I. KEY TAKEAWAYS
The election of Donald J. Trump as the 47th president and the change in the U.S. Senate control from the Democrats to the Republicans will substantially impact the healthcare enterprise, presenting both opportunities and challenges for healthcare stakeholders. Though the outcome of control of the U.S. House of Representatives is unknown at the time of this writing, Republican leaders are expressing confidence that they will retain a small majority. Democratic leaders continue to state that they still see a path to control.
On the immediate horizon, U.S. Congress may seek a short-term continuing resolution to fund the federal budget, perhaps through March 2025. There are a number of bipartisan initiatives in the health arena in this Congress that could be addressed in a 2024 year-end health package before Christmas. Several critical health "extenders," such as funding for community health centers, ambulances and safety-net hospitals, must be addressed, perhaps through a one-year extension. However, if Congress elects to delay the final appropriations legislation until March 2025, it is certainly possible that these health "extender" provisions could also be temporarily continued through the same March 2025 timeframe.
Going into 2025, we are likely to see the Trump Administration use its rulemaking and executive action authorities to examine and potentially reverse a number of the Biden Administration's actions and advance the new president's priorities. We could also see the use of the Congressional Review Act to repeal recent U.S. Department of Health and Human Services (HHS) rules if Republicans gain control of the House.
On Capitol Hill, reducing the size of the deficit and debt remain critical priorities for many Republicans. If the Republicans retain control of the House of Representatives, we anticipate that they will move a "budget resolution" to advance key priorities, particularly around extending the expiring provisions of the Tax Cuts and Jobs Act, and addressing additional promises made during the campaign such as eliminating the tax on tips and Social Security. As part of that "budget reconciliation" legislation, the Republicans may seek to include a number of tax-related healthcare provisions, such as expanding the limitations on health savings accounts and equalizing the tax treatment of individual and employersponsored health plans. Further, we expect budget legislation to include "site-neutral" Medicare payments for outpatient services, which would have an adverse financial impact on hospitals, but would bring substantial program savings.
We do not anticipate at this time that a Republican-controlled Congress, if that occurs, would seek a full repeal and replace of the Affordable Care Act (ACA). However, there are a number of other Republican priorities in healthcare, some of which can be included in the budget reconciliation legislation under Senate rules and some of which cannot, but could be advanced through the regular legislative process or perhaps part of a larger healthcare package. Some key themes that we expect from the Republicans in the White House and Senate, at least, include increasing price transparency, reducing consolidation in the healthcare industry (including in the hospital sector), empowering patients to make healthcare choices and enhancing competition among providers, including eliminating the ban on physician-owned hospitals.
II. ELECTION RESULTS (as of Nov. 11, 2024)
President of the United States – Donald J. Trump
- Former President Trump has secured the presidency, garnering almost 75 million votes and flipping Pennsylvania, Michigan, Georgia, Wisconsin, Nevada and Arizona for 312 electoral votes.
- Vice President Kamala Harris has received approximately 71 million votes and 226 electoral votes.
- While there are still some votes uncounted, the total votes for Vice President Harris are about 13 million fewer than were cast for President Joe Biden in 2020.
U.S. Senate – GOP Majority (At Least 53 Seats; Final TBD)
- The map this cycle favored Republicans, who only needed to flip one other seat in addition to West Virginia (GOP won) to gain a majority.
- Republicans have won a total of 53 races so far, with one race still undecided (Arizona).
- With wins in Montana, West Virginia and Ohio, Republicans have secured an operational majority of at least 53 seats.
- Notably, although The Associated Press (AP) has called the Pennsylvania Senate race in favor of David McCormick, Sen. Casey has not yet conceded.
U.S. House of Representatives – TBD
- Democrats needed a net gain of four seats to secure the majority, but Republican wins in Pennsylvania, Michigan and North Carolina offset losses in New York.
- As of Nov. 11, 2024, AP had called 416 of 435 seats, with Republicans holding 214 seats and Democrats holding 203 seats.
- 18 seats remain to be called. This includes nine close races in California, where absentee ballots can be counted up to a week after Election Day, as long as they are postmarked by that day.
III. LEADERSHIP CONTESTS
House of Representatives
In the House, the GOP is proceeding with leadership elections on the assumption that it will retain the majority. Speaker Mike Johnson (R-La.), Majority Leader Steve Scalise (R-La.) and Majority Whip Tom Emmer (R-Minn.) are all expected to win their respective reelections, and in Speaker Johnson's case, renomination. Speaker Johnson is likely to secure renomination for Speaker during the GOP Conference elections scheduled for Nov. 13, 2024, where he will need only a 50 percent majority. However, he would like to get as close to 218 votes as possible. Some members of the GOP may vote against Johnson in the conference as a signal of discontent over certain decisions he made this year, particularly regarding the March 2024 spending package. The actual election of a new Speaker for the 119th Congress will occur on Jan. 3, 2025, and Speaker Johnson will likely be working intensively between now and then to shore up support.
The House Democratic leadership is also expected to remain static; Minority Leader Hakeem Jeffries (D-N.Y.) and Minority Whip Katherine Clark (D-Mass.) both plan to remain in their leadership positions. Earlier in the year, Assistant Leader James Clyburn (D-S.C.) stepped down from his leadership role and was replaced by Democratic Policy and Communications Committee Chair Joe Neguse (D-Colo). House Democrats indicated they'll hold leadership elections Nov. 19, 2024. Should the Democrats take control of the House, this same group of three leaders would be expected to accede to the Speaker, Majority Leader and Whip positions, respectively.
Senate
Sen. Mitch McConnell (R-Ky.) is stepping down as Senate Republican leader, creating the first opening for the installation of a new Republican leader in decades. Sens. John Thune (S.D.) and John Cornyn (RTexas) have long been seen as the frontrunners in the Senate Republican leadership race. Both have been actively campaigning for months. Sen. Rick Scott (R-Fla.) is also running and is touting his close personal relationship with President-Elect Trump. Notably, Steve Daines (R-Mont.), who for weeks was considered a potential contender in the event of a Trump victory, recently expressed support for Thune's candidacy. The race for Majority Leader takes place behind closed doors and only requires a majority vote to declare a winner. The election is scheduled for Nov. 13, 2024.
Sen. John Barrasso (R-Wyo.) is running unopposed for Republican Whip. Sen. Tim Scott (D-S.C.) seems poised to take over the National Republican Senatorial Committee (NRSC). Sens. Joni Ernst (R-Iowa) and Tom Cotton (R-Ark.). are both seeking the Senate Republican Conference chair, the third-ranking Senate Republican leadership position.
As in the House, there is much less uncertainty expected on the Democratic side despite the fact that they lost control of the Senate. Sen. Chuck Schumer (D-N.Y.) is expected to remain in his leadership role as Minority Leader with Sen. Dick Durbin (D-Ill.) in the number two position. Sen. Debbie Stabenow (D-Mich.) did not run for reelection and is currently the number three Democrat in the Senate leadership. Sens. Cory Booker (D-N.J.) and Amy Klobuchar (D-Minn.) are expected to run to replace her. Sen. Kirsten Gillibrand (D-N.Y.) is reported running to lead the Democratic Senatorial Campaign Committee (DSCC).
Makeup of Key Healthcare Committees
HOUSE COMMITTEES
In the House, Speaker Johnson and Minority Leader Jeffries will need to agree on committee ratios (i.e., the number of Republicans and Democrats) for each House committee before new members can be assigned. Minority Leader Jeffries may withhold agreement until Speaker Johnson secures the Speaker vote on the floor, potentially delaying committee assignments. Democrat and Republican committee leaders who did not retire or move on to other offices are generally expected to remain in place.
House Committee on Energy and Commerce
The 119th Congress will yield a shakeup in the House Committee on Energy and Commerce. Current Energy and Commerce Chair Cathy McMorris Rodgers (R-Wash.) is retiring, and Reps. Brett Guthrie (RKy.) and Bob Latta (R-Ohio) are both running to become the lead Republican for the committee. Rep. Guthrie currently serves as the chair of the Health Subcommittee, so if he is promoted to chair/ranking member, there will be a new subcommittee chair. Reps. Buddy Carter (R-Ga.), Morgan Griffith (R-Va.) and Gus Bilirakis (R-Fla.) are possible contenders for that role should it open up. Rep. Richard Hudson (R-N.C.), who currently chairs the National Republican Congressional Committee (NRCC), could also throw his hat in the ring for Chair/Ranking Member of the Committee or the Health Subcommittee.
On the Democratic side, Ranking Member Frank Pallone (D-N.J.) will likely continue as the committee's top Democrat. Rep. Anna Eshoo (D-Conn.), the Health Subcommittee ranking member, is retiring this Congress, and Rep. Diana DeGette (D-Colo.) is the most likely member to take on this role.
Steering Committees for each party will determine top committee leaders, subject to ratification by the conference, and the committees then generally determine subcommittee chair and ranking member positions. Steering Committee leadership assignments are typically completed before the process of assigning members to open positions on committees.
The current ratio on the Committee is 29 Republicans to 23 Democrats. If the Republicans retain the House that ratio would not be likely to change appreciably, and if the Democrats were to take control it would of course be reversed but, again, not much different.
House Committee on Ways and Means
Unlike Energy and Commerce, the House Committee on Ways and Means will look substantially similar to how it looks now. The 118th Congress Ways and Means Chair Jason Smith (R-Mo.) and Ranking Member Richard Neal (D-Mass.) will likely remain as the committee's leaders. There likely will not be changes to Ways and Means Health Subcommittee leadership – Reps. Vern Buchanan (R-Fla.) and Lloyd Doggett (D-Texas).
The current ratio on the Ways and Means Committee is 25 Republicans to 18 Democrats. Like the discussion above, the ratio should be similar in the 119th Congress.
House Appropriations Committee
While changes are possible among the 12 chairs and ranking members on the spending subcommittees, the most likely scenario is that Reps. Robert Aderholt (R-Ala.) and Rosa DeLauro (DConn.) would remain at the top of the Labor, Health and Human Services, Education and Related Agencies subcommittee.
SENATE COMMITTEES
Given the one-vote Senate Democratic margin in the 118th Congress, Senate Committee ratios provided for one additional Democrat. With a majority of 53 or more Republican Senators, this ratio will likely expand to provide a margin of two GOP Senators on each Committee. The Senate has a longstanding tradition of respect for seniority in determining committee leaders.
Senate Committee on Health, Education, Labor and Pensions (HELP)
Current HELP Chair Bernie Sanders (I-Vt.) has indicated he is "interested" in pursuing a seat on the Senate Committee on Finance. He would not necessarily need to give up his leadership role on HELP to do so. Should he step down, Sen. Tammy Baldwin (D-Wis.) or Sen. Chris Murphy (D-Conn.) would likely take his place.
Current Ranking Member Bill Cassidy (R-La.) is expected to become chairman of the committee. Although Sen. Rand Paul (R-Ky.) could invoke his seniority to take the HELP Chair, it is expected that he will decline to do so and instead chair the Senate Committee on Homeland Security and Governmental Affairs (HSGAC). It is also possible that Sen. Susan Collins (R-Maine) could claim the HELP chairmanship should Sen. McConnell claim the Appropriations Committee chairmanship, but he is not expected to do so.
Several slots are likely to open up "down dais" on the Republican side of the HELP Committee as Sens. Mike Braun (R-Ind.) and Mitt Romney (R-Utah) are not returning in the 119th Congress. The two freshman Republican senators currently serving on HELP – Sens. Markwayne Mullin (R-Okla.) and Sen. Ted Budd (R-N.C.) – may opt to give up their HELP seats in favor of other committee assignments.
Senate Finance Committee
Current Ranking Member Sen. Mike Crapo (R-Idaho) will likely become chairman of the Senate Committee on Finance. All of the Republicans currently serving on the committee are returning in the 119th Congress, so significant shuffling is not expected.
Sen. Ron Wyden (D-Ore.) will almost certainly retain his leadership position as the ranking member. Additionally, a notable number of down-dais seats on the Democratic side will become vacant. Sens. Debbie Stabenow (D-Mich.), Tom Carper (D-Del.), Ben Cardin (D-Md.) and George Helmy (D-N.J.) are all leaving office. And Sens. Sherrod Brown (D-Ohio) and Bob Casey (D-Pa.) were not reelected.
Senate Committee on Appropriations
Sen. McConnell could reclaim his seniority on the Appropriations Committee when he relinquishes his leadership role. However, the expectation is that he will not do so and will instead take the chairmanship of the Defense Appropriations Subcommittee. This would leave Susan Collins (R-Maine) as the committee chair. The Labor, HHS, Education and Related Agencies Subcommittee will likely remain with Sen. Shelley Moore Capito (R-W.Va.) as chair and Sen. Tammy Baldwin (D-Wis.) as ranking member.
IV. KEY HEALTHCARE PLAYERS TO WATCH
The Biden Administration's political appointees will likely tender their resignations on or before the inauguration of President-Elect Trump. The process of vetting, nominating and installing Trump Administration leaders can be expected to take some time, especially where Senate confirmation is required. In addition, career civil servants in leadership positions may be reassigned and replaced by the new administration or may choose to leave public service.
The Trump transition team is currently vetting and recommending political appointees. Generally speaking, President-elect Trump is likely to bring back allies who served in his previous administration, key members of his current and former campaigns, and leaders of conservative policy organizations. Governors and retiring members of Congress could also be considered for important positions. Notably, the Trump/Vance transition team has to date eschewed the traditional General Services Administration (GSA)-provided transition assistance. It is unclear whether this could slow the process.
The following individuals are among possible leaders who could shape healthcare policy under the second Trump Administration:
- Brian Blase, Paragon Health Institute
Currently the president of Paragon Health Institute, Blase previously served as special assistant to President Trump for economic policy, where he focused on healthcare deregulation and insurance reforms. With his extensive background in policy analysis from both the Senate Republican Policy Committee and the House Oversight and Government Reform Committee, Blase is well positioned for a senior healthcare policy role in a second Trump administration.
- Michael Caputo, Former HHS Assistant Secretary for
Public Affairs
Caputo, a close ally of President Trump with deep political connections, notably to Roger Stone, served as assistant secretary for public affairs at HHS during the first Trump administration. His media acumen and loyalist reputation suggest he could return to a key public-facing healthcare role, potentially advising on communications strategy in a second term.
- Joe Grogan, Former Director of the Domestic Policy
Council (DPC)
Grogan led the DPC under President Trump and was a key player in drug pricing reform and the administration's COVID-19 response measures. With his experience at both the DPC and the Office of Management and Budget (OMB), Grogan is a likely candidate to return to a senior healthcare policy position, particularly in regulatory reforms or health crisis management.
- Bobby Jindal, Former Governor of
Louisiana
Jindal, who served as governor of Louisiana from 2008 to 2016, was previously considered for HHS secretary during Trump's first term. Now chairing the America First Policy Institute's (AFPI) Center 8 for a Healthy America, Jindal's deep experience in healthcare reform and executive leadership could place him back in the running for a top health policy role, potentially even Secretary of HHS. - Valerie Huber, Former Special Representative for
Global Women's Health
Huber served as special representative for global women's health at HHS, where she was involved in reproductive health policies during the first Trump Administration. She could be brought back into the fold for another leadership role, particularly in women's health policy.
- Charlie Katebi, Deputy Director of AFPI's
Center for a Healthy America
Katebi led the HHS Office of Civil Rights during President Trump's first term and has since become deputy director at the AFPI's Center for a Healthy America. His experience in conservative healthcare advocacy, including civil rights in healthcare and opposition to government overreach, positions him as a potential candidate for a key healthcare or civil rights role in a second Trump Administration.
- Ed Martin, Political Strategist and
Author
Martin has been instrumental in shaping President Trump's 2024 campaign platform on reproductive health, working closely with other conservative leaders such as Russ Vought and Paul Evans. A longtime Republican strategist and co-author of The Conservative Case for Trump, Martin could take on a senior advisory role within HHS or be involved in shaping health policy strategy from a political standpoint.
- Theo Merkel, Former Special Assistant to the
President for Economic Policy
Merkel was a driving force behind the June 2019 executive order on healthcare price transparency, and his expertise in economic and healthcare policy makes him a strong contender for another advisory role in a Trump Administration. Previously a legislative director for former Sen. Pat Toomey, Merkel's focus on transparency and market-driven healthcare solutions would align with Trump's deregulatory agenda.
- Roger Severino, Vice President for Domestic Policy
at the Heritage Foundation
Severino led the HHS Office of Civil Rights during President Trump's first term and has since been a leading voice at the Heritage Foundation, where he authored the healthcare section of Project 2025. His strong advocacy for religious freedom and opposition to the expansion of governmentrun healthcare would likely make him a key figure in shaping conservative healthcare policy, possibly with a return to HHS.
- Abe Sutton, Former Health Policy Advisor During the
First Trump Administration
Sutton served as a health policy advisor under the first Trump Administration, holding positions at the National Economic Council (NEC), the Domestic Policy Council (DPC) and Center for Medicare and Medicaid Innovation (CMMI). He was the "architect" of Trump's 2019 Advancing American Kidney Health Executive Order, which established CMMI's mandatory End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. Sutton also was closely involved with the DPC's drug pricing and individual insurance market reforms and worked to implement President Trump's 2017 executive order on healthcare choice and competition.
- Eric Hargan, Former Acting HHS Secretary During the
First Trump Administration
Hargan is a Chicago-based healthcare lawyer who was appointed by then-President Trump in 2017 to serve as HHS deputy secretary following the resignation of HHS Secretary Tom Price. He was an "architect" of Trump's hospital price transparency rule and was closely involved with the pandemicera Operation Warp Speed COVID-19 vaccine development initiative. Hargan is a strong proponent for telehealth and other health technology, including data sharing. He previously served at HHS under the Bush Administration.
- Robert F. Kennedy Jr.
Kennedy's decision to abandon his presidential bid, endorse Trump and become involved in his campaign is expected to result in him playing an as-yet undefined role in the new administration. Trump transition co-chair Howard Lutnick has indicated that Kennedy would likely have a role under the Trump Administration – at least nominally – focused on "health and vaccine data." Other sources suggest he could have broader responsibility. It is believed that he would not take a position requiring Senate confirmation but might take a White House position related to overseeing food safety issues and efforts to reform the U.S. Food & Drug Administration (FDA), Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH).
- Paul Mango
Former Deputy Chief of Staff at HHS under the first Trump Administration. Mango was instrumental in launching Operation Warp Speed at the onset of the pandemic. Currently, he is an advisor at the Paragon Health Institute. Mango's work at HHS also encompassed initiatives in transparency and interoperability, and he previously held roles as chief principal deputy administrator and chief of staff at the Centers for Medicare & Medicaid Services (CMS) under President Trump. He has also run for governor in Pennsylvania.
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