How Healthcare Fared in the First 100 Days of the Second Trump Administration | Asembia's AXS25 Summit

Healthcare has largely been in the backseat during the first 100 days of the second Trump administration in contrast to the first one, panelists at an Asembia AXS25 Summit session on those 100 days agreed.

But that could change as the administration and Republicans in Congress grapple with cutting federal Medicaid expenditures to help offset major tax cuts, the implications of the staffing reductions at HHS become more apparent, and the Trump administration puts its stamp on CMS drug price negotiation under the Inflation Reduction Act.

Emily Murry, a longtime policy adviser to former House Speaker Kevin McCarthy who is now a partner at Tarplin, Downs and Young, said she expects the House committee that has jurisdiction over Medicaid to announce its plans for $500 billion worth of Medicaid “reforms” next week that will include work requirements and tighter verification requirements. But Murry noted the contrast with the first Trump administration that prioritized “repeal and replace” efforts aimed at undoing the Affordable Care (ACA) during its first 100 days. “This time around, they don’t want to do healthcare,” Murry said.

Peter Fise, J.D., a partner at Tarplin, Downs and Young like Murry and a former Senate Finance Committee staffer who was involved in drafting the Inflation Reduction Act (IRA), said Democrats have seized every opportunity to talk about possible Medicaid cuts and defend the program as central insurance coverage for millions and millions of Americans.” Fise said the Democrats raising the alarm about possible Medicaid cuts has produced results, noting that Steve Bannon, a former adviser to President Donald Trump and an influential conservative populist, has warned Republicans about cutting Medicaid, and Sen. Josh Hawley, a Missouri Republican, has voiced concerns. Fise said the pushback against Medicaid cuts has been effective partly because the Trump-led Republican Party draws support from a more diverse group of people, including working class people, than the Republicans used to.

Ashley Flint, M.P.P., a principal at Avalere Health, agreed with Murry and Fise that Medicaid is now likely to become a major issue but as a kind of side effect of the spending cuts that Republicans are considering as part of the reconciliation process that allows budget and tax bills to pass in the Senate by a simple majority. “Medicaid is very clearly in the crosshairs and sort of accidentally so, given that healthcare is not intended to the primary focus of the reconciliation bill,” Flint said. “But as Emily mentioned, we're really going to get to where the rubber meets the road, and we're going to start seeing some more specifics.”

The session was held Monday afternoon on the first full day of the Asembia meeting, which runs through Wednesday. The moderator, Megan West, a managing director at Avalere, drew a small laugh from the audience when she alluded to the administration’s busy, aggressive agenda since Trump took office on Jan. 20. “We sit here on day 99 of the administration, very close to 100. That said there are still 24 hours left, and there could still be some additional action.”

Peter Fise, J.D., seated, and Emily Murry at the Asembia panel on the first 100 days of the Trump administration.

One of the themes of Murry’s remarks was that healthcare has largely escaped the fast-and-furious pace, tactics and rhetoric that the administration has used in areas like immigration and higher education. Murry said, for example, that Commerce Department officials, recognizing how complicated pharmaceutical pricing and global supply lines are, are taking a thoughtful approach to tariffs on pharmaceuticals. “It’s not so straightforward. Pharmaceuticals are not autos.” She also described the administration as being more thoughtful about what it does “within the CMS arena” and not wanting to disrupt the Medicare program. Murry also described changes to Medicaid as reforms, not cuts. Under a budget outline passed earlier this year, the House Committee on Energy and Commerce is responsible for coming up with $880 million in spending cuts over a 10-year period. Murry said the committee, which has a sprawling jurisdiction, has other areas it can look for cuts besides Medicaid.

Fise said the first 100 days of the first administration were also chaotic, but “this round feels more organized and more strategic.” Democrats could focus on defending ACA during the early days of the first Trump administration. “This time around it's more about picking and choosing your spots. I think that just given the number of things that there are to react to in any given day, Democrats have had to think about messaging, because messaging really is the only tool that you have on some of these items. You have to garner attention to things in order to get public pushback. That translates into polling, which translates into this administration having to think twice about something.”

Fise said that while earlier rounds of HHS staff reductions had not affected FDA reviewers and inspectors, more recent ones will. He predicted that there will be delays in FDA approvals and Medicare coverage decisions. “I think there's been some notion from the Department of Government Efficiency that a lot of these things can be automated. They can be just performed via AI. I think that's not the case for some of the core issues that the life sciences community may care about, whether it's coverage determinations or even approval of your drug.”

Flint said the significance of reorganization and staffing cuts at HHS is “really hard to overstate.” Flint said there are 20,000 fewer HHS employees than when the Trump administration took office, which amounts to a quarter of the workforce and brings the staffing down to the level it was in 2002. She also noted that there might be important consequences from HHS Secretary Robert F. Kennedy Jr.’s reorganization and various subagencies coming under the new Administration for a Healthy America.

Flint said the April 15 executive order put all of the administration’s notions about drug pricing in one place. She said it struck her as similar to the 2018 drug pricing blueprint issued by HHS during the first Trump administration. “Definitely some repeat-offender ideas and policies in there picking up on some old thread from the previous Trump administration,” Flint said, as well as some new tools, such as drug price negotiation under the Inflation Reduction Act.