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Think tanks draft plans for a GOP president

Aug 23, 2023
Illustration of the White House with a game strategy diagram in a thought bubble.

Illustration: Gabriella Turrisi/Axios

Conservative think tanks are preparing a health care game plan should a Republican retake the White House next year, by drafting regulations and identifying political appointees who could stock an incoming administration.

Why it matters: The goal is to avoid the chaotic transition that unfolded under ex-President Trump, whose team struggled to get qualified people in place who could run the executive branch and other critical agencies.

Driving the news: Early plans envision the return of some long-held conservative health priorities like association health plans and Medicaid block grants, along with newer ideas on site-neutral payments and radical reforms.

  • Another would split the CDC into entities for research and data collection and for making public health recommendations with "severely confined ability" to influence policy.
  • "A large part of it comes from the experience of 2017. There wasn't a clear agenda that was ready to go," said Brian Blase, a former Trump administration official who's now president of the right-leaning Paragon Health Institute.
  • "Four years goes quickly, and you don't want to spend the first year planning."
  • Trump's early miscues included four executive orders on drug pricing that were light on substance and a "most favored nation" regulation that faced legal scrutiny.

What's happening: Paragon Health, as well as the Heritage Foundation and America First Policy Institute, are the primary conservative think tanks now drafting health regulations, policy road maps and recruiting personnel.

  • Paragon's road map envisions a burst of rulemaking mostly through the Department of Health and Human Services.
  • Some resurfaced policies would aim for more transparency in Medicaid financing, like the controversial 2019 fiscal accountability proposal that was later pulled, and build on the Trump-era price transparency rules.
  • Blase worked on four major health regulations while at the White House's National Economic Council and notes that three are still in effect: price transparency rules, individual coverage HRAs and short-term insurance.
  • The fourth — association health plans that would have allowed small businesses to band together to set up insurance outside of Affordable Care Act requirements — was blocked in court.
  • "I think you learn from those experiences and try to craft the policy that tries to address the legal concerns," he said.

Meanwhile, the America First Policy Institute, founded by Trump administration alumni in 2021, is putting forward what it calls a 12-part "radical incrementalism" health policy agenda.

  • "If [the new president] turns to you, and says all right, what should I do? Well, when it comes to health care, we've got to be ready to answer that question," said former Louisiana Gov. Bobby Jindal, who is the chair of AFPI's health division, Center for a Healthy America.
  • The plan includes proposed legislation and rules that would allow Medicare and Medicaid to reimburse and contract with direct primary care providers and expand certain Medicare site-neutral policies and make them permanent.
  • The group is also analyzing President Biden's health care executive orders to identify which it would roll back, and what to put forward instead.
  • Possibilities include reinstating and making permanent the Trump administration's 2019 HRA rule, the 2018 short-term, limited duration insurance rule and 2018 ERISA-Association Health Plan rule.
  • "We are certainly thinking through what policies can be executive-ly done if needed, though you know, ideally, you get the legislative win, and it's codified," said Heidi Overton, director of the Center for Healthy America. "Association health plans, short-term plans, all of those components we would like to see."

The Heritage Foundation also is laying plans, having recently joined more than 70 other conservative groups to launch an initiative called Project 2025.

  • The group published a public plan this spring on how a future GOP president could overhaul HHS.
  • "It is designed to provide the road map and ammunition for the next conservative president to take the reins of government immediately upon taking office," said Roger Severino, Heritage's vice president of domestic policy, who led HHS' civil rights office under Trump and was lead author of the overhaul plan.
  • It names several Trump-era Medicare regulations, like the MCIT and RADV rules, that should be reinstated; proposes a Medicaid block grant system; codifies association health plans; strengthens price transparency; and advances site-neutral measures.

Reality check: Regardless whether it's Trump or someone else, the next Republican president is likely to be better prepared and have fleshed-out policy plans that are ready to roll.

  • That is, assuming the new president listens to the advice.
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