番茄社区

The following is a transcript of the podcast episode:

Rachael Robertson: Hey, everybody. Welcome to MedPod Today, the podcast series where 番茄社区 reporters share deeper insight into the week's biggest healthcare stories. I'm your host, Rachael Robertson.

We're approaching the show today a little differently. I'm discussing the implications of the presidential election with 番茄社区's Washington team. First, I'll chat with Joyce Frieden about what actions president-elect Donald Trump is likely to take in the healthcare realm. Then, Shannon Firth will tell us about how Trump may handle the Federal Trade Commission, which also has ramifications for healthcare.

On to the show.

With the 2024 presidential election now in the rear view mirror, speculation abounds over who will be in charge of healthcare in the second Trump administration. Same goes for what actions Trump is likely to take in the healthcare arena. Washington editor Joyce Frieden is here to tell us what we know so far.

So Joyce, what are you hearing about what actions the Trump administration may take to undo some of what President Biden did in his term? What ones are they likely to leave in place?

Joyce Frieden: Hi, Rachael. Well, two of the first actions I've been hearing that Trump is likely to undo are President Biden's executive order to have the U.S. rejoin the World Health Organization, which the previous Trump administration had withdrawn the U.S. from. And similarly, Biden's executive order to have the U.S. rejoin the Paris Climate Accord. There is also a Biden executive order on securing access to reproductive health services – he'll probably want that one undone also. On the other hand, Trump will likely want to redo – but not undo – a Biden executive order on strengthening access to high-quality contraception, according to the experts I spoke with. He'll want to remake it in a Republican fashion and emphasize families who are looking for alternatives, some of my sources have said.

Robertson: Okay, what about other actions he could take to undermine Biden's work?

Frieden: Well for agencies he doesn't like, he may not be able to get rid of them entirely, but he can starve them out of existence. I spoke with Leighton Ku, PhD, MPH, who directs the Center for Health Policy Research at George Washington University. He explained to me that, "Trump could say, 'I'm not naming anyone to head that agency' and transfer all the staff away, so in principle the office could exist but no one is there." This has happened in previous Republican administrations with HHS's Office of the Assistant Secretary for Planning and Evaluation, he told me. And Trump could zero out funding for the agency in his budget.

Another part of HHS that Trump might target is ARPA-H, the Advanced Research Projects Agency for Health, which promotes cutting edge research. That's what Michael Abrams, a healthcare consultant, suggested when I interviewed him. Abrams said that there was a good chance Trump would try to kill off that agency because "in the 2 years since the signing [of the executive order], ARPA-H has barely gotten off the ground" and "a lot of it is the government handing out grants to entrepreneurs who think they have a good idea, and I think from the Republicans' point of view, those decisions need to be made by the market."

Robertson: Got it. And what about the Affordable Care Act? What might happen to that while Trump is in office, given that he sought to repeal it last time around?

Frieden: Well, Rachael, one thing that most people are fairly certain of is that the subsidies given to low-income enrollees on the Affordable Care Act's health insurance exchanges to make their premiums more affordable will likely not be extended, so that will make those insurance policies much less popular. However, although Trump dislikes the ACA, killing it entirely could have political consequences, so he probably won't do that, according to Michael Abrams. One other thing he could do is try to bolster short-term, limited duration insurance policies. He was a big fan of them in his previous term. These were meant to tide people over when they were temporarily without health insurance coverage, but Trump might try to extend their use. They generally are cheaper than regular health insurance, but their benefits are also skimpier. We'll be watching to see what changes he makes in the healthcare realm.

Robertson: Thanks so much, Joyce.

Frieden: Thanks, Rachael.

Robertson: And now we'll turn to the Federal Trade Commission. The FTC is charged with enforcing antitrust law -- in other words, ensuring that markets are fair and competitive -- and it's also tasked with enforcing consumer protections. It's been said that under the Biden administration, with chair Lina Khan at the helm, that the agency has taken a more aggressive approach to curbing corporate power than has been the case in decades. Reporter Shannon Firth is here to tell us more.

Shannon, what can you tell me about the FTC's approach to things like mergers and acquisitions and to private equity under Khan's leadership? Is the Trump administration likely to continue that same approach?

Shannon Firth: So Rachael, under Khan, the FTC has been very aggressive, both in the healthcare and the big tech space. The FTC, the Department of Justice, and HHS launched a joint investigation into the role of private equity and corporate profiteering, which is a particular concern for healthcare. So part of what that joint investigation has done is to issue a request for information to learn more about private equity's impact on hospitals and other healthcare facilities, with the idea that the agency can then decide which enforcement tools would best address the problems.

A former policy director for the FTC and an antitrust lawyer, David Balto, told me he thinks that Republican antitrust enforcement would be more cautious than what we've seen under Kahn, and probably less likely to pursue action. But another source, David Schwartz, a former FTC lead investigative attorney who's now a partner at a global law firm, said he thinks both Republicans and Democrats are concerned about the impact of "far off owners" who may not prioritize patient safety. Comments have already closed on the joint request for information, but no action has been taken to date. Schwartz said he'll be looking to see if the Trump administration makes a move or lets the investigation expire quietly. That will be the first signal of how a Trump FTC might approach these players.

Robertson: Okay, so another area of healthcare that the FTC sought to tackle are noncompete agreements. Can you explain what noncompete agreements are and why Khan tried to ban them? And do you think a Trump administration will follow suit?

Firth: So noncompetes prevent employees from working for a competitor or from opening a competing business even after the relationship with a prior employer has ended. One in five American workers has a non-compete clause in their contract. The current FTC sees noncompetes as "an unfair method of competition." In April, the agency issued a final rule and tried to ban almost all noncompetes, with some exceptions for senior executives. But in August, that ban was struck down by a federal court. The FTC appealed, but the rule is essentially stalled for now.

From what I'm hearing from former FTC sources, it's not totally clear that the agency has the rule-making authority to take this pretty drastic step. Daniel Gilman, PhD, JD, of the International Center for Law and Economics and a former attorney advisor in the FTC's Office of Policy and Planning, told me that even if the ban were revived, the agency lacks the staff or experience to implement something this broad, and for that reason, it's kind of hard to imagine the new administration fighting to save it, he said.

Robertson: To some, Kahn has been seen as an enemy of Wall Street and Silicon Valley. But her supporters consider her an antitrust warrior on a mission. Do you expect Khan to stick around after president-elect Trump takes office?

Firth: So that's a really important question. I spoke with Mitchell Li, MD, an emergency physician in North Carolina and founder of Take Medicine Back, a group that advocates against the corporate practice of medicine and private equity in particular. Li pointed out that in addition to Senators Elizabeth Warren and Bernie Sanders, Khan has a handful of powerful GOP allies, including Vice President J.D. Vance and Donald Trump Jr. But Khan also has some serious enemies, Li noted, in Wall Street and in Silicon Valley, and that includes Elon Musk, who recently posted on X, the site he owns, that Khan would be "fired soon."

In reality, a president cannot fire an FTC chair without cause, but in Li's opinion, whether Khan stays or goes will largely depend on who Trump decides to turn to for advice on agency appointments. But as Schwartz told me, it's tradition that a chair typically resigns when a new party takes over, but it's not a fixed requirement. The basic math of the agency is that the FTC has five commissioners at present: two are Republican and three are Democrats. To have majority, Trump needs to flip that ratio. Currently, the only open seat belongs to Khan, and her term expired in September. As I mentioned, it's tradition for a chair of a different party to step down when a new administration takes over, but it isn't required. So Khan can remain on the commission, possibly even as an acting chair, until a replacement is confirmed by the Senate. However, that may be unlikely.

Robertson: So it sounds like we may just have to wait and see. Thanks for your reporting on this, Shannon.

Firth: Thanks, Rachael.

Robertson: And that is it for today. If you like what you heard, please leave us a review wherever you listen to podcasts (, ) and hit subscribe if you haven't already. We'll see you again soon.

This episode was hosted and produced by me, Rachael Robertson. Sound engineering by Greg Laub. Our guests were 番茄社区 reporters Joyce Frieden and Shannon Firth. Links to their stories are in the show notes.

MedPod Today is a production of 番茄社区. For more information about the show, check out medpagetoday.com/podcasts.

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