President-elect Donald Trump’s return could bring several changes in US health policy, with reforms across Medicaid, the Affordable Care Act, and HIPAA’s Privacy Rule.
Expert predictions
Medicaid restructuring
Guided by the Paragon Health Institute’s recommendations, Trump's administration could reduce federal funding for Medicaid expansion and limit subsidies to those below the poverty line.
Specifically, former Trump advisor Brian Blase suggests ending the ACA’s 90% federal funding for expanded Medicaid and giving states more control over eligibility rules. So, those living above the poverty line would have to use tax credits to buy coverage through ACA exchanges, while states could impose work requirements.
Expired Affordable Care Act (ACA) subsidies
Following the failed 2017 attempt to repeal the ACA outright, the upcoming administration will likely allow subsidies for ACA exchange plans to expire, a cost-cutting measure projected to reduce federal spending.
However, The White House statement on repealing the ACA warns this could result in “higher healthcare costs for tens of millions of Americans; ending critical protections for people with pre-existing conditions; millions of people losing health coverage and care; and threats to health care for seniors and people with disabilities, including growing home care waiting lists and worse nursing home care.”
Reform of federal health agencies
Trump’s health policy approach will likely be affected by Robert F. Kennedy Jr.’s “Make America Healthy Again” (MAHA) platform, which he endorsed in his victory speech. Kennedy’s MAHA agenda suggests redirecting the National Institutes of Health (NIH) $47 billion budget toward “preventive, alternative, and holistic approaches to health,” prioritizing chronic disease prevention over traditional treatments.
These changes could affect biomedical research nationwide, impacting thousands of researchers and the direction of US biomedical innovation.
Reproductive health regulation
It is in reproductive health where a Trump administration can make giant leaps, particularly through reinterpretations of the Comstock Act (19th-century law that prohibited the mailing of "obscene" materials), which included medications relevant to abortion and contraceptives.
Using Comstock as a legal basis, Trump might try to roll back the Biden administration's legal memo that allowed for the mailing across state lines of abortion drugs and attempt to ban access to abortion pills across the country.
Such a move would reduce abortion pill distribution, even as Trump has distanced himself from supporting an outright national abortion ban.
Changes to HIPAA Privacy Rule
The Trump administration is expected to challenge recent Biden-era changes to the HIPAA Privacy Rule that strengthened reproductive health privacy protections following the 2022 Supreme Court decision overturning Roe v. Wade.
Privacy attorney Kirk Nahra anticipates that "The Trump administration [will] downplay any compliance obligations stemming from the recent Dobbs-related changes to the Privacy Rule.”
Adam Greene of Davis Wright Tremaine law firm states, “I expect that the 2024 updates to the Privacy Rule will be under attack on a number of fronts,” suggesting Trump’s team may halt enforcement and withdraw opposition to the Texas lawsuit challenging these amendments. He also foresees the Northern District of Texas “to begin the process of proposing to delete the amendments.”
While previous Trump proposals to alter the HIPAA Privacy Rule stalled during Biden’s term, experts believe Trump will renew efforts, particularly around rules affecting opioid and social service disclosures. Greene commented that these proposals have “laid dormant as the Biden administration focused on other priorities.”
Increased healthcare cybersecurity
On the cybersecurity front, the Trump team is expected to continue bipartisan initiatives for improving healthcare cybersecurity. Greene states, "I think there is bipartisan recognition of the need for increased cybersecurity efforts in the healthcare sector." So, we can expect Trump’s HHS Office for Civil Rights (OCR) to advance ongoing efforts that enforce stronger cybersecurity standards.
Why it matters
Trump’s administration emphasizes deregulation, a slimmed-down ACA, and reorganized federal agencies, coupled with limitations on reproductive health services. From an industry perspective, this could result in more state-level responsibility, more regulatory oversight, and less consistent health services at the federal level.
If confirmed, Trump's agenda would push US healthcare toward a more privatized, deregulated system and socially conservative direction that will have a lasting impact.
Read also: How Trump’s re-election could impact US cybersecurity
FAQs
What is HIPAA?
The Health Insurance Portability and Accountability Act (HIPAA) sets national standards for protecting the privacy and security of certain health information, known as protected health information (PHI).
HIPAA is designed to protect the privacy and security of individuals’ health information and to ensure that healthcare providers and insurers can securely exchange electronic health information. Violations of HIPAA can result in significant fines and penalties for covered entities.
Who does HIPAA apply to?
HIPAA applies to covered entities, which include healthcare providers, health plans, and healthcare clearinghouses. It also applies to business associates of these covered entities. These are entities that perform certain functions or activities on behalf of the covered entity.
How could HIPAA impact access to alternative therapies?
HIPAA protects patient data in all treatment types, but new therapies could create demand for updated guidelines on data privacy and consent.
