How Trump's Initial Executive Orders May Impact Medicaid, Medicare Models

Upon taking office, President Donald Trump issued executive orders to rescind numerous Biden-era initiatives, leaving the status of various efforts to reform health care in the US uncertain. Adam Colborn, JD, associate vice president of Congressional Affairs at AMCP, discussed the potential impacts of Trump's order and questions that remain unanswered.

How would the rescinded executive orders have impacted Medicare and Medicaid beneficiaries, and how might Congress respond to the rollback of these efforts?

The big thing for how the executive orders impact Medicare and Medicaid beneficiaries are the CMMI [Center for Medicare and Medicaid Innovation] models that were rescinded under some of these executive orders. The main ones are the Part D $2 Drug List; the Medicaid Cell and Gene Therapy, or CGT, Access Model; and then there was a model for altering payments based on accelerated approval status.

I think there's a lot of uncertainty at this point whether these models will actually move forward. The rescinded executive order actually only directed CMMI to develop the models, so the implementation is a little bit of a question mark, right? Does does the new order from President Trump mean that implementation must stop, or does it actually not have that much of an impact because the order that was being rescinded only directed the creation of the [CMMI model]? That's a big question mark.

I would also say that many of the Medicaid provisions from the rescinded executive orders have already met their goals. So, in some ways, the executive order from President Trump was more symbolic than substantive. I think, for example, Executive Order 14070 from the Biden administration was very focused on facilitating Medicaid expansion in Missouri and Oklahoma. But the the order is 3 years old at this point. Both states had expanded Medicaid before that, and so, you know, they're on the road on implementation of Medicaid expansion. So rescinding that order, in my view, probably doesn't change too much for those programs.

Drug pricing was the focus of a lot of the Biden administration, and so I'm sort of waiting to see what Congress might do in response to this. I think they have their own goals and their own approaches. There may be some overlap there, but I do expect to see movement from Congress on some of these issues, like PBM [pharmacy benefit manager] reform or Medicaid drug pricing.