Joel White [00:00:03]:
You think about 2.5 trillion. In the context of the federal budget, you’re not going to get that from federal foreign aid or the Education Department or, you know, reforming the justice system. It’s entitlement programs and it’s primarily health care entitlement programs.

Intro [00:00:31]:
Welcome to Hospitals In Focus from the Federation of American Hospitals, here’s your host, Chip Kahn.

Chip Kahn [00:00:33]:
Well, the Republicans have come to town. The Trump White House and Republican Congress have an ambitious agenda ranging from immigration and border security to military renewal to energy dominance and tax cuts. To achieve this agenda, many GOP legislators will want to see deficit reduction accompany expansive legislation to reduce future spending. Republicans may look to health care, which is such a large portion of the federal budget. At the same time, much of the health agenda from the 118th Congress did not make it beyond the House. So that will likely be revisited and with the return of President Trump, they will likely resurface his first term. CMS agenda and Maja in is much discussed. There are few better to review the possible healthcare policy agenda than our guest today, Joel White, President and CEO of Horizon Government Affairs.

Chip Kahn [00:01:35]:
Joel is a well known face around Washington healthcare circles and we go way back to our days on the hill in the 1990s. Joel, thanks for coming today. It’s great to have you here and I look forward to catching up.

Joel White [00:01:50]:
Thanks, Chip. Always a pleasure.

Chip Kahn [00:01:52]:
Joel. Before we get into the agenda that we’ll be looking forward to over the next many months with Republicans taking over Washington, let’s get your view on what you think and maybe this will, you can be aspirational, what you think are the challenges and opportunities they should be looking at over the next many months.

Joel White [00:02:15]:
The bad thing in, in healthcare is that there are so many problems, it’s hard to focus on one specific issue. But I think if I had to characterize the, the, the kind of incoming administration and new Congress, they’re really focused on, as you mentioned, cleaning up the old business and then getting on with the new agenda. And the first thing that’s going to hit them square in the face is, is the government runs out of money in March. The next thing that’s going to hit them is our debt limit comes winging back in, was reapplied in January and we’ll run out of money for the debt and possibly default on that debt sometime later in the year. So those are two big things that have to get done in the middle of everything else they want to pursue on their new agenda. And if I had to define that new agenda, I think what members of Congress with the MAGA movement, what President Trump is really focused on is a populist approach. And by that I mean how do we kind of empower consumers and put the health system more to work for them versus the other way around? And so they’re interested in. In kind of providing more information on prices and quality and coverage options that give them more control over their money, Other coverage options out of, like Medicaid or Medicare that they can pick to, to really empower them and choose a plan that might meet their needs best, and then, of course, getting them better access to different types of care. But really, it’s the consumer at the center. It’s how do we kind of empower the little guy to go against what sometimes seems like an overwhelming, large and complicated and confusing health care system?

Chip Kahn [00:03:56]:
That’s a great start, Joel. And to give us a little structure for our conversation, I’m going to bifurcate, sort of talking about the administration. Then we can talk about these congressional challenges, which you’re giving us some first view of, and talk about the synergies between the two. So to sort of start with the administration side of it, we saw on the first day executive orders. A few of them did affect healthcare directly. And we also see the development of the Department of Government Efficiency as a embed in the Office of Management and Budget at the White House, sort of starting with the eo. And what do you see as the signals that it sends, taking a little bit of a deeper dive in terms of policies that you think HHS and CMS may take up in the near future? As we get into the first Trump regulatory cycle.

Joel White [00:04:56]:
I think day one, the president was very active. He signed about almost 100 executive orders or memorandum implementing the policies of his federal government or his perspective on it. And the way I think about executive orders is they’re legal documents, but they’re kind of like the memo from the CEO that sets out the framework for how people are going to operate and what the principles are as they think about the regulations, rules, and programs that they’re charged with operationalizing. And so the first thing Trump did that affects the health care space is he established a regulatory freeze. And that’s not unusual. Like, when Trump came in the first term in 2017, he froze all of Obama’s regulatory things that were in process. Biden did the same thing when he came in in 21. Trump’s doing the same thing in 25 now.

Joel White [00:05:50]:
And basically what it says is any. Any regulation or rule that’s in process, we got to Stop it. We got to review it. We got to make sure it’s consistent with our principles and policies. Then we’ll figure out whether we need to revise it or rescind it or let it go forward. And so for us, you know, some of those rules are like the Medicare Advantage rate announcement that sets rates for more than half of beneficiaries in those plans in Medicare for 2026. There was also a rule that required coverage of obesity products, things like Ozempic and WeGovy and things like that in Part D, that’ll, that’ll be frozen. And there’s, there’s multiple rules, right, that are, that are subject to those three.

Joel White [00:06:32]:
So that’s kind of like the first thing. But then the second thing that was big was he rescinded a lot of the Biden administration executive orders, 68 executive orders. He rescinded 10 presidential memoranda. And, and really, in that space, what we’re talking about are two primary rules. The first really gave the order to dramatically expand Medicaid and the Affordable Care act enrollment activities and, and kind of flexed up on some of the standards around enrollment and opened up the enrollment processes. That was a very expensive proposition because it kind of got a lot more people into Medicaid. And so what Trump is saying is we should clamp back down on that and make the enrollment process verify eligibility for enrollment, verify income levels, things like that. And that will have to be a new HHS rule that comes out to effectuate those changes.

Joel White [00:07:31]:
And then one, one thing that I know Senator Sheldon Whitehouse and others have focused is Trump rescinded an executive order on prescription drugs. And the interesting thing is there really isn’t a lot of daylight between president and Democrats on prescription drugs. He’s proposed a number of different ways to bring the cost down, primarily through price controls. And so White House and others have kind of scratched their head and said, why is he resenting an executive order that says HHS should negotiate drug prices or set up $2 generics or create reinsurance models for high cost? They’re selling gene therapies, for example, and Medicaid. And the answer is he wants to do it his way. He wants to put his own stamp on it. And, but that will have to again, again, the demos on $2 Generics and others will have to be paused. And that has to be another affirmative action through those agencies and departments.

Joel White [00:08:28]:
So it’s not the last thing we’ll see on it. But it’s definitely this administration, this president coming in and saying, I’m going to do things my way. And that’s very consistent with what he said on the campaign trail.

Chip Kahn [00:08:39]:
Well, that’s a lot to unpack and some great review of, of the effect of, of the eo. It does lead to some questions. Do you see on the MA rate that he wouldn’t go forward with that for some reason? Where do you, what do you think the attitude basically of the new administration is going to be about Medicare Advantage, which is now, I don’t want to say well over, but clearly over half of the Medicare program.

Joel White [00:09:08]:
Yeah, it affects a lot of people. It’s basically Medicare now for a majority of people in the country. And so I think that rate announcement, the Medicare Advantage rule that came out was very positive for plans. Right. They’ve been completely complaining about being cut for the past couple years under the regulatory rate setting process. This would be a plus up. It would be a nice plus up. It would be almost 5% I think and that’s for 2026.

Joel White [00:09:36]:
And what we see in the market is a very unstable market, I think largely driven by the Inflation Reduction Act. But this would be a nice plus up. And I think that one will go forward for two reasons. The first is a timing issue. Plans have to take those rates and, and tell, tell Medicare what they’re going to do in the market in 2026. And there’s a whole time frame around that where they’ve got to submit bids, they’ve got to get approved, they’ve got to show what their networks are, they’ve got to say these are the benefits and this is what we’re offering. All that stuff takes time and there’s a prescribed timeline for that. And so that one’s got to kind of be reviewed and get out the door probably before April.

Joel White [00:10:17]:
But the second reason is really more the administration’s perspective. And Dr. Oz, well known TV personality and ran percent and an interesting and successful surgeon east be with Columbia and very interesting guy. He is very supportive of Medicare Advantage and even wrote an op ed during the Senate campaign saying we don’t need Medicare for all, we need Medicare Advantage for all because he likes how the plans compete with each other in the marketplace and strive to offer additional benefits at a lower premium. But I think that there are clear issues in Medicare Advantage that need to be taken a look at and I think the department and the agency will do that. But I think Dr. Oz comes into the role predisposed to like Medicare Advantage. So I think that’ll play out well for plans and for beneficiaries.

Chip Kahn [00:11:12]:
That brings up an issue for hospitals, for the physician community, particularly of all the concern that’s been raised over recent years about the plans in terms of denials and delays and arbitrary prior authorization and abuse of the no Surprises act where even when appeals are done, they don’t pay if they’re decided against by the arbiters. And from the hospital standpoint, we have this issue of observational visits versus inpatient admissions. And insurance companies never saw anyone going into a hospital that they didn’t want to say was just there for observation versus being inpatient. And the last administration began to recognize this, started a reform on prior authorization, started to look at this issue of physician discretion and decision making with patients in terms of inpatient admissions versus observation. Where do you think that will play out in this new administration in terms of how they’ll read that?

Joel White [00:12:24]:
Boy, that’s a great question. And this is where you get the weird caught cross cross currents of the MAGA perspective and the consumer at the middle and maybe the more experiential perspective of some of the people who are running the programs. And so while I think the general approach is we support Medicare Advantage, the on the ground reality is there’s a lot of patients who are experiencing a lot of friction with their health plans. And you put your finger on it, right? Prior authorization is a massive problem for patients and it’s a massive problem for providers. And so I think that kind of challenge in the system, prior authorization in particular is something that where the administration defaults to kind of the pro consumer, let’s look for the little guy. And so I would expect those rules in Medicare Advantage and prior authorization for drugs and Part Part D to be significant regulatory efforts from cms. I also think that Congress has a huge issue in passing legislation to codify the rules of the road around prior authorization and maybe take a new look at no surprises and how that’s played out and maybe how that could be improved this year and next.

Chip Kahn [00:13:45]:
In terms of one of the other points you made, do you think that the administration has much degrees of freedom in terms of the prescription drug area, in terms of the negotiation that basic is laid down by legislation, in terms of how they deal with that.

Joel White [00:14:02]:
They actually have quite a bit of flexibility the law. I don’t want to get dorky here Chip, but you know I’m a dork. Section 1192 of the law,

Chip Kahn [00:14:13]:
You just have a lot of experience on the Hill.

Joel White [00:14:14]:
There we go. And I read those wonderful thousand page regulations, section 1192 of the law the Inflation Reduction act says CMS can implement this program not through the normal regulatory process, but through program memorandum. And that’s basically, you know, they’ve come out with several hundred pages of these memos on how they’re going to operate the program. They can do that through 2028. And so that’s kind of the operating rule. And they can change that at any time. They can write it on a cocktail napkin. And that’s kind of like how they’re going to run the program.

Joel White [00:14:51]:
And Biden could have done that as well. It was really a bad process, flaw of the law to not have a standard, the regular, normal process for taking public input and then revising the regulation based on that input to get the best end product and the most transparent apparent way. So they got lots of flexibility there. But the law constrains them because the law has hard deadlines around how the negotiation process works. So, like, you know, at the end of February, manufacturers have to sign a negotiation agreement and then submit data to CMS by March 1st, I believe. And then that starts the ball rolling in the negotiation process. And. And so the question is, can the administration push pause on that process? And I think they can.

Joel White [00:15:41]:
Other folks think it’s pretty hardwired. We’ll see. I think what we’ve seen with this administration and this president in particular, is they’re willing to kind of push the boundaries on the exercise of power. But I go back to, you know, it’s a more fundamental question. Is Trump going to support that negotiation process or will he view it as like Biden’s thing? And it’s just like empowering a bunch of bureaucrats to. To get in the way of doing a poor job at negotiating lower drug prices. Is he going to want to do his own thing?

Chip Kahn [00:16:16]:
Boy, that. We’ll get to legislation later and see whether you think that, that. That they may seek some kind of changes in legislation on the drug area. If you remember back in the first Trump administration, there was a change in part B payment for certain drugs for hospitals that there was a Discount taken for 340B hospitals that get a discount from the pharma companies. It was thrown out by the courts, but on process, not on substance. Do you think that that could make a return, that particular regulation and approach to paying for drugs in hospitals?

Joel White [00:16:56]:
I think it’s on the list. You know, I think in this environment, well, the fiscal environment, certainly they’re looking for every quarter between every couch cushion. I think, you know, 340B overall is going to take a Hard look from Congress and the administration. There will be regulations around 340B. There may even be an effort to take 340B out of HRSA and put it into CMS. And I think Congress is very interested in, you know, if there was a process foul on that rule, maybe they ought to codify it. And I think some estimates have put the numbers, if you paid acquisition costs plus a little, you know, percentage bump up like ASP does on the doc side and the hospital side, that you could, you could save about $140 billion over 10 years. And again, they’re looking for quarters, couch cushions.

Joel White [00:17:47]:
That’s a big chunk of change.

Chip Kahn [00:17:49]:
Before we go on to the legislative side, which be required to do that kind of action. What do you think about this new animal, the doge? Do you think it will have any impact and do you have any idea what kind of recommendations they might make in the healthcare area that would affect us directly, affect the department?

Joel White [00:18:09]:
Well, I think the jury’s out. Right. I think you’ve got Musk involved and he’s got a megaphone and he’s spent a lot of time focused on highlighting some ridiculous things. Right. But, but what I go to is on day one, he signed an executive order or day two, he signed an executive order setting up DOGE within the federal government, within the Department of Digital, the U.S. digital Service Office. It’ll have staff and employees and we would expect a DOGE officer in HHS and cms. And they’re going to be looking at, they’re going to use AI to go do a top to bottom review of every rule and regulation, every program and every dollar spent.

Joel White [00:18:54]:
And if they, they’re going to then say, does it make sense? If it makes sense, does it need to be reformed? If we need to be reformed, let’s issue a rule to reform it. If it doesn’t make sense, let’s get rid of it and let’s rescind it. We’ll issue a rule to rescind it. And so I think if you think about health care, it is one of the most heavily regulated spaces in our economy. And you and I could sit here and probably list out 100 things in health care that make very little sense that we would reform. I think as I think about it, the top candidates are probably the Stark law which defines how people relate to each other when they have a financial interest, the anti kickback statute which relates to how folks get paid in the marketplace. And then the MIPS program, which is the physician quality, you know, tended to Drive higher value in Medicare for in the physician side, thousands of quality measures that cost about one north of $1 billion for docs to comply with. But they’re not really used for much of anything to improve care.

Joel White [00:20:02]:
A lot of process stuff, not a lot of outcomes things. There’s the hospital quality program, there’s the hospital readmissions program, there’s the safety programs, discharge planning, electronic inserts for prescription drugs and labeling. I mean, you could, you could spend all day kind of going through the Federal Register identifying things. And I think that’s what they’re going to do. The other thing I think about in the regulatory side is in Trump won. He was his. The net cost of his regulatory agenda was $3 billion. Under Biden, it was 2 trillion.

Joel White [00:20:36]:
So orders of magnitudes of difference. And they really pay attention to the regulatory process. They establish processes in place to make sure the regulatory burden is at least net zero, if not reduced across industries. So I think it’ll be a priority whether they’ll be successful. I think the jury’s still out.

Chip Kahn [00:20:55]:
Let’s move on to the congressional side. And Republicans are.

Joel White [00:21:01]:
Oh, wait, Chip, Chip, you forgot about Maha.

Chip Kahn [00:21:05]:
Oh, yeah. Yes. We’ll have to see who ends up being secretary if RFK Jr gets his nomination approved. But assuming he does. So tell us about what you think the impact of Maha will be.

Joel White [00:21:20]:
Look, I think Kennedy, RFK Jr. Was nominated Secretary for a lot of different reasons. He is on fire for make America Healthy Again and is going to take a look at food, air, soil, water, drugs, vaccines. And the theory is that those things are making us sicker as a country. And three primary goals, root out corruption and regulatory capture. At the age agencies like fda, cdc, nih, return those agencies to a gold standard of science. Then the third goal is to end the chronic disease epidemic, particularly with children. He’s committed his life to this, so this will be a priority.

Joel White [00:22:04]:
They brought a bunch of people in at the nih, fda, CDC to do this, and so they’re going to focus a lot on those processes and improve them. I think most people have assumed that’s an anti innovation stance, and I don’t think that’s where Trump comes from, particularly for people who have limited access to treatments and cures. So I think the focus in Maha will be nih, cdc, and we’ll see where he gets. But, but he is, he’s got religion. He’s on fire for making America Healthy Again. And I think there’s a lot of people who are waiting to see what the first steps are going to be there.

Chip Kahn [00:22:43]:
We shall see. You know, the, the issue I think for some of the things you’ll want to do is that there’s law behind it as well as hefty regulations. So turning the ship of state over there may not be such a simple process.

Joel White [00:22:57]:
I agree.

Chip Kahn [00:22:58]:
On the congressional side there will be, I don’t know whether it’ll be a two step process or a one step process. A big budget bill and from all the discussion, 2.5 trillion is the number that’s been bandied around about how much deficit reduction or spending reduction will have to be achieved in order to play a role in the bill to get the votes to pass the tax side and the spending side on immigration and border security and military renewal. There are various areas that savings can be wrought outside of health care in terms of rolling back some Biden past policies as, as well as other usual suspects and food programs and other programs. But health care is probably exposed. Where do you see it in terms of the direction of at least the proposed likely health care share of that 2.5 trillion?

Joel White [00:24:02]:
Yeah, I think that 2.5 is important to understand a broader context there. And that is if you just the tax cuts that Trump enacted in 2017 expire at the end of this year and so do the Affordable Care act subsidies, enhanced subsidies at the end of this year, you add those two things up, that’s 5 trillion. If you did everything Trump wanted to do promised on the campaign trail on taxes, it’s another trillion. You’re at 6 trillion. Add in solve the state and local tax deduction issue and you’re north of 6 trillion. And there’s a lot of members in Congress, particularly Freedom Caucus members and deficit hawks who are basically saying we’re at a fiscal situation in our country right now where we’re spending more on interest on the debt than we are on all of national defense. And this entitlement growth that’s driving the fiscal environment, we need to get our arms around that. And so they’re saying, well, we need Chip Roy said we need at least 2.5 trillion in budget savings if we’re going to do the tax extenders.

Joel White [00:25:11]:
And others have said 2 trillion. Some have said less, some have said more. But the point is like they don’t feel like we can eat dessert without having our vegetables. And so this two bill, one bill thing is kind of like part of that process where people are saying put it all together so that we eat our vegetables and our dessert and guarantee that outcome. And so if you think about 2.5 trillion. In the context of the federal budget, you’re not going to get that from federal foreign aid or the Education Department or, or, you know, reforming the justice system. It’s entitlement programs and it’s primarily health care entitlement programs because in this process you can’t impact Social Security by rule. So you’re looking at Medicaid and Medicare.

Joel White [00:25:58]:
And then the initial focus has been on Medicaid and trillions of dollars in proposals to reduce spending there. And that’s creating some political headaches because you have. I was just talking to a member from Iowa. I won’t mention her name, but she won by less than 800 votes this last cycle. She’s got one seventh of her constituents are on Medicaid. And so you start making big changes there. You’re affecting big swaths of the population in these districts that have political repercussions because believe me, the argument from Democrats is going to be you cut poor people’s health care to pay for rich people’s equals taxes. And then the other dynamic you have in any Medicaid fight is when you have red state governors, Republican governors, who say, I can’t afford that level of cut to my Medicaid program.

Joel White [00:26:49]:
They get their members of Congress from that state ginned up and it doesn’t matter if you’re a Republican or a Democrat. There’s political issues where they’ll kind of say, I can’t vote for this. So it’s tricky to get that level of savings on the Medicaid side all from Medicaid. So, you know, I think they’re going to have to look at Medicare. And so there’s, you know, there’s lists floating around. The ideas here are not new per se, requiring Medicaid recipients to work, volunteer or go to education classes as a condition of receiving a subsidy, capping the amount of spending on a per capita basis in Medicaid, maybe the Medicaid expansion, the adult population gets a 90% match and the poor woman with kids gets a 50% federal match on the dollar. Maybe we should equalize those or bring the 90% down to 50. There’s all kinds of things you can do in the Medicaid space to save money.

Joel White [00:27:50]:
In the Medicare space, though, we can get into that. It is most of the money, as you know, is in caring for really sick people and that’s mostly in the hospital.

Chip Kahn [00:28:01]:
Well, in terms of Medicaid, you make a point about Iowa. There’s some couple Republican congressmen in California. I think one of them over 50% of the people in his district are on Medicaid. And so that’s an issue. And coverage becomes an issue. You know, if you gave up that 9010 ratio, that’s the federal match for the federal match versus the state portion for the ACA expansions of Medicaid and lowered it. There are a number of states, I think, double digits that have triggers, and they would then, if the federal government backed off, drop their ACA expansion. So major cuts in, in.

Chip Kahn [00:28:48]:
Well, first, their interactions between these policies potentially and major cuts in Medicaid could affect coverage.

Joel White [00:28:56]:
It could. And I would say, you know, a lot of members. So again, this will, this will play out politically on a member by member basis and largely defined by their districts and the composition of Medicaid enrollees, but also politically at a national level about what are you trying to accomplish here? And I think many Republicans will say, look, Medicaid has been fed a lot and it’s pretty portly and we’re not getting good value for the money. So can we design a program with appropriate rules that limit what we pay, create good incentives to get people into good plans? And then the missing link to this that we’ve been talking members of Congress about is it’s well known that people in Medicaid have the worst access of any, any of the federal programs to care. Right. It’s very hard in many areas to see a doctor if you have Medicaid. Just not a lot of doctors will take Medicaid reimbursement and they end up in a hospital, typically in an emergency room or maybe more minor, more. More things that are more appropriately cared for in a physician office.

Joel White [00:30:11]:
And that’s a burden on hospitals who have to take them. And it’s a highly ineffective and inefficient way to say, we are committed to covering you, but we’re not willing to put the resources on the table that are necessary to make sure that you have access to the care. And so that is a situation, I think that if they combine those two concepts, want to pay appropriately and make sure that if you’re paying a state for a person who’s supposed to be on Medicaid, but they’re not supposed to be on Medicaid, that we stop that we stop some of the gains that go on in Medicaid, but at the same time, we make sure that if you get an insurance card, you actually have access to a doctor, which is not the way the system works.

Chip Kahn [00:30:55]:
Now, another coverage issue that you’ve alluded to when you talked about the enhanced tax credits for certain individuals on the exchanges. That’s helped that number of people covered by the exchanges, not quite 25 million, but it’s in the 24 million range, which means that a lot of people, particularly in states like Texas and Florida that didn’t expand Medicaid, that they’re getting really important coverage for them. And you did mention, too, that regulatorily, the administration, you know, wants to revert. Revert. Will revert back to the stance it took prior to the Biden administration that I guess suffice it to say, mutes, in a sense, the encouragement from the federal government for people to be covered. What do you see as the fate of the enhanced tax credits in this process? Because so many people depend on it now. And you would have a real contraction of coverage if they were not extended beyond 2025. I should point out that, you know, they, they go to the end of 2025 and those enhanced tax credits for those people in the exchanges.

Joel White [00:32:16]:
Yeah, I think the, in general, the House Republican caucus, they’re okay if the subsidies, the enhanced subsidies expire right now at this point in time. That’s the, that’s where the caucus is. I think most, many of them know that if they expire, there will be a premium hit in 2026, and that there will be, you know, political ads and on the ground problems for, for some people, and they’re, they’re willing to do that. I think what we’ve heard from people like Lisa Murkowski and others in the Senate is they want to extend the credits. And so you’ve got, within the Republican Party a split. And when there’s a split like this, Chip, you and I are experienced enough to know that that usually ends up in a compromise. And so I think one of the ways this could play out is that you have an extension of the enhanced subsidies with reforms to those subsidies. So requiring people to verify their income and pay back credits if that income is less than what they actually made would be one thing.

Joel White [00:33:27]:
Another thing would be tightening up on the enrollment process and making sure people aren’t hopping in and out of the program throughout the year. Those are kind of two things. And then I think one thing that a lot of Republicans would argue is that the premium subsidy itself is poorly designed, and that encourages insurers to just kind of inflate the premiums because the subsidy reduces the amount the individual has to pay based on their income. So it doesn’t really matter what the insurer charges in a general sense, because ultimately the Consumer is not going to pay more. Capping premium subsidy at a national average to the insurer would reduce spending but probably not reduce access. So those kind of three reforms I think in an extension of the subsidy may be where they end up. But right now I got to tell you, there is not Republican House interest in extending any of those subsidies. And I think, you know, advocates will will be very active this year trying to explain both the policy and political dynamics and the practical on the ground impact could have on people.

Chip Kahn [00:34:41]:
Maybe to close out, looking Back to the 118th Congress, there were extenders, Medicare extenders, DISH extenders, Medicare extenders such as Medicare Dependent Hospitals, Medicare low volume hospitals, delay of a major cut in Medicaid, the disportion share cut, and there’s interest in areas like physician payment and telehealth. Telehealth was dealt with somewhat, but physician payment wasn’t in terms of from the 818th. And then there was the House bill that included a number of items, transparency and other items. How much of that do you see carrying over into the next Congress particularly I would hope that the extenders will again be extended because they’re critical for rural health care particularly. But how do you see the 118th agenda being played out in the 119th Congress?

Joel White [00:35:40]:
Great question. The answer is I think all those things are on the table. In particular, the funding of the government runs out in March and they got to go through the exercise they went through in December with funding the government all over again. And so all those items that were part of that healthcare package, the Medicare and Medicaid extenders, the programs that were, you know, expired, their authorization expired, the PBM reforms, the transparency stuff on hospitals and plans, all kind of in the mix. I think that they, my bet is that they get done in March because these were all a bipartisan agreement, okay, between the House and the Senate. And members don’t spend a lot of time. You know, PBM reform has been worked on for years by a lot of folks who are still in Congress. They want to see that get done.

Joel White [00:36:40]:
And so you don’t spend that much time on something like that without seeing it through to enactment. And so my bet is that all those get done. If you don’t extend the expiring things, bad things happen, like dish payments don’t get made and things like that. So it’s all in the mix. My only question is a process question, like there were things in that bill that saved money. Do they kind of pull those out and put them into the budget bill and use those as the quarters they’re looking for to pay for some of that to and, and the last thing I would say is they want to leave the impression that everything in the budget bill is like not an investment. Like I think the thing I talk about with populism and consumers and empowering them to make choices, we’ll see. Like I think there’s a strong desire for many to include an expansion of health savings accounts and make those more robust for more people in like ACA plans, like a bronze and a catastrophic plan, individual coverage, health reimbursement arrangements, reforming some of the drug policies in the inflation reduction act, maybe even repeal the inflation reduction Act, Medicare stuff kind of everything is all on the table right now.

Joel White [00:37:55]:
It’s all swirling around. But there are positive, proactive things I think Republicans want to put in here that would expand consumer choices and really empower them to, to be closer to the decisions in their health care.

Chip Kahn [00:38:10]:
To close out, let me say that if you listen to the inaugural address that the president gave the other day, there was he barely touched on health care and the almost 45 or 45 minute conversation we just had barely below the surface of all the issues in health care that the administration, that Congress, that all those that are involved in health policy in Washington are going to be focusing on on the next many months. So it’s just massive. And I really deeply appreciate all your insights and touching on really much of what will be discussed. But as with healthcare, develop policy development and you know this better than me. You know the devil’s in the details and heavens knows what’s going to happen with all this stuff. Because it all sounds good. When a congressman says we’re going to go do X and then he gets into the process or she gets into the process and sees what the implications of it are.

Joel White [00:39:16]:
That’s a great point.

Chip Kahn [00:39:17]:
Well, great. Thank you so much, Joel, for giving us your time today.

Joel White [00:39:22]:
It’s been my pleasure. Thank you Chip.

Outro [00:39:50]:
Thanks for listening to Hospitals in Focus from the Federation of American Hospitals. Learn more  at fah.org follow the Federation on social media at FAH Hospitals and follow Chip Kahn. Please rate, review and subscribe to Hospitals in Focus. Join us next time for more in depth conversations with health care leaders.

Outro [00:39:58]:
Voxtopica.

Joel is the Founder and President of Horizon Government Affairs (HGA), a health care consultancy that represents two dozen clients and runs four coalitions comprised of 200 organizations dedicated to reforms that improve our health system.

Since Horizon’s founding in 2007, his team has helped enact more than 50 laws and helped shape countless regulations governing all aspects of the U.S. health care system.

Joel is also the President of the Council for Affordable Health Coverage, an HGA-managed coalition to improve affordability, increase competition in health care, and protect and strengthen employee health coverage. Recent campaigns include reforming the Inflation Reduction Act, promoting outcomes-based arrangements for gene therapies, and expanding small-group coverage.

Previously, Joel spent twelve years on Capitol Hill including as Staff Director of the Ways and Means Health Subcommittee. While on the Hill he helped enact nine laws, including the 2002 Trade Act, which created health care tax credits for private coverage, the 2003

law that established the Medicare prescription drug benefit and Health Savings Accounts, the 2005 Deficit Reduction Act, and the 2006 Tax Reform and Health Care Act, which reformed Medicare payment policies.

Joel is on the Boards of Directors of Samaritan Inns, Arlington Bridge Builders, the Schizophrenia and Psychosis Action Alliance, SafeNetRx, and Chaddock Behavioral Health. Joel holds a B.S. in Economics from the American University and is the co-author of the book, Facts and Figures on Government Finance.