President Donald Trump has been in office for 102 days.
He has been quick to shake up U.S. foreign policy priorities and import tariffs, but his goals for commercial health coverage are still hazy.
He has not yet shown whether he intends to eliminate the Affordable Care Act soon, focus at least temporarily on simply updating the ACA-based rules or make the priority dealing with matters such as efforts to increase competition in the health care sector.
But here’s a look at some of the health benefits moves Trump has made so far.
The people: Trump has already won confirmation for three members of its health benefits administration team. The Senate confirmed Robert F. Kennedy Jr. as secretary of the U.S. Department of Health and Human Services, Feb. 13; Lori Chavez-DeRemer as secretary of the U.S. Department of Labor, March 10; and his administrator for the Centers for Medicare and Medicaid Services, Dr. Mehmet Oz, April 4.
The nomination for Daniel Aronowitz, the attorney and fiduciary insurance company executive picked to the assistant Labor secretary in charge of the Employee Benefits Security Administration, is still pending.
The confirmation process has moved more quickly for Trump’s key health benefits nominees than for those of the previous president, Joe Biden.
When Biden was in office, he won Senate confirmation of his HHS secretary, Xavier Becerra, March 18, 2021; his Labor Secretary, Martin Walsh, March 22, 2021; his CMS administrator, Chiquita Brooks-LaSure, May 25, 2021; and his EBSA head, Lisa Gomez, Sept. 29, 2022.
The Department of Government Efficiency: Trump brought in Elon Musk to help drive efforts by DOGE to downsize and reorganize many federal agencies, including CMS and EBSA.
At this point, the impact of the DOGE moves on teams that work with employer-sponsored health benefits is unclear.
The team may have eliminated about 300 of 10,000 positions at CMS, but the posts eliminated appear to be in offices that support Medicare and Medicaid recipients, not Affordable Care Act programs.
About 200 of EBSA’s 889 full-time employees seem to have agreed to voluntary early retirement or deferred resignations.
Communications: Early on, the Trump administration paused almost all CMS and EBSA communications, including the flow of routine reports on infectious diseases and mortality. Since then, the flow of releases has been light, but publication of regular, routine morbidity and mortality reports has resumed.
Affordable Care Act: For now, at least, the Trump administration has been developing tougher enrollment rules for the ACA public exchange open enrollment period for 2026 coverage, but it seems to be proceeding on the assumption that the exchange system will continue to exist.
Prescription drugs: The Trump administration has also been slow to show how it will address the conflict between pharmacies, pharmacy benefit managers, drug manufacturers, patient groups, employer groups and other interest groups over who’s to blame for high prescription drug costs.
But the administration has taken a keen interest in the topic and issued an executive order in April that calls for the Labor secretary to work to lowering drug prices by developing new PBM transparency regulations. The order also calls for his administration to review all players in the drug supply chain.
Other benefits issues: Trump has worked to reverse many health benefits moves made by the Biden administration and start other initiatives by posting executive orders.
Some of the key executive orders have:
◆ Reversed Biden efforts to discourage sales of short-term health insurance and critical illness insurance.
◆ Promoted stronger enforcement of regulations that require hospitals and health insurers to post detailed health care price information.
◆ Called for efforts of ideas for making it easier for families to pay for in vitro fertilization procedures.
Litigation: The Trump administration has been aggressive about going to court to fight what it sees as unfair efforts by large health insurers and other large organizations to join together to decrease competition in the health care market.
The administration has also gone to court to defend the Affordable Care Act preventive services package, through arguments that could increase the administration’s ability to hire and fire members of what have been advisory panels that were supposed to be insulated from political pressure.
The tariffs: Trump began announcing and modifying major tariffs, or import taxes, April 2. Tariffs on prescription drugs appear to be in the pipeline.
For now, the immediate effects on health benefits appear to be modest, but benefits advisors have been busy working with benefits buyers to analyze the implications.