Resource Center / Staffing Insights / From Policy to Practice: The Changing Face of Healthcare Under a New Administration

From Policy to Practice: The Changing Face of Healthcare Under a New Administration

Welcome to a new era in American healthcare. With the changing of the guard in Washington, D.C., the healthcare industry and patients alike are preparing for a laundry list of potential changes — e.g., policy shifts, funding reallocations, and regulatory rollbacks — that will significantly impact the industry, its workers, and the people who rely on it.

While predicting precisely what President Trump and his administration will do and when they’ll do it is impossible, he and his allies have discussed a range of healthcare priorities and initiatives they intend to focus on in the coming months and years. To adapt and thrive in this evolving landscape, stakeholders must understand and anticipate these changes in healthcare reform, insurance coverage, federal regulations, and public health initiatives. The healthcare organizations that build skilled teams and have the right talent in place will be poised to take advantage of these opportunities.

Potential Implications for the Healthcare Industry

The new administration’s promises and priorities could have immediate and long-lasting ramifications for providers and insurers. Let’s explore what could be in store for them.

Impact on Healthcare Providers

Site-neutral payments

The focus on outpatient infrastructure and services is likely to continue, with site-neutral payment policies gaining traction. This shift aims to reduce healthcare costs by reimbursing providers the same amount for services regardless of the care setting, potentially impacting hospital outpatient departments and ambulatory surgery centers.¹ That means health systems will be financially incentivized and motivated to focus on expanding outpatient services and operations. Why? Because it costs less to treat a patient outside of the hospital. Under the existing system, hospitals often receive higher payments² for the same services compared to other settings. These reforms aim to reduce wasteful spending, lower patient expenses, and address healthcare consolidation by equalizing payment rates across different care settings. With this increased focus on outpatient services, healthcare providers should prepare for higher patient volumes by building the infrastructure and hiring the talent needed to meet demand.

Value-based care

While the administration has signaled it may reverse some Biden-era policies, the fundamental shift toward value-based care is expected to continue, if not accelerate. Key aspects include emphasizing downside risk and accountability for healthcare providers, expanding models like Accountable Care Organization Realizing Equity, Access, and Community Health, and focusing on lowering costs while improving patient outcomes. The administration supports rural healthcare transformation through programs like the Community Health Access and Rural Transformation Model and maintains Medicare Access and CHIP Reauthorization Act incentives for value-based care. These initiatives reflect the administration’s primary goal to reduce costs, improve quality, and enhance patient outcomes through innovative payment and care delivery models. This supports a broader healthcare strategy of increasing efficiency and reducing government spending while improving care quality.

Public health infrastructure

The incoming administration’s plans for the Centers for Disease Control and Prevention and National Institutes of Health include significant restructuring and potential budget cuts, reflecting a broader strategy to reform U.S. public health. For the CDC, this includes possible budget reductions, restructuring into separate entities, narrowing its mission, and reducing its emergency powers. The NIH faces similar budget cuts, potential reorganization, and increased scrutiny of research grants. Overall, this approach emphasizes restoring public trust, increasing political oversight, focusing on chronic diseases, and implementing stricter controls on certain types of biomedical research.

Global health initiatives

In what is a recurring theme, significant reductions in funding and U.S. involvement are the drivers of the Trump administration’s plans for global health initiatives. What’s on tap? Substantial budget cuts to various global health programs, potential withdrawal or reduced engagement with international organizations like the World Health Organization, and a shift in focus toward aligning global health with U.S. security interests. Specific changes may include cuts to programs like the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the UN Population Fund. The administration has expressed its intent to reshape priorities in global health funding and cooperation, emphasizing domestic interests and security concerns.

Impact on Health Insurers

Medicare changes

Trump’s plans for Medicare and its 66 million users³ are designed to balance privatization, reduce costs, and maintain benefits while emphasizing efficiency and innovation.

Expanding and promoting Medicare Advantage plans.
Implementing cost reduction measures without cutting benefits.
Improving program integrity and efficiency.
Increasing access to telehealth and innovative services.
Expanding supplemental benefits for chronic disease patients.
Supporting rural healthcare options.

Medicaid changes

To reduce federal spending and increase state flexibility, the administration’s sweeping proposals would reshape Medicaid’s structure and funding and put coverage for millions at risk.⁴

Shrinking Medicaid through funding cuts and regulatory changes.
Rolling back the ACA’s Medicaid expansion.
Implementing work requirements for able-bodied adults.
Lowering federal matching funds, potentially to 40% or less.
Adding enrollment hurdles, such as annual reapplications.
Encouraging states to adopt block grants or per-capita caps.
Approving waivers that restrict eligibility or impose premiums.
Streamlining managed care regulations.
Potentially phasing down the 90% federal match for expansion states.

Insurance risk pools, premium, network adequacy requirements

Significant changes are planned for the health insurance industry. Here are a few of the most impactful. Expanding Association Health Plans⁵ and short-term insurance, potentially fragmenting risk pools. Increased premium rates due to market uncertainty and policy shifts while modifications to Essential Health Benefits may affect coverage and costs. Network adequacy requirements might see reduced federal oversight, with states taking a larger role. As a result, healthier individuals could see their premiums decline while those with pre-existing conditions or more significant health needs might face higher costs and reduced coverage. These changes will put new demands on health insurers, who will have to build nimble teams with the knowledge and skills to help patients and providers alike adjust to a new environment.

New or rescinded regulations

Healthcare is likely to see a range of new regulations targeting some of today’s hot-button topics with an eye on reducing regulations, promoting market-driven solutions, and fostering innovation.

Telehealth: Addressing the uncertain long-term outlook for telehealth as Medicare flexibilities expire on March 31, 2025. The administration may extend some pandemic-era prescribing waivers. Talent with tech skills will be in demand as a result.
Artificial intelligence: Shifting toward deregulation of AI use and development in healthcare, focusing on minimizing federal oversight to foster innovation and competition. Even without the new administration’s initiatives, healthcare organizations need to make hiring talent with experience a priority as the tech rapidly evolves.
Over-the-counter drugs: Reauthorizing the OTC Monograph Drug User Fee Program before its September 30, 2025, expiration date.
Drug pricing: Potentially modifying or repealing parts of the Inflation Reduction Act related to drug price negotiations.
Health savings accounts: Possibly expanding the use of health savings and health reimbursement accounts for individual coverage.
Rural healthcare: Introducing reforms to support and modernize rural healthcare systems. New opportunities seem likely in these underserved areas, creating more opportunities for job seekers and more demand for talent for healthcare organizations.

Affordable Care Act

A record 24.2 million⁶ people purchased a health plan through the Affordable Care Act (a.k.a. Obamacare) in the most recent open-enrollment period. Although efforts to entirely repeal the ACA seem to have lost their luster, Trump is likely to introduce tweaks to fulfill his promise to improve it.

Allowing enhanced federal premium subsidies to expire at the end of 2025, potentially increasing out-of-pocket premiums for ACA enrollees by an average of $705 a year, or 79%⁷.
Potential implementation of spending caps on ACA-related programs.
Consideration of changes to reduce federal spending on ACA subsidies.
Possible efforts to streamline or reduce ACA regulations.

Navigate the Future of Healthcare with a Staffing Partner

The next four years have all the makings of being a time of change and challenge in healthcare. A new Trump administration coupled with Republican control of Congress could implement initiatives with wide-ranging impacts on healthcare providers, insurers, and patients. While challenges and uncertainties lie ahead, the healthcare industry also has the opportunity to innovate, collaborate, and improve patient care. By staying informed, adaptable, and focused on patient needs, healthcare stakeholders can navigate the changing landscape and contribute to a more equitable and effective healthcare system.

With 20+ years of experience in healthcare and life sciences staffing, Medix has the depth and breadth of knowledge to be an indispensable partner to healthcare organizations during this time. Our team has been working with healthcare leaders to find the best talent available and build skilled teams through eras like these. With flexible staffing solutions tailored to your organization, we enable healthcare organizations to scale their staff or downsize as new policies and regulations come online. Contact us today to get started.