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Focus on Regulation

What’s in store for the Affordable Care Act and drug pricing policy under the Trump administration?

The Trump administration has been vocal in its criticism of the Affordable Care Act (ACA), and already has worked with the Republican-controlled Congress to begin rolling back key provisions of the legislation. The promised repeal and replacement of the ACA has effectively left insurers in a holding pattern. It has also created a period of extraordinary uncertainty for the Centers for Medicare & Medicaid Services (CMS) and the healthcare stakeholders that it regulates. Ken Choe and Beth Roberts, partners in the health group at Hogan Lovells, say that the changes being considered would have profound impact across the healthcare landscape, and may also impact drug pricing in the US.

“Over 20 million people get their health insurance through the Affordable Care Act – if it is repealed and replaced, that will dramatically change the healthcare landscape,” says Roberts. “Many of our clients rely on ACA healthcare coverage to ensure that the patients they serve have access to their innovations. If that coverage shrinks, providing access to these treatments and therapies will inevitably become more difficult and costly.”

And the Trump administration faces choices about transitioning from the ACA to a replacement plan, a complex and potentially messy process. “In the short term, there is a legal challenge to availability of the cost sharing subsidies that help people afford their deductibles and copayments and coinsurance,” says Choe. “In some ways, it puts the new administration in a bit of a bind. If there is a delay before replacement policies come to pass, there will be a need for continuing coverage for the millions of people who are currently insured under the existing system.”

There are also concerns and unanswered questions around the new administration’s stance on drug pricing. “The Trump administration supports market pricing, and is likely to use transparency measures, reduced regulations, faster regulatory approvals, and consumer pressure to drive prices down,” says Roberts. “But the President hasn’t explicitly said that this is the approach his administration will take. That creates uncertainty in the market.”

Despite the challenges, Roberts and Choe believe that the coming changes, if carefully navigated, provide enormous opportunities for drug makers, insurers, providers, and others to be a voice at the table in shaping the future of healthcare in the US.

“I think we’ll see a lot more responsibility handed to patients – asking them to choose wisely in making healthcare and spending decisions,” says Roberts. “And I think we’re going to see a lot more control being given back to the states.” That’s important because states are more likely to experiment with delivery reforms that better serve the needs of their own population. And that could mean more variation in both healthcare coverage and delivery.” Roberts says that companies need to be actively engaged in order to truly benefit from this shifting landscape. “These changes bring incredible opportunity for our clients,” she says. “We’re urging them to get involved in the process and really advocate for patients. That’s how companies can ensure that patients have continued access to the amazing innovations they’re creating.”

Watch the video for more insights from Beth Roberts and Ken Choe on the changing healthcare landscape.

[via STATnews.com]