The 2024 elections are raising important questions about the future of healthcare and federal health policy. Stakeholders are especially interested in how a new presidential administration and a potentially reconfigured Congress will address a range of topics, including drug pricing under the Inflation Reduction Act (IRA) and reforms to the Medicare Advantage (MA) program.

On August 14, Avalere hosted a webinar that featured the Honorable Alex M. Azar, former Secretary of Health and Human Services, and Dan Mendelson, CEO of Morgan Health and founder of Avalere. During the event, titled, “Election 2024: What’s at Stake for Healthcare?” Avalere and external experts explored the policy differences—and similarities— between former President Donald Trump and Vice President Kamala Harris, and the potential implications of these stances on life sciences firms, health plans, providers, and patients and patient advocates.

Below is a summary of key takeaways from the webinar. To access the full conversation—which addressed issues such as the impact of Part D redesign, the headwinds facing Medicare Advantage, the 340B drug pricing program, the future of the Affordable Care Act (ACA), reproductive rights, and private insurance, among others—download the webinar recording.

Presidential Candidates’ Priorities

Neither candidate has offered much detail on their healthcare priorities thus far, but with experience in the White House, both offer a track record from which to make inferences.

Reproductive health has emerged as a critical and voter-supported issue for Vice President Harris; if elected, she may pursue related policies as much, if not more, forcefully than the Biden administration. If elected, she may also prioritize adding dental and vision benefits to standard Medicare coverage. If Democrats have a majority in one or both chambers, this is especially likely, as there is already interest among Congressional lawmakers.

Former President Trump is likely to revive policies pursued in his first term. These include offering states more flexibility with regards to Medicaid, emphasizing price transparency, and promoting alternatives to ACA marketplace plans, such as association health plans and short-term, limited duration insurance plans. It is unlikely that a potential Trump administration will attempt to repeal and replace the ACA again, but it will likely not promote the law.

IRA Implementation and Drug Pricing

The next president will be a key decider when it comes to continued IRA implementation and what the second round of Medicare drug price negotiation looks like. February 1, 2025 (just 12 days after inauguration) is the deadline for the US Department of Health and Human Services to announce the next 15 drugs selected for negotiation, with prices taking effect in 2027.

Under a Harris administration, it is likely that implementation of the IRA will follow the same trajectory as under the Biden administration. During the webinar, Ashley Flint noted that the August 15 announcement of the maximum fair prices for the first round of negotiated drugs came just before the two-year anniversary of the IRA’s passage and “represents a passing of the baton from Biden to Harris on this issue.” If elected, Vice President Harris may also pursue incremental expansions to the IRA, such as extending caps on insulin copayment to the commercial market.

If elected, former President Trump is unlikely to pursue a complete rollback of the IRA—even with Republican majorities in Congress—but is expected to explore flexibilities within the law. Specifically, a second Trump administration may resurrect its previous “Most Favored Nations” proposal for Part B drugs that would have relied on an international reference pricing approach. Further, it could revisit the Center for Medicare and Medicaid Services’ (CMS’s) current approach to defining drugs eligible to be selected for negotiation and the approach that the agency has taken to assessing whether generic or biosimilar competition exists in the market. With a Congressional majority, a potential Trump administration may also pursue incremental legislative reforms such as clarifying the orphan drug exclusion from negotiation.

A second Trump term may also shape the implementation timeline: If Trump is elected in November, the Biden administration may attempt to release the drugs selected for the second round of negotiation before inauguration.

Medicare Advantage

Policymakers across the political spectrum are interested in reforms to Medicare Advantage. With enrollment growth accelerating in recent years and increased plan sponsors’ use of cost containment tools such as prior authorization, policymakers are grappling with how to incentivize plans to innovate how they provide care.

A Harris administration is expected to continue—if not intensify—current oversight of MA plans. Over the last nearly four years, the Biden administration has put rate pressure on MA plans and increased oversight of utilization management practices, marketing tactics, and risk adjustment.

A second Trump administration could return growth in the MA payment rate to historic levels and continue to incentivize growing enrollment in the program. It may, however, pursue further reforms to cut government spending, especially if there is progress on budget legislation to address issues arising out of changes to provisions in the Tax Cuts and Jobs Act at the end of 2025.

What Comes Next

As stakeholders plan for the new Congress and administration, they should organize their strategy into three key phases: pre-election, the two months between the election and inauguration, and post-inauguration. Between now and the election, stakeholders should consider messages or data that could help shape the candidates’ thinking on healthcare policy priorities. In the last few months of 2024 (and potentially into January 2025), government funding will be a priority, regardless of the election outcome. Depending on party control of the 119^th Congress, other legislative activities could stall during the lame duck session and instead spill over into 2025. Post-inauguration, stakeholders will need to implement strategies in keeping with the new political landscape.

Healthcare stakeholders should be preparing now for the spectrum of potential election outcome scenarios and resulting impact on business strategy. To learn more about the election outlook and how Avalere can help you prepare, watch our recent webinar or connect with us directly.