After pulling off the greatest political upset in the history of American politics, President-elect Donald Trump’s administration would arguably be a disappointment if it didn’t go on defying the odds. True, slaughtering sacred cows on the campaign trail is far easier than offing blessed bovines protected by legislative language, but it’s precisely the challenge Trump will now face.
His approach to repealing and replacing Obamacare looks like it is, indeed, going to start slicing and dicing ungulates of the sanctified persuasion. One need only look to Trump’s declaration on "60 Minutes" that he is going to preserve the provisions in the Affordable Care Act barring discrimination on the basis of preexisting conditions, and extending the time in which adult children can remain on their parents’ healthcare plans. From a candidate whose rivals during the primary promised to repeal “every letter of Obamacare,” that’s quite a deviation from the orthodox Republican position.
And thank heaven, because it’s a deviation that sends all the right signals. Namely, that Trump wants to not merely erase Obamacare, but actually steal this bit of President Obama’s legacy by passing the health care reform that American consumers actually need. As another example, look to recent news that Trump is expected to finally push through drug pricing reform to counteract the out-of-control increases threatening American wallets and the US healthcare system itself.
At the same time, Trump also seems ready to pull the plug on the most overzealous elements of FDA regulation in order to permit more drugs to hit the market, even if they arrive at lower prices. Really, it’s generous of Trump to throw the industry even that big a bone, considering they donated in record numbers to his opponent, Hillary Clinton. But presidents who prioritize revenge over helping out the American people don’t tend to do well in office, and thankfully Trump is letting his reformist and pro-growth instincts override that particular vice.
The other good news is that Trump doesn’t have to start from scratch in creating a patient and consumer centered American healthcare system. During the primary, he seemed to instinctively grasp that as president, his control over Medicare and Medicaid funding would be a vastly important bargaining chip in undergoing this endeavor.
The fact is that a policy that has been highly successful in extending health care to vulnerable populations -- the 340B drug discount program -- uses precisely this type of leverage to achieve its goals. To explain 340B quickly, it requires drug companies that want access to funds from Medicaid and Medicare Part B to offer reduced-price meds to hospitals serving disadvantaged groups like rural patients, children, and people relying on the safety net. Under Hillary Clinton, pharma could have easily killed it, and it has been trying to weaken the program for several years now. This is unsurprising, given that 340B actually holds the drug industry’s feet to the fire and forces it to justify the massive amounts of corporate welfare cash it receives from the government.
President-elect Trump, the master of the Art of the Deal, could very easily extend the logic of programs like 340B to the rest of American health care as part of his effort to #DraintheSwamp in service of Making America Great Again. When drug pricing emerges under this president, look for it to follow exactly that sort of carrot and stick approach, and to put America’s pharmaceutical industry back in its place: serving patients, rather than profits.