Summary
As the November election approaches, presidential candidates are announcing more details about their respective health care agendas. In today’s issue, we highlight proposals recently released by the Harris-Walz campaign on new Medicare benefits and rural health. Since the Trump-Vance campaign has not released comparable proposals, we draw from Project 2025, and the Trump Administration’s previous actions on potential policies that a Republican administration could pursue. See the IHPP 2024 Election Outlook & 2025 Congressional Preview for a comparison of policy positions on other key health issues.
New Medicare Benefits
- Harris-Walz: The Harris-Walz campaign proposes “Medicare at Home” to create a new Medicare benefit to cover home care services, improve wages and working conditions for care workers, and enhance the overall quality of care. They also propose to create a new Medicare benefit to cover hearing aids, eye exams, and glasses. The plan states that the new benefits would be fully paid for without impacting existing premiums by expanding Medicare drug price negotiations, increasing the discounts drug manufacturers cover for certain brand-name drugs in Medicare, and addressing Medicare fraud. However, Congress would need to pass new legislation to authorize expanded Medicare drug price negotiations and the creation of these benefits, which would be particularly challenging in a possible divided government.
- Trump-Vance: While the Trump Republican platform ( 10, 12) proposes to protect and strengthen the Medicare program, it has not released detailed Medicare policy proposals. Former President Trump has endorsed “at-home senior care,” which includes reallocating resources to this area, addressing workforce shortages, and providing support for unpaid family caregivers through tax credits and reduced red tape. However, during his presidency, former President Trump’s 2021 budget proposed significant cuts to Medicare spending, including reduced payments to hospitals and healthcare providers, which, according to the Center for Budget and Policy Priorities (CBO) projected to negatively impact beneficiaries by limiting access to care. His 2021 budget suggested approximately $500 billion in Medicare cuts over ten years, which could lead to decreased access to services and higher out-of-pocket costs for beneficiaries. Additionally, efforts to repeal the Affordable Care Act could reopen the drug “donut hole” and reinstate cost-sharing for preventive services, further harming Medicare beneficiaries.
Rural Health
- Harris-Walz: Building on a $75 million investment by the Biden-Harris administration, Vice President Harris and Governor Walz have outlined comprehensive strategies to bolster health care access in rural communities, focusing on several key initiatives. They aim to recruit 10,000 health care professionals, including doctors, nurses, community health workers, and EMS personnel, to alleviate workforce shortages in rural and tribal areas. Their plan also includes permanently extending Medicare coverage for telemedicine services and doubling federal funding for telehealth equipment and technology to improve access. Additionally, they seek to reduce the number of ambulance deserts by half to ensure timely emergency care, launch a grant program to train and fund Rural Community Health Workers, and provide financial and technical support to strengthen EMT and paramedic services in these communities. While the plan lays out ambitious goals, it would require congressional support to secure funding which would be challenging in a divided government.
- Trump-Vance: The Trump-Vance campaign has provided limited details on policies to support rural health. Project 2025 (p. 487) acknowledges challenges to health care access in rural areas. Project 2025 proposes to reduce “regulatory burden” to foster private innovation in health care delivery, enhance telehealth access through increased services and interstate licensure for providers, and explore cost-effective care alternatives, including independent telehealth services and less expensive options outside traditional hospital settings. In his past presidency, former President Trump issued an Executive Order with directives to launch a new rural health payment model, improve rural health infrastructure, and extend telehealth flexibilities.
Regulatory Update
The Office of Management and Budget (OMB) is reviewing the following:
Medicare
- Physician Payment – The final rule would make changes to the Medicare physician fee schedule for calendar year 2025 (November 2024).
- Outpatient Payment – The final rule would make changes to the Medicare hospital outpatient prospective payment system for calendar year 2025 (November 2024).
- Home Health – The final rule would make changes to the Medicare home health prospective payment system for calendar year 2025 (November 2024).
- ESRD – The final rule would make changes to the Medicare End-Stage Renal Disease (ESRD) payment system for calendar year 2025 (November 2024).
- Medicare Advantage – The proposed rule would make policy and technical changes to the Medicare Advantage, Medicare Prescription Drug Benefit, and Medicare Cost Plan Programs, and PACE for contract year 2026 (September 2024).
Other Topics
- Healthcare System Resiliency and Modernization – The proposed rule would revise and update national emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers (was set for December 2023).
- Retail Pharmacy Standards – The final rule would require pharmacies and vendors to modify the currently adopted National Council for Prescription Drug Programs (NCPDP) standards to the Telecommunications Standard Implementation Guide Version F6 (F6); Batch Standard Implementation Guide version 15; and Batch Standard Subrogation Implementation Guide version 10 (was set for February 2024).
- Organ Transplants – The final rule would establish a new mandatory Medicare payment model, the Increasing Organ Transplant Access Model (IOTA Model), that would test whether performance-based incentive payments paid to or owed by participating kidney transplant hospitals increase access to kidney transplants for patients with end-stage renal disease (ESRD) while preserving or enhancing the quality of care and reducing Medicare expenditures.
- Cybersecurity – The proposed rule would make modifications to the Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act). These modifications will improve cybersecurity in the health care sector by strengthening requirements for HIPAA regulated entities to safeguard electronic protected health information to prevent, detect, contain, mitigate, and recover from cybersecurity threats.