BOSTON — There are huge stakes for health care in the upcoming U.S. election — and leaders from across the political spectrum weighed in on policy priorities for the next U.S. president at STAT’s flagship Summit.
Speakers included former officials from the Biden, Trump, and Obama administrations as well as top industry executives, who addressed health care topics from Medicare to drug pricing to artificial intelligence. We collected the highlights from our coverage below.
Joe Grogan’s forecast for Medicare Part D: It’s a ‘time bomb’
Should former President Donald Trump resume office, Republicans will need to repeal or revisit President Joe Biden’s signature drug pricing reform and expanded Affordable Care Act premium subsidies, according to Joe Grogan, a former Trump White House official.
Grogan argued that Biden’s Inflation Reduction Act destabilized Medicare Part D, the program’s prescription drug pricing benefit. He forecast that higher premiums would send the Part D program into an inevitable “death spiral,” and said lawmakers should consider repealing it.
“Congress needs to ask: Do we want a standalone Part D program anymore?”
To replace Medicare Part D, Grogan suggested transferring all beneficiaries into the privately-run Medicare Advantage program or offering a combination of MA and health savings accounts.
Grogan also maintained that the GOP should not extend the enhanced ACA subsidies for lower healthcare premiums. The subsidies, which the Biden administration passed in its Covid relief bill and extended through the IRA, are set to expire in 2025. He dismissed concerns that many of the people who benefit from the subsidies live in Republican-led states and said that there is an “intolerable” amount of fraud in the program.
Read more from Sarah Owermohle, including Grogan’s take on what could be Republicans’ chance to reform public health agencies.
‘We gotta regulate the heck out of’ Medicare Advantage, Don Berwick advises
Medicare Advantage is dragging the Medicare program down, said Donald Berwick, who ran Medicare during the Obama administration. His policy recommendations are directly at odds with Republican leaders, including Joe Grogan, who suggested transferring everyone into the MA program at the STAT Summit.
Medicare pays private insurers a set annual rate for each MA enrollee based on “risk scores” that describe how sick a beneficiary is. This arrangement is supposed to adequately reimburse insurers for providing care to sicker patients. However, the complicated system for calculating MA pay rates, which incentivizes insurance companies to make patients appear really sick on paper, results in taxpayers paying over $80 billion more annually for people in MA than those in traditional Medicare.
“There is a hemorrhage going on,” Berwick said.
More than half of people on Medicare are already enrolled in private MA plans, which often have lower premiums, and that number is growing fast. Private insurers don’t necessarily need to be eliminated from Medicare, but “we gotta regulate the heck out of them,” Berwick said.
Berwick does not believe that traditional Medicare’s fee-for-service reimbursement model is the way to go, either. Instead, he suggested a system that adjusts payment based on patients’ social and demographic characteristics, such as their age, gender, and income, would be better.
Read more from John Wilkerson about Berwick’s policy prescription for the Medicare program.
The left is emerging as more business-friendly, says Tony Coles
The Republican party no longer appears to be what’s best for business, according to veteran biotech executive Tony Coles. Coles, who has maneuvered two multibillion-dollar acquisitions, sends most of his public gifts to Democratic candidates.
“Where is it that, as a capital-risk and capital-based industry, we can actually find the kind of support and patronage that we need to continue to deliver innovation? Right now, I would argue — pricing reimbursement notwithstanding — that’s on the left side of the aisle.”
As the election draws closer, negative depictions of the biotech and pharma industry are coming from both sides of the campaign trail, and Coles urged industry leaders not to grow jaded over drug pricing and reimbursement debates. His north star is remaining focused on the good they’re doing.
“We have a responsibility as an industry to step up and be responsible corporate citizens, to remember what George Merck taught us in the middle of the 19th century — that if we focus on the patients first, the profits will follow,” he said.
Read more from Allison DeAngelis about Coles’ advocacy for corporate responsibility, as well as political parties’ response to his outreach on behalf of the nonpartisan Black Economic Alliance.
Bristol Myers Squibb’s D.C. journey
When asked about the toughest moment of his first year as CEO, Bristol-Myers Squibb CEO Christopher Boerner he said it was the “unexpected opportunity” to testify before Sen. Bernie Sanders’ (I-Vt.) Health, Education, Labor and Pensions Committee on the company’s drug pricing strategy.
Bristol was also faced with one of the toughest challenges in the industry: price negotiation around Eliquis, the blood thinner that Bristol sells with Pfizer. It generates $12.6 billion in annual sales and was one of the first products subject to negotiation under the IRA.
Onstage, Boerner said he was “proud of how the team engaged with [the Centers for Medicare and Medicaid Services],” and that Eliquis was actually the kind of drug that the system should be incentivizing: relatively low-cost, widely taken, and could help prevent hospitalizations in the future.
Boerner emphasized that BMS is a global company that operates on both sides of the aisle, and stuck to that point when prodded repeatedly about which presidential candidate would be better for his company. “Our focus as a company doesn’t really change depending upon who’s in the White House or who controls Congress,” Boerner said.
But the company does have policy goals. Boerner said BMS would be “front and center” in pushing for pharmaceutical companies to be able to offer patient assistance in the Medicare program, which is currently prohibited by law
Offstage, he expressed his love for the company, saying, “I feel like we’re at a really pivotal period where we’ve got to navigate some stuff, and having somebody who cares deeply about this place is important.”
Micky Tripathi thinks the election won’t impact federal AI rules
The federal government’s top official in charge of regulating artificial intelligence in health care said the upcoming presidential election won’t impact regulations, despite fears that a Donald Trump administration could mean less tech oversight.
Micky Tripathi, assistant secretary for technology policy at the Department of Health and Human Services, said he would expect a continuity of health tech policy if Vice President Kamala Harris wins the election. Should former President Donald Trump take office again, Tripathi said, “We’ve had relative consistency across parties in terms of, you know, the focus on AI, the focus on interoperability.”
Over the past four years, the Biden administration has taken several steps toward minimizing AI’s dangers in health care, including biased algorithms, diagnostic errors, and medical discrimination. Prominent Silicon Valley leaders with stakes in AI, such as venture investor Marc Andreessen, have championed Trump because they say he’s less likely to over-regulate the technology.
No matter who takes the White House, Tripathi faces significant constraints in regulatory power and budget. Given these limitations, Tripathi has touted public-private partnerships and suggested that health care provider groups will ultimately be responsible for their use of AI.
Read more from Mohana Ravindranath about Tripathi’s vision for the future of AI regulation.
Matt Herper contributed to this story.