Healthcare programs, policy and pricing are on the ballot for the 2024 US presidential election on Nov. 5, 2024. What can Americans expect from either a Harris or Trump administration? How will a new administration and Congress impact healthcare access, affordability and innovation? Rick Weissenstein, Managing Director at TD Cowen’s Washington Research Group, recently shared his insights on the current and future healthcare political landscape with Cure CEO Seema Kumar.
Healthcare's Messy Political Landscape
Weissenstein pointed out that the healthcare policy landscape in 2024 has been unusually tumultuous. "It's been messier than any time I can remember, even going back to my days covering the Clinton administration," he said.
Part of the upheaval stems from the conflicting messages within the Republican Party, particularly on issues like Medicare. Weissenstein observed that while some GOP think tanks have flirted with the idea of cutting Medicare, former President Trump’s clear opposition to those cuts has muddied the waters. Weissenstein highlighted the unpredictability of future healthcare appointments, noting the uncertainty surrounding who might lead the Department of Health and Human Services (HHS) or the Centers for Medicare & Medicaid Services (CMS) under a potential second Trump term.
Drug Pricing and the Inflation Reduction Act
One of the most critical policy issues is drug pricing, particularly the fate of the Inflation Reduction Act (IRA), which has already reduced the cost of several drugs, including insulin. Weissenstein noted that a Harris administration would likely push for more aggressive drug price negotiations, potentially expanding the list of drugs subject to negotiations and accelerating timelines.
In contrast, a Trump administration may take a more cautious approach. Weissenstein speculated that a Trump team might continue negotiations but would likely seek to make larger cuts than the Biden administration to claim a political victory. However, he emphasized that the core provisions of the IRA, such as the $2,000 annual out-of-pocket cap, would likely remain intact under either administration.
The BIOSECURE Act: An Area of Bipartisan Support
With Congress often divided on key issues, Weissenstein pointed to the BIOSECURE Act as a rare example of bipartisan cooperation. The act aims to reduce the country’s reliance on China for essential drug ingredients and medical supplies, which could become a critical national health security concern if relations between the two nations worsen.
“It’s one of the few things in Congress that everyone seems to agree on,” Weissenstein said. However, he doubted the legislation would be finalized before the end of 2024 due to the usual Congressional gridlock.
Digital Health and Telemedicine: Here to Stay
Another significant discussion area was the growing importance of digital health and telemedicine, which boomed during the COVID-19 pandemic. Weissenstein noted that while there is some nervousness about potential regulatory changes, he believes telehealth has become too ingrained in the healthcare system to be rolled back.
"Telehealth is literally a lifesaver in rural areas where there aren’t enough hospitals," he said, predicting that the trend toward more outpatient and remote care will continue regardless of who wins the election. Weissenstein noted that telehealth has been proven to help cut certain costs, so it’s an area that could attract more investment.
The Future of Women’s Health Initiatives
On the issue of women's health, Weissenstein discussed the Biden administration's significant investment in research through the National Institutes of Health, ARPA-H (Advanced Research Projects Agency for Health) and the Department of Defense. This support is reversing years of underfunding research on diseases that disproportionally affect women. He acknowledged that a Trump administration might rebrand these initiatives because of their close association with First Lady Jill Biden. However, the core focus on women's health, including heart disease, Alzheimer’s and menopause, would likely remain intact due to bipartisan support.
Weissenstein said, “I would argue that they'll probably rebrand it if she's not there. But as far as making big changes to it, no. I think everybody understands that something along these lines is necessary and well overdue.”
Impact on Biotech and Healthcare Innovation
Weissenstein suggested that the election results would have less immediate impact than some might fear when maintaining financial incentives for biotech and healthcare innovation. While the IRA’s drug pricing reforms could eventually impact the biotech sector, they won’t fully take effect until 2026, giving the members of Congress in 2025 time to make adjustments.
The International Pricing Index (IPI) model for Medicare payments discussed during Trump’s term in office, where drug prices would be pinned to those in comparator countries, could seriously impact biotech investment, Weissenstein noted. In this election cycle, however, his spokespeople said Trump has walked away from it.
“[IPI] could be catastrophic [but] if Trump's team sticks with their plan to walk away from pegging drug prices to international benchmarks, that takes a lot of the pressure off the biotech community," Weissenstein said.
Looking Ahead: What the 2024 Election Means for Healthcare
As the election draws near, healthcare remains a pivotal issue with an uncertain future, whether drug pricing, access to care, or innovation and investment in biotech. While Weissenstein doesn't foresee sweeping changes, he emphasized that the outcome will likely influence how quickly or slowly existing policies evolve and, how accessible and affordable healthcare becomes for all Americans.
"I think we’ve peaked on healthcare as a campaign issue," he said, "but once the votes are counted, we'll see how the landscape shifts for the future of healthcare in the US."
