March 21, 2025 • 15 mins
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Health Affairs' Jeff Byers welcomes Deputy Editor Chris Fleming and Katie Keith of Georgetown Law to the program to discuss the 15th anniversary of the Affordable Care Act and the first 50 days of the new Trump administration.
Katie Keith is a frequent contributor to the Health Affairs Forefront series Health Policy At A Crossroads. Catch up on what you may have missed.
Health Affairs will be hosting a theme issue briefing on April 8 to celebrate the release of our April 2025 issue focusing on food, nutrition & health. RSVP for the event and preorder your copy of the new issue today!
Also, join Health Affairs on April 23 for an exclusive Insider virtual event exploring site-neutral payments.
Make sure you sign up for all of our free newsletters to stay up to date on new events, podcasts, Forefront, and journal articles.
Related Articles:
- HHS Proposes To Restrict Marketplace Eligibility, Enrollment, And Affordability In First Major Rule Under Trump Administration (Part 1) and (Part 2) (Health Affairs Forefront)
- What Lies Ahead For Medicaid In Budget Reconciliation? (Health Affairs Forefront)
- Health Affairs Forefront's Following The ACA series
- The Affordable Care Act At Fifteen: Policy Surprises And Lessons (Health Affairs Forefront)
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jeff Byers (00:38):
Hello and welcome to Health Affairs This Week. I'm
your host, Jeff Beyers. We arerecording on 03/20/2025. Before
we begin, heads up, we have avirtual briefing for our
upcoming food, nutrition, andhealth issue on April 8. That
event is open for all.
Check the show notes for that toget more info. We also had a
(00:58):
very, very successful event forour Health Affairs Insider
Program on Medicaid's uncertainfuture. Our next insider event
is April 23 with Brady Poston-site neutral payments. Sign
up for Insider to watch all ofour past events, including the
Medicaid one, and join us inApril. And with that, today on
the program, I am joined byhealth affairs own Chris Fleming
(01:21):
and Georgetown Law's KatieKeith.
Katie and Chris, welcome back tothe program.
Chris Fleming (01:26):
Thank you, Jeff. And I really wanna welcome
Katie, who many of our longtimelisteners and readers will be
very familiar with. For severalyears, the rapid responder for
our Following the ACA featuretopic on Forefront. That was the
rapid responder for our HealthPolicy at a Crossroads track,
which is designed to keep trackof, the many new, health policy
(01:47):
developments and debates thatare happening under the new
administration and the newcongress, which as anybody who
follows that at all remotely,will know. We have our hands
full.
In between those two stints,Katie was at the White House
where she was the deputyassistant to the president and
deputy director of the WhiteHouse Gender Policy Council. And
(02:08):
now in addition to, doing herwork at health affairs, she's
also, as Jeff mentioned, atGeorgetown, where she's the
director of the Health Policyand Law Initiative at the
O'Neill Institute for Nationaland Global Health Law at
Georgetown. Katie, welcome andthanks for joining us.
Katie Keith (02:24):
Thanks, Chris. And you should get all the credit,
as my one time editor, which isa lot more work than than most
people probably realize. Sothank you as always.
Chris Fleming (02:33):
Well, I've I've enjoyed every minute of it. It's
it's been a lot of fun. As Imentioned, you are now doing the
rapid response work for, healthpolicy at a crossroads. So as we
hit the two month mark of thenew administration, I'll be
asking you to look forward interms of what we should be
watching. But I want to startwith something that involves
(02:53):
looking back as well as lookingforward, and that's on March 23
on Sunday, we will hit thefifteenth anniversary of the
Affordable Care Act.
And as I mentioned, you did forseveral years a lot of work
looking at the implementation ofthe ACA under the following the
ACA topic on on forefront. Soyou obviously will have a lot of
(03:15):
thoughts about the legislationand what we've learned. So can
you talk to our listeners alittle bit about, you know, what
we've learned over the pastfifteen years? What are the
takeaways from decade and a halfof of having that landmark
legislation in effect? And thenafter that, we'll we'll look a
little bit forward as to what'sat store for the ACA now.
Katie Keith (03:35):
So I'll start by saying, you know, it's good to
be here. I think fifteen yearsin, there were many pivotal
moments throughout this decadein a, you know, fifteen year
history where that was notalways guaranteed between
supreme court, challenges, youknow, really existential legal
threats, attempts to repeal thelaw broadly in 2017, and then
efforts to undermine itsimplementation during the first
(03:56):
Trump administration, which,spoiler alert, are back. There
have been a lot of threats andwrinkles all along the way. But
I think it's really worthrecognizing at this moment right
now, we're really seeing, Ithink, the benefits of the
Affordable Care Act, thesuccesses of the law itself.
We're at record high enrollment.
That is thanks in large part tochanges made by the Biden
(04:18):
administration and Democrats inCongress to, extend premium tax
credits, first during theAmerican Rescue Plan and then
again during the InflationReduction Act. We again, more
than 24,000,000 people havemarketplace enrollment. You have
many millions more peopleenrolled through Medicaid
expansion. And I would just givea recommendation to some pieces
coming out on forefront fromsome of the architects of the
(04:39):
Affordable Care Act to do aneven better job kind of looking
back at the history and some ofthe lessons learned. I will
spare you, you know, talk of theindividual mandate.
Did it matter? Did it not? Andeven some of those big lawsuits.
But I think we are really at apivotal moment where we are
seeing, again, record highenrollment and yet, you know,
the potential that those,enhanced premium tax credits
(05:01):
will expire if congress does nottake action. That would lead to
millions more people beinguninsured.
Consumers would feel much higherhealth care costs, leading them
to drop their coverage, lead tomore uncompensated care. All of
that could come to fruitionearly next year if congress
doesn't take action, and I thinkyou would really see the erosion
of many of the gains that we'veseen in recent years. And then
the Trump administration in itsfirst major health care rule is
(05:23):
is focused on the AffordableCare Act. We're we're sort of
very far from talks of repealingit replaced that, you and I and
and some of the listeners willrecall from 2016 and 2017 in
particular, but there are stillsort of fundamental differences
in how the Trump administrationapproaches the Affordable Care
Act marketplaces in ways that Ithink are definitely going to
(05:45):
reduce eligibility, lead tocoverage losses, raise premiums,
erode the value of coverage, andand sort of in general, I think,
raise health care costs forconsumers, which ironically is
maybe not what theadministration was elected to
do.
Chris Fleming (05:57):
You mentioned that, the the rule that just
came out, you and Jason Lovitisdid a great job on ForeFront of
analyzing what that rule did andand the the ways it changed the
Affordable Care Act'simplementation. Can you give us
sort of one or two of the most,important ways in which the rule
changes the way that theAffordable Care Act is being
(06:18):
implemented that might hinder,the kinds of enrollment and
access that you just talkedabout?
Katie Keith (06:24):
Yeah. Absolutely. So it really is, Chris, you said
this, but to step back, it's apretty comprehensive rule where
they make a whole series of ofchanges. Yeah. This rule, even
as HHS itself acknowledges, willlead to coverage losses.
They they themselves estimate upto 2,000,000 people could lose
coverage in 2026 alone becauseof these changes. Chris, you
asked for some examples of thechanges in general. A lot of it
(06:47):
is reversing back to policiesthat were in place during the
first Trump administration. So ashorter annual open enrollment
period limits on the ability ofpeople to enroll during the
year, sort of through specialenrollment periods outside of
that annual period, morepaperwork requirements, whether
through the tax filing system orto show your eligibility. One of
the things that they reallytarget that is something the
(07:09):
Biden administration put inplace was a low income a special
enrollment period just for lowincome people to give folks
under a 50% of the federalpoverty level the opportunity to
enroll each month.
They would get rid of that assoon as the rule goes into
effect, so that could besomething that's changing as
quickly as this year. Theyrecognize, I think, lot of these
policies woulddisproportionately impact
(07:30):
consumers in states that havenot expanded their Medicaid
programs in part because a lotof the changes target folks at
the lowest income levels. And sostates like Florida and Georgia
and Texas are most likely, Ithink, to face some of the
coverage losses as a result ofthis rule. So it is a proposed
rule. Do recommend the pieces tofolks if you haven't seen them
(07:52):
yet.
Comments are due April 11, andthen it will take the
administration a little at leastsome time to issue the final
rule. But a lot of the changeswould go into effect sixty days
after that, so we could beseeing some of this disruption
in 2025 and then other changesto come in 2026.
Chris Fleming (08:08):
Well, thanks, Katie. I wanna shift a little
bit, and talk about, some of theother issues that I know you're
watching. We'll start with somesome budgetary issues. We just
had, as you know, a continuingresolution passed by congress
signed by the president thatback in the old days, used you
know, quaint old days, we we hadappropriations bills. Now we
(08:28):
seem to live on continuingresolutions.
This will fund the governmentthrough the end of the fiscal
year. Can you talk a little bitabout what the health elements
or perhaps the lack of healthelements is maybe the more,
accurate way to put it, youknow, that were, part of that
CR?
Katie Keith (08:45):
No. I think it is the most notable for what was
not included in that package.There were some changes like
extending telehealthflexibilities, for example, that
I know a lot of stakeholderswere interested in. There were
some cuts to NIH funding, forexample, but I think most
notably, things that were notincluded in the continuing
resolution was a fix to thephysician fee schedule, which
(09:09):
continues to be delayed, andhistorically has not been
delayed, has actually been takencare of on a regular basis, at
least put off over time, andhere that was not included. I
think, physicians have beenadvocating for that fix over and
over and have now been told itwill be in the coming budget
reconciliation package.
There were not sort ofbipartisan reforms that have
(09:30):
been talked about, things likesite neutral payments. Shout out
to that insider program thatJeff just mentioned. You know,
there was a whole package ofhealth policy changes with
bipartisan support that were notattached to this, vehicle. So I
think more to come. There therewasn't a ton to say, but I do
think that's notable for some ofthe policies that were not
included this time around.
Chris Fleming (09:49):
And then, of course, one of the other
budgetary elements that we'rewatching is, we've got this
reconciliation bill. The recordfor for folks that don't know,
budget reconciliation is amechanism that is often used
because you need generally 60votes in the senate to to pass
anything. But underreconciliation, there's
restrictions, but you can passand you can pass budget bills
(10:12):
with a bare majority, 50 votesplus the the vice president or
51 senators, obviously. Unlikethe CR you just mentioned where
there wasn't a lot of healthpolicy involved, that's gonna
involve a huge amount of healthpolicy and and fights over, in
particular Medicaid, I think wewould definitely say is perhaps
(10:34):
the main area in terms of healthpolicy that where there's going
to be a huge battle. You talkedabout how Medicaid expansion was
part of the ACA.
We saw growth in Medicaid aswell as in the marketplaces. Can
you talk a little bit about thefights that we're gonna see over
Medicaid and, know, everythingfrom work requirements to budget
(10:55):
cuts? What should we be watchingthere?
Katie Keith (10:57):
So first, I would highly recommend a piece by,
star Rosenbaum and AlisonBarkoff for forefront that
really goes through kind of whatis at stake and, the details of
exactly what you laid out andand the fight. I think if if
Republicans in congress getanywhere close to to the cuts
that they have talked aboutmaking that were sort of laid
out in their budget blueprintfor this, budget resolution
(11:18):
process, it would be the largestcut to Medicaid in the history
of the program. And and I thinkthe step back there, of course,
is Medicaid insurers more than80,000,000 Americans all across
the country, the size and scaleof the cuts that are being
discussed, whether from workrequirements to rescinding Biden
era regulations on Medicaid to,I think, per capita caps have
(11:39):
fallen off the discussion table,but anything can happen. And if
those kinds of things come back,provider tax, there's a whole
range of elements that I thinkhave been batted around. I think
the takeaway is anytime you weremaking this scale or even
discussing the scale changes,it's going to come down to cuts
to state budgets, to health careproviders, to benefits for
(12:01):
beneficiaries, and to cover hugedramatic coverage losses.
So again, the largest cut toMedicaid in the history of the
program is what's at stake. Andit's why I think you've had,
even earlier this week, formerRepublican members of Congress
come out and sort of warnagainst this type of cut. You've
seen some moderate House membersalready raise concerns about
cuts to Medicaid. And and thiswas a huge part of the
(12:22):
Affordable Care Act repeal andreplace debate in 2017. And I
think the cuts to Medicaid, inaddition to the Affordable Care
Act, but there was a huge amountof discussion on Medicaid,
helped stave off those broadercuts because it's an extremely,
popular program.
And I think Republicans sort ofunderestimated that in 2017. We
will see if that has changed. Ithink Billy Wynn also had a
(12:45):
great piece for Forefronttalking about some of these
dynamics, And I think his takeis that congress will not get
there, but, of course, there'smore to wait and see. And I
guess, Chris, maybe on the tomake a little bit of a bigger
political point too, I thinkyou've got the budget resolution
process, which could be sort ofthe first big fight on health
care in, you know, presidentTrump's first year here, which
(13:05):
we've seen before. And then youdo have these premium tax
credits for the Affordable CareAct that will expire at the end
of this year.
And so that sets up almost asecond health care fight, again,
during the first year on anissue that it does not seem like
the president himself has reallyprioritized. And so I don't you
know, other politicos could talkabout the wisdom of teeing up
two major health care fights,but but more to come there. And
(13:26):
I just think it's reallyimportant to keep that in mind,
especially ahead of the twentytwenty six midterm elections.
Chris Fleming (13:32):
Let me we we're running out of time, but let me,
go a little bit to you did apiece just recently, the first
fifty days of the, newadministration. Now I guess
we're at sixty days as werecord, on Thursday the
twentieth. So so, Katie, youknow, we obviously, we don't
have time to go through thewhole piece, but maybe pick, one
(13:54):
of the most interestingelements, from what you wrote
that we're you're watching, aswe move forward in the new
political environment.
Katie Keith (14:02):
Yeah. So instead of maybe picking one, I guess what
I would emphasize to folks is myobservation is there's a lot of
old that is new again. So youcan really see an emphasis on
some of the priorities from thefirst Trump administration. I'm
thinking of health care, pricetransparency, I'm thinking of
reproductive health, I'mthinking of tax on sort of
gender affirming care. So all ofthat is discussed there.
(14:23):
And then really keeping an eyeon some of the new changes, the
Make America Healthy Againcommission that's being set up
at Med Quietly, I think,recently in private, which I
didn't have a chance to cover,some of the attacks on public
health and vaccine access thatwe're already starting to see,
and then recissions of Biden eraguidance on anything, everything
from Medicaid to HIPAA. So I Ithink a lot more to come. There
(14:46):
there really is a lot to unpack,and and we'll you know, I will
do my best, to to continue totry to do that at Forefront and
beyond.
Chris Fleming (14:53):
Well, thanks, Katie, and I and I encourage
listeners to watch Katie'sarticle on Forefront for further
developments of which there willbe many, we can be sure. Let me
turn it back over to Jeff toclose us out.
Jeff Byers (15:04):
Yeah. Yeah. Thanks, Chris. Thanks, Katie. And what
better way to stay on top ofForefront than to be a Health
Affairs Today or Health AffairsSunday Update newsletter
subscriber.
So those are free newslettersthat you can get updated on all
those new articles if you don'tgo to our website. And with
that, thank you, Chris andKatie, for joining us today on
(15:24):
Health Affairs This Week. Ifyou, the listener, enjoyed this
episode, send it to the textenthusiasts in your life,
convert them over to audio, andwe will see you next week.
Thanks all.
Hello and welcome to Health Affairs This Week. I'm
your host, Jeff Beyers. We arerecording on 03/20/2025. Before
we begin, heads up, we have avirtual briefing for our
upcoming food, nutrition, andhealth issue on April 8. That
event is open for all.
Check the show notes for that toget more info. We also had a
(00:58):
very, very successful event forour Health Affairs Insider
Program on Medicaid's uncertainfuture. Our next insider event
is April 23 with Brady Poston-site neutral payments. Sign
up for Insider to watch all ofour past events, including the
Medicaid one, and join us inApril. And with that, today on
the program, I am joined byhealth affairs own Chris Fleming
(01:21):
and Georgetown Law's KatieKeith.
Katie and Chris, welcome back tothe program.
Chris Fleming (01:26):
Thank you, Jeff. And I really wanna welcome
Katie, who many of our longtimelisteners and readers will be
very familiar with. For severalyears, the rapid responder for
our Following the ACA featuretopic on Forefront. That was the
rapid responder for our HealthPolicy at a Crossroads track,
which is designed to keep trackof, the many new, health policy
(01:47):
developments and debates thatare happening under the new
administration and the newcongress, which as anybody who
follows that at all remotely,will know. We have our hands
full.
In between those two stints,Katie was at the White House
where she was the deputyassistant to the president and
deputy director of the WhiteHouse Gender Policy Council. And
(02:08):
now in addition to, doing herwork at health affairs, she's
also, as Jeff mentioned, atGeorgetown, where she's the
director of the Health Policyand Law Initiative at the
O'Neill Institute for Nationaland Global Health Law at
Georgetown. Katie, welcome andthanks for joining us.
Katie Keith (02:24):
Thanks, Chris. And you should get all the credit,
as my one time editor, which isa lot more work than than most
people probably realize. Sothank you as always.
Chris Fleming (02:33):
Well, I've I've enjoyed every minute of it. It's
it's been a lot of fun. As Imentioned, you are now doing the
rapid response work for, healthpolicy at a crossroads. So as we
hit the two month mark of thenew administration, I'll be
asking you to look forward interms of what we should be
watching. But I want to startwith something that involves
(02:53):
looking back as well as lookingforward, and that's on March 23
on Sunday, we will hit thefifteenth anniversary of the
Affordable Care Act.
And as I mentioned, you did forseveral years a lot of work
looking at the implementation ofthe ACA under the following the
ACA topic on on forefront. Soyou obviously will have a lot of
(03:15):
thoughts about the legislationand what we've learned. So can
you talk to our listeners alittle bit about, you know, what
we've learned over the pastfifteen years? What are the
takeaways from decade and a halfof of having that landmark
legislation in effect? And thenafter that, we'll we'll look a
little bit forward as to what'sat store for the ACA now.
Katie Keith (03:35):
So I'll start by saying, you know, it's good to
be here. I think fifteen yearsin, there were many pivotal
moments throughout this decadein a, you know, fifteen year
history where that was notalways guaranteed between
supreme court, challenges, youknow, really existential legal
threats, attempts to repeal thelaw broadly in 2017, and then
efforts to undermine itsimplementation during the first
(03:56):
Trump administration, which,spoiler alert, are back. There
have been a lot of threats andwrinkles all along the way. But
I think it's really worthrecognizing at this moment right
now, we're really seeing, Ithink, the benefits of the
Affordable Care Act, thesuccesses of the law itself.
We're at record high enrollment.
That is thanks in large part tochanges made by the Biden
(04:18):
administration and Democrats inCongress to, extend premium tax
credits, first during theAmerican Rescue Plan and then
again during the InflationReduction Act. We again, more
than 24,000,000 people havemarketplace enrollment. You have
many millions more peopleenrolled through Medicaid
expansion. And I would just givea recommendation to some pieces
coming out on forefront fromsome of the architects of the
(04:39):
Affordable Care Act to do aneven better job kind of looking
back at the history and some ofthe lessons learned. I will
spare you, you know, talk of theindividual mandate.
Did it matter? Did it not? Andeven some of those big lawsuits.
But I think we are really at apivotal moment where we are
seeing, again, record highenrollment and yet, you know,
the potential that those,enhanced premium tax credits
(05:01):
will expire if congress does nottake action. That would lead to
millions more people beinguninsured.
Consumers would feel much higherhealth care costs, leading them
to drop their coverage, lead tomore uncompensated care. All of
that could come to fruitionearly next year if congress
doesn't take action, and I thinkyou would really see the erosion
of many of the gains that we'veseen in recent years. And then
the Trump administration in itsfirst major health care rule is
(05:23):
is focused on the AffordableCare Act. We're we're sort of
very far from talks of repealingit replaced that, you and I and
and some of the listeners willrecall from 2016 and 2017 in
particular, but there are stillsort of fundamental differences
in how the Trump administrationapproaches the Affordable Care
Act marketplaces in ways that Ithink are definitely going to
(05:45):
reduce eligibility, lead tocoverage losses, raise premiums,
erode the value of coverage, andand sort of in general, I think,
raise health care costs forconsumers, which ironically is
maybe not what theadministration was elected to
do.
Chris Fleming (05:57):
You mentioned that, the the rule that just
came out, you and Jason Lovitisdid a great job on ForeFront of
analyzing what that rule did andand the the ways it changed the
Affordable Care Act'simplementation. Can you give us
sort of one or two of the most,important ways in which the rule
changes the way that theAffordable Care Act is being
(06:18):
implemented that might hinder,the kinds of enrollment and
access that you just talkedabout?
Katie Keith (06:24):
Yeah. Absolutely. So it really is, Chris, you said
this, but to step back, it's apretty comprehensive rule where
they make a whole series of ofchanges. Yeah. This rule, even
as HHS itself acknowledges, willlead to coverage losses.
They they themselves estimate upto 2,000,000 people could lose
coverage in 2026 alone becauseof these changes. Chris, you
asked for some examples of thechanges in general. A lot of it
(06:47):
is reversing back to policiesthat were in place during the
first Trump administration. So ashorter annual open enrollment
period limits on the ability ofpeople to enroll during the
year, sort of through specialenrollment periods outside of
that annual period, morepaperwork requirements, whether
through the tax filing system orto show your eligibility. One of
the things that they reallytarget that is something the
(07:09):
Biden administration put inplace was a low income a special
enrollment period just for lowincome people to give folks
under a 50% of the federalpoverty level the opportunity to
enroll each month.
They would get rid of that assoon as the rule goes into
effect, so that could besomething that's changing as
quickly as this year. Theyrecognize, I think, lot of these
policies woulddisproportionately impact
(07:30):
consumers in states that havenot expanded their Medicaid
programs in part because a lotof the changes target folks at
the lowest income levels. And sostates like Florida and Georgia
and Texas are most likely, Ithink, to face some of the
coverage losses as a result ofthis rule. So it is a proposed
rule. Do recommend the pieces tofolks if you haven't seen them
(07:52):
yet.
Comments are due April 11, andthen it will take the
administration a little at leastsome time to issue the final
rule. But a lot of the changeswould go into effect sixty days
after that, so we could beseeing some of this disruption
in 2025 and then other changesto come in 2026.
Chris Fleming (08:08):
Well, thanks, Katie. I wanna shift a little
bit, and talk about, some of theother issues that I know you're
watching. We'll start with somesome budgetary issues. We just
had, as you know, a continuingresolution passed by congress
signed by the president thatback in the old days, used you
know, quaint old days, we we hadappropriations bills. Now we
(08:28):
seem to live on continuingresolutions.
This will fund the governmentthrough the end of the fiscal
year. Can you talk a little bitabout what the health elements
or perhaps the lack of healthelements is maybe the more,
accurate way to put it, youknow, that were, part of that
CR?
Katie Keith (08:45):
No. I think it is the most notable for what was
not included in that package.There were some changes like
extending telehealthflexibilities, for example, that
I know a lot of stakeholderswere interested in. There were
some cuts to NIH funding, forexample, but I think most
notably, things that were notincluded in the continuing
resolution was a fix to thephysician fee schedule, which
(09:09):
continues to be delayed, andhistorically has not been
delayed, has actually been takencare of on a regular basis, at
least put off over time, andhere that was not included. I
think, physicians have beenadvocating for that fix over and
over and have now been told itwill be in the coming budget
reconciliation package.
There were not sort ofbipartisan reforms that have
(09:30):
been talked about, things likesite neutral payments. Shout out
to that insider program thatJeff just mentioned. You know,
there was a whole package ofhealth policy changes with
bipartisan support that were notattached to this, vehicle. So I
think more to come. There therewasn't a ton to say, but I do
think that's notable for some ofthe policies that were not
included this time around.
Chris Fleming (09:49):
And then, of course, one of the other
budgetary elements that we'rewatching is, we've got this
reconciliation bill. The recordfor for folks that don't know,
budget reconciliation is amechanism that is often used
because you need generally 60votes in the senate to to pass
anything. But underreconciliation, there's
restrictions, but you can passand you can pass budget bills
(10:12):
with a bare majority, 50 votesplus the the vice president or
51 senators, obviously. Unlikethe CR you just mentioned where
there wasn't a lot of healthpolicy involved, that's gonna
involve a huge amount of healthpolicy and and fights over, in
particular Medicaid, I think wewould definitely say is perhaps
(10:34):
the main area in terms of healthpolicy that where there's going
to be a huge battle. You talkedabout how Medicaid expansion was
part of the ACA.
We saw growth in Medicaid aswell as in the marketplaces. Can
you talk a little bit about thefights that we're gonna see over
Medicaid and, know, everythingfrom work requirements to budget
(10:55):
cuts? What should we be watchingthere?
Katie Keith (10:57):
So first, I would highly recommend a piece by,
star Rosenbaum and AlisonBarkoff for forefront that
really goes through kind of whatis at stake and, the details of
exactly what you laid out andand the fight. I think if if
Republicans in congress getanywhere close to to the cuts
that they have talked aboutmaking that were sort of laid
out in their budget blueprintfor this, budget resolution
(11:18):
process, it would be the largestcut to Medicaid in the history
of the program. And and I thinkthe step back there, of course,
is Medicaid insurers more than80,000,000 Americans all across
the country, the size and scaleof the cuts that are being
discussed, whether from workrequirements to rescinding Biden
era regulations on Medicaid to,I think, per capita caps have
(11:39):
fallen off the discussion table,but anything can happen. And if
those kinds of things come back,provider tax, there's a whole
range of elements that I thinkhave been batted around. I think
the takeaway is anytime you weremaking this scale or even
discussing the scale changes,it's going to come down to cuts
to state budgets, to health careproviders, to benefits for
(12:01):
beneficiaries, and to cover hugedramatic coverage losses.
So again, the largest cut toMedicaid in the history of the
program is what's at stake. Andit's why I think you've had,
even earlier this week, formerRepublican members of Congress
come out and sort of warnagainst this type of cut. You've
seen some moderate House membersalready raise concerns about
cuts to Medicaid. And and thiswas a huge part of the
(12:22):
Affordable Care Act repeal andreplace debate in 2017. And I
think the cuts to Medicaid, inaddition to the Affordable Care
Act, but there was a huge amountof discussion on Medicaid,
helped stave off those broadercuts because it's an extremely,
popular program.
And I think Republicans sort ofunderestimated that in 2017. We
will see if that has changed. Ithink Billy Wynn also had a
(12:45):
great piece for Forefronttalking about some of these
dynamics, And I think his takeis that congress will not get
there, but, of course, there'smore to wait and see. And I
guess, Chris, maybe on the tomake a little bit of a bigger
political point too, I thinkyou've got the budget resolution
process, which could be sort ofthe first big fight on health
care in, you know, presidentTrump's first year here, which
(13:05):
we've seen before. And then youdo have these premium tax
credits for the Affordable CareAct that will expire at the end
of this year.
And so that sets up almost asecond health care fight, again,
during the first year on anissue that it does not seem like
the president himself has reallyprioritized. And so I don't you
know, other politicos could talkabout the wisdom of teeing up
two major health care fights,but but more to come there. And
(13:26):
I just think it's reallyimportant to keep that in mind,
especially ahead of the twentytwenty six midterm elections.
Chris Fleming (13:32):
Let me we we're running out of time, but let me,
go a little bit to you did apiece just recently, the first
fifty days of the, newadministration. Now I guess
we're at sixty days as werecord, on Thursday the
twentieth. So so, Katie, youknow, we obviously, we don't
have time to go through thewhole piece, but maybe pick, one
(13:54):
of the most interestingelements, from what you wrote
that we're you're watching, aswe move forward in the new
political environment.
Katie Keith (14:02):
Yeah. So instead of maybe picking one, I guess what
I would emphasize to folks is myobservation is there's a lot of
old that is new again. So youcan really see an emphasis on
some of the priorities from thefirst Trump administration. I'm
thinking of health care, pricetransparency, I'm thinking of
reproductive health, I'mthinking of tax on sort of
gender affirming care. So all ofthat is discussed there.
(14:23):
And then really keeping an eyeon some of the new changes, the
Make America Healthy Againcommission that's being set up
at Med Quietly, I think,recently in private, which I
didn't have a chance to cover,some of the attacks on public
health and vaccine access thatwe're already starting to see,
and then recissions of Biden eraguidance on anything, everything
from Medicaid to HIPAA. So I Ithink a lot more to come. There
(14:46):
there really is a lot to unpack,and and we'll you know, I will
do my best, to to continue totry to do that at Forefront and
beyond.
Chris Fleming (14:53):
Well, thanks, Katie, and I and I encourage
listeners to watch Katie'sarticle on Forefront for further
developments of which there willbe many, we can be sure. Let me
turn it back over to Jeff toclose us out.
Jeff Byers (15:04):
Yeah. Yeah. Thanks, Chris. Thanks, Katie. And what
better way to stay on top ofForefront than to be a Health
Affairs Today or Health AffairsSunday Update newsletter
subscriber.
So those are free newslettersthat you can get updated on all
those new articles if you don'tgo to our website. And with
that, thank you, Chris andKatie, for joining us today on
(15:24):
Health Affairs This Week. Ifyou, the listener, enjoyed this
episode, send it to the textenthusiasts in your life,
convert them over to audio, andwe will see you next week.
Thanks all.
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