The Trump administration inherited some big health policy headaches on Monday. And the nature of federal rules means it can’t start from scratch on key questions about surprise billing, coverage of GLP-1s and prescribing controlled substances.
The big picture: All eyes will be on Trump health appointees as they sort through unfinished business from the Biden years.
Here are some of the most pressing matters:
Covering anti-obesity drugs: The Biden administration in November proposed requiring Medicare and Medicaid to cover GLP-1s for weight loss. Medicare law prohibits that, but there’s room for a “reinterpretation” that would extend coverage.
- The new policy would cost Medicare about $25 billion and Medicaid $11 billion over a decade. But it would likely be popular with seniors and could spare the administration’s allies in Congress a difficult vote on coverage expansions down the road.
Lowering nicotine in cigarettes: Just last week, the Food and Drug Administration proposed limiting the nicotine in cigarettes to make them less addictive. The goal is to force more than 28 million cigarette smokers to switch to less harmful products or quit.
- The FDA in Trump’s first term proposed a nicotine rule, but the effort was never finalized. The question for Trump 2.0 is how much finishing the job now syncs with the Make America Healthy movement’s goals.
Settling billing disputes: The Biden administration left office without finalizing changes to the complex process that governs how insurers and doctors settle disagreements over the cost of patients’ out-of-network care.
- Neither insurers nor providers are happy with the current arbitration system that was established by the surprise billing law. Biden administration efforts to find a solution were stymied by litigation, leaving a significant backlog of unsettled disputes.
Telehealth and controlled substances: The Biden Drug Enforcement Administration proposed an 11th-hour registration system for the virtual prescribing of Adderall and other amphetamines like Vyvanse used for ADHD.
- Current flexibilities on teleprescribing expire at the end of this year. Without them, providers have to do an in-person evaluation before prescribing — a situation behavioral health experts say will limit access to increasingly scarce treatments.
Health data privacy: Health and Human Services in late December proposed a sweeping update to federal security standards aimed at better protecting patient data against cyberattacks. But hospitals say the proposed changes are too costly and cumbersome.
Like past administrations, Trump officials bought themselves some time Monday by freezing rules that the previous administration finalized but hadn’t taken effect. Congress also can pass resolutions to void policies finalized within 60 days of the end of the last legislative session.
- Trump’s team can also choose not to enforce certain rules or to not defend Biden-era rules being challenged in court. And it can initiate the formal rulemaking process to roll back Biden-era regulations officially.
- One early test for the new administration will be whether to fight a lawsuit filed on Friday against the Biden administration’s rules to bolster insurers’ mental health coverage requirements.