicles might be something that would be embraced — as well as the greater specificity of a line item for the federal government.
So block granting or whatever the latest term may be for giving states resources to allow them to spend in their Medicaid program as they see fit, with fewer strings from the federal government, including potentially work requirements — I think all of those things will be explored.
You mentioned policies allowing Medicaid beneficiaries to use different types of coverage vehicles. Can you be more specific?
There have been discussions in the past about being more responsive to patients through a high deductible catastrophic plan, with health savings arrangements, even in the Medicaid program. There are some who believe that a direct primary care program is an ideal opportunity for reform in Medicaid, giving folks ready access to a provider which they oftentimes don’t have. If you’re trying to read tea leaves, I think one ought to think expansively and creatively about what could be done to allow patients to have something more responsive to their needs than what currently exists.
Trump describes the ACA as “lousy,” but has failed to elaborate upon the concepts of a healthcare plan he teased during the campaign. Do you think his administration might try again to repeal Obamacare?
I don’t think so. What — 21 million people covered in exchange plans? What we would see is going back to choices and transparency and competition. In the ACA, that would be similar to what I’ve mentioned with Medicaid: much greater flexibility with what recipients can select as their coverage vehicle.
Vice president-elect JD Vance has proposed allowing insurers to stratify risk pools, a common practice before the ACA that could lower costs for healthy individuals but make insurance unaffordable for people with preexisting conditions. Is that, or should that, be on the table?
That would be a heavier lift. But it could be discussed, because it makes insurance work more like insurance, rather than just a subsidized plan. But it’s one of those issues that tends to get demagogued pretty quickly. So it would be a challenge.
Are there any areas for bipartisan movement?
The healthcare workforce. We’re getting stretched thinner and thinner in doctors, nurses and other workers. There’s a ready way to marry that with the desire of the incoming administration to have some immigration reform early on. The whole issue with merit-based visas, and about 20% of folks in the healthcare workforce being foreign-born — if you make it so individuals who are trained here are able to stay here, that will address workforce issues.
That seems to fly in the face of the president-elect’s plans for mass deportations and restricting other immigration policies like birthright citizenship.
Well, that’s not specifically in my wheelhouse. But President-elect Trump has talked about making certain foreign students that get educated here have an opportunity to stay right away. If you look at the posture of the incoming administration on immigration, I think they would say that for folks who add benefit from a workforce standpoint to American society, then that’s all to the good.
The objections I think that they have are for folks that aren’t necessarily bringing any talents that will benefit the society.
This overlaps with the Biden administration’s staffing mandate for nursing homes, a push to improve care quality which industry opposed citing a lack of workers. Is that something the Trump administration might roll back?
It’s possible. The dogmatic approach that the Biden administration took was, classically, to define very specifically what folks must do without any real attention to the quality of care being provided.
Coming back to the ACA and one of the biggest questions facing Washington in 2025. Do you think Republicans will move to save more generous subsidies for marketplace plans that have spurred record enrollment, or let them expire at the end of next year?
That’s one area where you’ve got a huge opportunity to keep the subsidies, but provide greater flexibility and choices for patients. I see that as a negotiating opportunity for the administration and folks on the Hill who want patients to have greater flexibility to select the plans they want.
These deadlines are often the impetus for an agreement to be put in place. Ending subsidies across the board would be a challenge. But the problem is that if nothing is done, that’s what happens. And oftentimes Washington is very good at doing nothing.
Will the Trump administration will once again expand alternatives to ACA plans, like short-term coverage?
Yes, along with association health plans. There was a lot of good work done in the previous Trump administration on AHPs, and the courts objected to a portion of that. They have to be tinkered with a bit. But anytime you can allow for individuals from a flexibility standpoint to pool their resources to purchase coverage that fits the bill for choices and competition. I wouldn’t be surprised at all.
Pivoting to Medicare — there’s a desire among many Republicans (including Mehmet Oz, Trump’s pick for CMS administrator) to continue privatizing Medicare and push more enrollees to Medicare Advantage, despite evidence it costs the government more. What do you think the Trump administration’s stance will be on MA versus traditional Medicare?
Anything that gives greater predictability and shifting of risk to the folks insuring those MA plans, that will be seen as attractive within the administration. The responsibilities of the federal government become more predictable when you’re shifting that risk.
The Biden administration was supportive, they just didn’t allow for the kind of flexibility for the plans to be, from a financial perspective, successful.
Do you think Kennedy and Oz will be good stewards of the government’s healthcare programs? Do you think they’ll be confirmed by Congress?
My sense is that this is not where the battles are going to be held for confirmations. I’m not sure I would have said that three weeks ago. But it seems like other nominations are taking the fore. And the Senate can’t battle everybody.
I’m heartened that the top folks being nominated for major health positions are physicians, besides Kennedy obviously. Anybody that’s practiced medicine and taken care of patients brings a broader perspective to the job.
Do you have any advice for Kennedy if he’s confirmed?
HHS is a wonderful institution — 80,000 employees, all around the world, whose mission is to make us healthier and safer. Gaining a perspective about the breadth of the HHS’ mission is incredibly important, and so is recognizing that the vast majority of folks working in HHS, across all the agencies and divisions, are incredibly dedicated.
Many of them have chosen this to be their life’s work. There’s some subject matter experts within HHS that don’t exist anywhere else. And it’s important to appreciate that and then lead in a way that allows them to do the absolute best job they can on behalf of the American people.
