Health Care Matters | February 21, 2025
Health Policy Tracker: Trump’s First 100 Days
RFK Jr. Backtracks on Vaccine Pledge to Senator Cassidy
Robert F. Kennedy Jr. told HHS staff during a closed-door meeting on Tuesday that he vowed to investigate the childhood vaccine schedule, despite previously assuring Senator Bill Cassidy that he would not alter it. During the confirmation process, this assurance resulted in Cassidy voting in favor of sending Kennedy’s nomination to the Senate floor. Read more here:
US Health Department Layoffs Expand to Medicare, FDA
Several outlets, including Modern Healthcare, Politico, and Bloomberg, have reported on the recent mass firings across HHS, including those affecting the FDA, CMS’s Center for Consumer Information and Insurance Oversight (CCIIO), and the Center for Medicare and Medicaid Innovation (CMMI) raising significant concerns across the health care sector. These staff cuts are part of a broader effort to reduce federal spending and reduce the federal government's footprint.
The Associated Press reports that while there is no official figure available of the total firings, the jobs of more than 5,000 probationary employees are on the line at HHS. This reduction in workforce has sparked fears about the potential delays in medical device approvals, the implementation and oversight of Medicare and Medicaid initiatives, and the overall ability to respond to public health threats. Read more here, here, and here.
Why It Matters
The recent staff reductions are likely to have significant implications for the implementation and management of various initiatives, including the Medicare Shared Savings Program (MSSP) and payment models within CMMI. While the MSSP itself has not been directly impacted by the staff reductions, the broader effects on CMS and CMMI could indirectly affect the program. Most CMS initiatives rely on many parts of the agency for both design and implementation and any disruptions or resource constraints could potentially slow progress. CMMI was more affected by the reductions in force of probationary employees due to recent hiring to prepare for new models set to launch in 2025, including the AHEAD Model, Innovation in Behavioral Health (IBH) Model, and Transforming Maternal Health (TMaH) Model. We expect the loss in staff to hamper ability to effectively roll out and manage these new models especially as they are revamped to align with the new administration's priorities. Medicare claims processing, including within the ACO context, is not expected to be impacted, as most of this work is contracted out to external vendors.
Budget Reconciliation at a Crossroads: Fiscal 2025 Strategy and Health Care Funding in the Balance
The budget reconciliation process is at a critical juncture, with House and Senate Republicans adopting different fiscal 2025 budget blueprints to advance the Trump administration's legislative agenda. The House's plan includes $4.5 trillion in tax cuts and $1.5 trillion in spending cuts over the next decade, with increased spending for border security and defense, resulting in a $4 trillion increase in federal deficits. However, as reported by Politico, intra-caucus disputes over Medicaid cuts are causing divisions within the GOP.
In contrast, Senate Republicans are focusing on new spending for border security, defense, and energy, with plans to incorporate large tax cuts into a second bill. The Senate Budget Committee has advanced the first phase of this plan, but the specifics of Medicaid cuts will be determined in the second bill. The Hill reports that President Trump has endorsed the House GOP's strategy, emphasizing the importance of passing a single bill to advance his full agenda. The reconciliation process remains fluid as lawmakers navigate competing priorities and internal disagreements. Read more here, here, and here.
Why It Matters
Politico reports Trump's endorsement of the House plan has surprised Senate Republicans and created uncertainty about the path forward. Senate Republicans believe that their plan is the most likely to deliver on Trump's promises for increased border security and have some skepticism around the House's ability to pass a larger budget bill given internal disputes. Vice President JD Vance conveyed that while Trump prefers the House’s one-bill approach, he also supports the Senate's two-bill strategy as a backup. Key to determining the legislative approach will be decisions around the future of the Medicaid program. To pay for tax cuts, Medicaid is definitively in the crosshairs, but Trump has sent some unclear signals including declaring that Medicaid would not be touched in a recent Fox News Interview. Pressure on law makers from health care providers and hospitals, especially those that will be most affected (rural and safety net hospitals), will continue to ramp up as GOP House members debate what is included in this bill.
What We Are Reading
A Dose of Love: The Winning Health Policy Valentines
The annual Health Policy Valentines contest has announced its winner, celebrating the creativity and humor of health policy enthusiasts. These witty, heartwarming, wonky valentines remind us to find pockets of joy in the midst of change and uncertainty. Read here.
Reflections On Caregiving Policy: Progress, Challenges, And Opportunities
Health Affairs Forefront published an article exploring where family caregiving policy has been with planning for what lies ahead as the new Congress and administration begin to put forward proposals. Read here.
Prioritize Prior Authorization Reforms In Medicare Advantage
In their new Forefront article, Molly T. Turco and Meena Seshamani argue that policy makers should continue to provide clear Prior Authorizations rules, increase transparency, apply more effective oversight, and accelerate the streamlining and modernization of processes. Read here.
What We Are Listening To
Relentless Health Value: Medicare Advantage Policies—Which Will Stay and Which Will Go Now?
In the latest episode of Relentless Health Value, four major policy areas for Medicare Advantage under the new administration are discussed, including the MA Stars program, risk adjustment and recoupment, AI and prior authorization, and agent/broker relations. Listen here.
See the Coral Team in Action
Insights for Navigating Value-Based Care Policy and Regulatory Trends in 2025
Coral’s own, Maria Alexander, joins James Pelletier, National Director of Provider Quality at MRO, for a deep dive into the latest policy and regulatory updates shaping the future of value-based care. Register here.
Podcast Spotlight
From Policy to Practice: Making the TEAM Model Work
with Rob Mechanic & Jennifer Perloff