The Future of U.S. Healthcare: What to Expect in 2025
As we look ahead following the 2024 Presidential Election, the healthcare landscape is set to shift, with Republicans now controlling the Senate and a tightly contested House of Representatives. The election cycle brought campaign rhetoric from figures like RFK Jr. and even Elon Musk, suggesting potential shifts in vaccine policy and a broader focus on chronic diseases. We anticipate more clarity once key agency leaders are announced, as these appointments will set the tone for policy direction across the healthcare spectrum. At a high level, we will likely see some common themes: deregulation (which is very challenging), a shift to state-based healthcare, ACA cuts, growth in Medicare Advantage, and tariffs to boost domestic production of healthcare goods.
In this edition, I break down the most likely changes we can expect in key healthcare domains based on past Trump administration policies, campaign discussions, and proposals for 2025.
1. Schedule F and Its Impact on Healthcare Policy
One of the most significant policy shifts could come from the revival of Trump’s Schedule F executive order. Originally issued in 2020, Schedule F would reclassify tens of thousands of federal employees from protected civil service roles to at-will positions. This move would give the administration the power to replace career civil servants—experts in public health, healthcare policy, and scientific research—with political appointees.
The implications for healthcare policy are substantial. By sidelining non-partisan experts, the administration could accelerate its agenda but at the risk of diminishing the role of science-based decision-making. We could see a more rapid implementation of ideologically driven policies, with reduced input from subject matter experts. The potential outcome? A shift away from evidence-based policymaking, which could undermine long-term public health initiatives. If implemented, Schedule F could result in the dismissal or replacement of tens of thousands of federal employees, creating instability and a loss of institutional knowledge across agencies like HHS, FDA, and CMS. If implemented, the public could find navigating agencies particularly difficult.
2. Digital Health Regulation
The previous administration aimed to reduce regulatory hurdles in digital health, prioritizing innovation over compliance. We’re likely to see a continuation of this approach, with a focus on accelerating the approval process for digital health solutions and telehealth platforms. Expect a push for state-level oversight to take precedence, which could lead to greater variability in digital health standards across the U.S.
3. AI Regulation in Healthcare
AI in healthcare remains a hot topic, with growing interest from both industry leaders and policymakers. We anticipate that AI regulations will focus on balancing innovation with patient safety. There will likely be fewer restrictions on AI development but increased scrutiny on AI-driven decision-making tools, especially in areas like diagnostics and predictive analytics. Federal agencies may play a reduced role, shifting oversight responsibilities to states, potentially leading to a patchwork of regulations.
4. Price Transparency
Price transparency has been a bipartisan issue, with the Trump administration initiating policies to mandate clearer pricing from hospitals and insurers. We expect these efforts to continue, with additional pressure on providers and payers to disclose costs upfront. However, without strong enforcement mechanisms, the actual impact on lowering healthcare costs may remain limited.
5. Growth of Medicare Advantage
Medicare Advantage plans have seen significant growth in recent years, a trend we expect to continue. The emphasis will likely be on expanding these plans as a preferred model of care, given their cost-control mechanisms and appeal to seniors. However, there may be a push for increased scrutiny on the quality metrics and potential overbilling issues associated with some Medicare Advantage providers.
6. Contraction of Obamacare (ACA) and Medicaid Subsidies
Campaign rhetoric hinted at potential rollbacks of ACA provisions, particularly around Medicaid expansion. The focus may shift to reducing federal involvement and pushing more control to the states, leading to variability in Medicaid coverage. If past is prologue, a move to block-grant or per-capita caps could be on the horizon. This could result in decreased subsidies and eligibility, potentially leaving millions at risk of losing coverage.
7. Vaccine Policy and Chronic Disease Focus
With campaign figures like RFK Jr. vocal about vaccine skepticism, there’s a potential for policy shifts that could impact vaccine mandates, particularly in school settings. At the same time, we anticipate a broader focus on chronic disease management, especially given the high burden of diseases like diabetes and heart disease. Expect more public health initiatives aimed at prevention and lifestyle changes, though funding levels could be impacted by broader federal budget cuts.
8. Reproductive Health and Project 2025 Proposals
Although former President Trump has distanced himself from Project 2025, many Republicans continue to support the proposed measures, which include significant restrictions on abortion rights and access to mifepristone across state lines. We can also expect a reduction in federal funding for reproductive health programs (domestic and international), with a possible shift towards state-level control. This could lead to a more fragmented landscape for reproductive healthcare access, depending heavily on individual state laws.
These are just a few of the changes we might see unfold over the next year. While much remains uncertain, it’s clear that healthcare policy will continue to evolve in ways that could have profound impacts on the industry.
Stay tuned for more updates as the new administration's healthcare priorities become clearer. I’ll continue to keep you informed on what these changes mean for your practice, your business, and your patients.
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