The GOP’s health care policy evolution

Jul 09, 2024

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With Carmen Paun

Driving The Day

The healthcare.gov website is seen on a laptop.

Unlike the 2016 Republican platform, the 2024 version doesn't mention the Affordable Care Act. | Alex Brandon/AP

THE 2016 REPUBLICAN PLATFORM VS. 2024 — The many substantive differences between the Republican’s 2016 platform and its likely 2024 version underscore how former President Donald Trump has moved the party away from traditional conservative positions on health care.

The Republican National Committee platform committee agreed to Trump’s platform Monday, which is set to be finalized next week. The GOP didn’t release a platform in 2020 when Trump lost to President Joe Biden.

The RNC didn’t return a request for comment on this year’s changes.

Here are some key differences:

Obamacare: After a protracted and failed GOP bid in Congress to repeal the Affordable Care Act under the Trump administration, the 2024 platform makes no mention of the health care law.

Trump said late last year that he was “seriously looking at alternatives” to Obamacare and that the 2017 repeal and replace bid was a “low point” for the party. The 2016 platform pledged that a Republican president would sign its repeal with unanimous GOP support.

The 2024 platform also doesn’t mention Medicaid, while the 2016 platform proposed turning it into a block grant program.

Medicare: Republicans’ traditional fiscal conservatism is in nearly every corner of the 2016 platform, including on the federal health insurance program benefiting older adults.

In stark contrast, the 2024 platform pledges not to slash “one penny” from Medicare.

In 2016, Republicans called for a substantial overhaul of Medicare to preserve its solvency, pointing to an aging population, suggesting a premium support system and guaranteeing a contribution toward plans dependent on income. That platform also floated changing the eligibility age, though it pledged not to make changes for those 55 and older.

Although light on details, 2024’s platform proposes border security as a way to shore up Medicare’s finances by preventing “tens of millions of new illegal immigrants” from being added to the program’s rolls. Undocumented people are not eligible for Medicare, but some noncitizens are eligible, with restrictions.

Abortion: Trump has ushered in a significant softening of the party’s position on abortion in a post-Roe America.

Unlike the 2016 edition, the platform doesn’t call for a 20-week federal abortion ban, instead saying the party opposes “late term abortion” and supports access to birth control and in vitro fertilization.

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A message from the PBM Accountability Project:

Patients, providers, and employers deserve to pay transparent, fair prices for prescription drugs, but pharmacy benefit managers (PBMs) are gaming the system while eating up profits and driving up costs. The Wall Street Journal recently uncovered that PBM middleman “mark up prices of generics for cancer, multiple sclerosis and other complicated diseases,” particularly medications from mail-order pharmacies that PBMs own. Congress must act now and protect patients from big PBMs pigging out on patient savings. Learn more at pbmaccountability.org.

Cybersecurity

People type on laptops

Health care groups support CISA's goal to improve its ability to detect and stop hacks but take issue with the agency's reporting requirements. | Philippe Huguen/AFP/Getty Images

RELIEVE HACK REPORTING BURDEN — Groups across the health care sector are calling for CISA to reduce their reporting burdens and harmonize requirements across agencies in enacting a landmark law mandating faster reporting of hacks to the government.

The Cybersecurity and Infrastructure Security Agency is tasked with enacting a 2022 law that would require firms in critical infrastructure sectors to report hacks within 72 hours and ransom payments within 24 hours. CISA has argued the law would allow it to speed up assistance to victims and bolster information-sharing to counter threats. In the spring, it proposed rules on how it would implement the law.

Health care organizations have other breach reporting requirements under federal privacy law HIPAA, the FTC’s health breach notification rules and, in some cases, SEC disclosure rules.

The response: Health care organizations supported the law’s goals in written comments to CISA but were decidedly chilly on the details, especially with how they argue the requirements would add to current mandates without sufficient harmonization across agencies.

“Four separate standards with similar but slightly different compliance expectations would impose an unreasonable burden with marginal benefit towards improving cybersecurity,” the Blue Cross Blue Shield Association wrote. The group called for HIPAA-covered entities to be exempted and to create an information-sharing agreement with HHS to satisfy requirements.

The American Hospital Association called the rules’ potential penalties, including suspension and debarment, “too harsh” and “vague.” The Medical Group Management Association called for “collaborative policies” instead of “overly punitive” penalties.

The Medical Device Manufacturers Association said that health care IT entities should fall under the requirements, saying their exclusion leaves “gaps” in the broader framework.

What’s next: CISA plans to finalize the rules by Oct. 2025.

Understand 2024’s big impacts with Pro’s extensive Campaign Races Dashboard, exclusive insights, and key coverage of federal- and state-level debates. Focus on policy. Learn more.

Covid

CHINA SAYS IT’S BEEN ‘TRANSPARENT’ — The Chinese Embassy is hitting back on the Heritage Foundation, which on Monday called for Congress to create a bipartisan reparations committee so Americans can get restitution from China for the pandemic.

“Tracing the origins of the virus is a scientific issue that should not be politicized. Relevant parties should stop stirring up the ‘laboratory leak’ theory, stop smearing China and stop politicizing the issue of origins tracing,” Chinese Embassy spokesperson Liu Pengyu said.

Pengyu also made the case that China has been “open” about the origins of Covid-19 despite broad bipartisan agreement that it has stymied investigations.

More on the report: The conservative think tank formed the commission to recommend how to hold China accountable for the pandemic, Carmen reports.

It called for Congress to pass legislation to audit all U.S. federal funding for biomedical research in China and the BIOSECURE Act, which effectively would prohibit Chinese biotech companies from doing business in the U.S.

The 10-member commission comprised six people who served in former President Donald Trump’s administration, including John Ratcliffe, former director of national intelligence; Robert O’Brien, former national security adviser; and former CDC Director Robert Redfield. Two Democrats were also part of the commission: former North Dakota Sen. Heidi Heitkamp and Jamie Metzl, a former Clinton administration official.

Meanwhile: House Speaker Mike Johnson said Monday at a Hudson Institute event that the House will vote on the BIOSECURE Act, contending that Americans’ health care data is at risk.

That’s a significant win for House GOP lead Rep. Brad Wenstrup (R-Ohio), who has sought a floor vote since the act didn’t hitch a ride on the defense policy bill. Johnson said his goal is to have a significant China-related package signed into law by the end of the year.

The Senate Armed Services Committee’s version of the fiscal 2025 National Defense Authorization Act released Monday didn’t include the legislation after it wasn’t attached to the House’s NDAA. That doesn’t spell doom for it, though — it could likely be addressed on the floor since it’s not in the committee’s jurisdiction.

A message from the PBM Accountability Project:

AROUND THE AGENCIES

NEW MISINFORMATION GUIDANCE — The FDA has signaled that drug and medical device manufacturers could be allowed to directly rebut false or misleading information about a company's medical product published online, including on social media.

Some patient advocates and academics have called for the FDA to clarify what can be done about online influencers’ claims. In draft guidance released Monday that would replace previous guidance issued a decade ago, the agency said the response should be limited to necessary information to counter misinformation.

The draft guidance comes amid broader concerns about online medical misinformation that surged during the Covid-19 pandemic.

NEW DEMENTIA MODEL — CMS released a list of about 400 participating organizations Monday in a voluntary model test for dementia care through the Center for Medicare and Medicaid Innovation.

The test is evaluating alternative payment for dementia care, allowing patients and caregivers a care navigator that could help with access to clinical and nonclinical needs, including food and transportation.

The news comes amid scrutiny on the CMMI over its low rate of successful models from top House Republicans, who have pointed out that the agency with lowering Medicare costs increased spending by more than $1 billion.

Understand 2024’s big impacts with Pro’s extensive Campaign Races Dashboard, exclusive insights, and key coverage of federal- and state-level debates. Focus on policy. Learn more.

Names in the News

Kristen Shatynski will become health policy director for Senate HELP Committee ranking member Bill Cassidy (R-La.). She was previously vice president at SplitOak Strategies.

Mary Moody Johnson, the HELP Committee GOP health policy director, is joining SL Strategies as senior vice president.

Kristin Lee is now VP for communications and client advocacy at Waystar. She most recently was director for technology communications at Meta.

Suzanne Gerhardt has been reelected as the 2024-2025 chair of the Georgia Health Care Association’s board. She is senior area vice president for PruittHealth.

Jessica Somers has joined Aledade as chief financial officer. She was previously at Evolent.

WHAT WE'RE READING

Reuters reports on the fight over Johnson & Johnson's attempts to end talc lawsuits.

Modern Healthcare reports on how Congress’ changes to gun violence research impact hospitals.

A message from the PBM Accountability Project:

PBMs are pigging out on employer and patient savings while Americans struggle to afford the medicines they need.

A groundbreaking new study in Washington state uncovered several ways that big PBMs are reaping record amounts of prescription drug profits, hurting local pharmacies, employers and ultimately the patients at the pharmacy counter:

· For a subset of matched claims between the plan sponsors and the pharmacies, the average plan sponsor (employer) costs were approximately $165,000 higher (roughly 80% more) than the reimbursement provided to pharmacies (approximately $8 more per prescription).
· Plan sponsor (employer) costs increased by 30% while pharmacy reimbursement decreased by 3% between 2020-2023.
· PBM-owned mail-order pharmacies had drug markups that were more than three times higher than the markups at retail pharmacies.
· In one example, as reported by the Wall Street Journal, PBMs charged more than $6,000 for a cancer drug that costs $55.

We need Congress to put an end to the great PBM pig-out. Learn more at pbmaccountability.org.