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AHLA's Speaking of Health Law
What Does a Second Trump Administration Mean for Health Care?
David Cade, Executive Vice President and CEO, American Health Law Association, speaks with Eric Zimmerman, Partner, McDermott Will & Emery, about the potential health care priorities of a second Trump Administration. They discuss possible health care considerations in any upcoming tax bill, drug pricing and Pharmacy Benefit Manager reform, the Affordable Care Act, reproductive health, the future of the CMS Innovation Center, antitrust enforcement, and the role of private equity.
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Speaker 2:Greetings everyone. Our guest today is Eric Zimmerman. Eric is a recognized expert in Medicare law and policy and a registered lobbyist who represents clients before Congress and administrative agencies and helps clients navigate federal, legislative and regulatory processes related to Medicare coverage, coding, reimbursement, and compliance. He primarily counsels and represents hospitals and health systems, ambulatory surgery centers, clinical laboratories, pharmaceutical biotechnology, and device manufacturers and suppliers, medical trade associations, and professional societies. Eric just quite frankly, does it all. He also serves as a principal of McDermott plus McDermott's, integrated health focused policy lobbying and data analytics consultancy. Eric is a past president of the American Health Law Association, a HLA, and is a fellow of this esteemed association. So welcome, Eric.
Speaker 3:It's very nice to be with you, David. And I think we should just stop right there.
Speaker 2:Uh , yeah, no, no, no. I , uh, I know our folks are quite excited about what you've been doing, what you've been studying, and what you think about the coming year, the coming administration. And so today I want to talk about the year ahead and the upcoming new administration and what that means for healthcare and perhaps health law in 2026 and beyond. But before we get into the specific questions, I know you've done this before, and quite frankly, it feels like deja vu a little bit. So if you could reset for the audience what you see on the horizon specifically since, you know, as we note in this dejavu moment, Congress is controlling the House and the Senate similar to last time President Trump took charge. So how are you evaluating what might be coming and what, if anything, are you looking forward to in the new administration?
Speaker 3:Well, David, one of the things that we do here at McDermott Plus is try to help clients look over the horizon and look ahead to what the policy agenda may be, what the health policy agenda specifically may be in the forthcoming year, so that they can plan and prepare , uh, and when we are encountering a new Congress and , uh, transition in the presidency , uh, it's a particularly challenging and interesting time to try to look ahead in some respects, as you noted , um, we've seen this movie before. We are in a very unusual , uh, certainly unprecedented in our lifetimes circumstance where we have a former president coming back into be president. And so in some ways that , um, president's policy agenda should be familiar. And also, as you pointed out, Republicans are going to control the hundred 19th Congress, which also is similar to , um, uh, the hundred 17th Congress. And so should be some lessons we can draw from that experience in 2017 and 2018. Uh , but there's also some things that are very different, and there's some lenses that I'm deploying to help clients look at . Um , and I'm gonna go through , um, I , I guess four or five different things that I think people trying to prognosticate on 2025 should be thinking about. First of all, The 2024 election was not a healthcare election. Unlike , um, uh, 2016 and maybe to some extent 2020, and a lot of midterm elections in between the Affordable Care Act did not feature prominently into this election. And generally speaking, other than say, reproductive health , um, and access to abortion, this really was not a healthcare election per se. Other issues, economic issues, inflation, immigration, they really dominated , um, voter choice. So that's first, second , um, the president-elect has always been , um, fluid on policy, willing to shift and move in ways that , um, serve ultimate goals, ultimate outcomes, without being really deeply rooted in either specific policy objectives or party orthodoxy. So that, that much, that's a very important thing to keep in mind. Keep in mind, the third is, I think this is always true, but, but it's particularly true in a Trump administration for the reason I just said, personnel matter, who's in charge of the departments, who's in charge of the agency, who are the deputies and who are the , who are staffing particularly particular functions, particularly like within CMS? When we think about the Innovation Center, for example, and I think we'll get to that a little later , uh, who's in charge of the innovation center? CMS is gonna be hugely relevant for the reason I just said, and that is the , this was not a healthcare election, and the President is fluid on policy. And even when you look, or specifically, especially when you look at who the nominees are for HHS and CMS, neither of them come with deep experience in running bureaucracies or in decades of health , of advancing health policy. And so, our expectation that a lot of discretion is going to be pushed down to , uh, um, some of the lower level political appointees who are gonna be able to shape policies , uh, maybe more than they would , um, in this, in this past administration, just as, as an example, the fourth thing that we're looking at is the margins in Congress. Now, as you pointed out, Republicans are controlling the House and Senate, but by very thin margins, Republicans actually have a, a better margin of control in the Senate than Democrats currently have with 53 seats. Um, but that is still very tight, and it's not enough to overcome a filibuster for as long as the filibuster remains in effect, the margin of control in the house is even slimmer than it is now. And we don't have to look much past the experience in , uh, experiences in 2023 and 2024 to see how a few members who are particularly vocal or dead set on advancing a policy outcome can upend processes. We've gone through a number of speakers this , uh, past Congress as a result of those thin margins. And the current leadership in the house has had a lot of trouble getting , um, policy priorities through, through the house, and that's gonna be even more difficult with their two 20 to two 15 margin. So that's, I wouldn't say that's going to necessarily force compromise for reasons that we'll get into, but I think it's going to limit , um, the running room on certain policies. Um, and then the last thing I'll say, David, and then we can get into the specific , uh, policy priorities is this won't be Trump 1.0. Trump 2.0 we think is gonna look a lot different. Number one, the president's much more experienced. Um, he came in to his first administration , um, not only inexperienced in government , uh, entirely, but also without , um, a lifetime of relationships and , uh, um, people to put into key positions , uh, or with relationships in , um, the, the political class. And, and within Congress, he has those relationships now, and he will leverage those relationships , uh, much more effectively. And you see that already in how quickly he's been able to appoint people to key positions. He's pretty much already got his cabinet , uh, filled out at this point, and is now moving down to those lower levels. There's other reasons why this transition may not be going as smoothly as , um, it could, but he , um, he has his people, he has his PO policy priorities. We've seen , um, through a number of , uh, think tanks, including the Heritage Foundation, a lot of , uh, policy roadmaps being developed. And so they're gonna come in ready to roll this time, much more so than they were in , uh, 2017.
Speaker 2:So I, as I , I , I listened to the , to your lens, I'll call that the, the Eric Zimmerman lens. And, and by the way, it already kind of indicates to me we need to double check this lens in a couple of months just to see , um, if you adjust the priorities through which you , um, sort of see the future. And, and , and the other thing is, I'm tr I'm listening and I'm trying to figure out should I sit here and be optimistic or pessimistic? Where am I? And here's, here's what I wanna get back to you. There is a roadmap . One could argue the campaign such as it was heritage and, and other think tanks have have opined on where they think the future goes. But two things you said that, that I wanted to sort of lift up for a moment that , uh, the , uh, president-elect is fluid on policy. Maybe that's a good thing. Maybe that's not a good thing. Least fluid on policy. One could argue , um, interested in learning and adapting and adjusting as information comes in, maybe. Um, but I wanna pair that with , uh, the , the issue you made , the comment you made about personnel matters, who's in charge? And that one takeaway I have is as an institutional guy, you know, you know, for you anyway, you know, I'm a former fed for many years and at HHS, and I know that as an institution, the career folks there are deep in knowledge and experience. And , um, if, if there's not great policy depth at the top, then yes, the career folks are there with great institutional knowledge throughout the , uh, the department. And so I don't, I don't know, I wanna pause and say, are you optimistic or pessimistic? Do you see that being fluid on policy is a good thing? And it sounds like you are optimistic about the depth of experience that exists in the institutions in the department, and perhaps a little bit less worried that the folks who are being tapped to lead are not steeped in policy.
Speaker 3:Well, I think I would say optimism or pessimism depends a lot on your perspective and where you sit and what you're hoping is going to , um, happen. And I would say , um, it's really impossible to answer that question , um, in terms of policy outcomes, at least for me. But what I will say is I'll, I'll maybe , um, respond to the personnel question in a slightly different way. I'm not trying to imply, and I certainly don't believe that this administration is going to rely on the expertise of the career bureaucracy. In fact, I think it's gonna be the opposite. What I was trying to say was , um, me , Oz is not gonna be Chiquita Brooks. Lahore Meau has a lot of experience, but very different sets of experience than the current CMS administrator who spent a lifetime steeped in detailed Medicare and Medicaid policy, and had , um, her own set of experiences, her own set of priorities. Of course, the administration had its priorities and she was carrying those out. I think what I'm trying to say is that the president doesn't have a detailed Medicare policy agenda. Just to take an example, RFK Junior and then at OZ also don't have detailed Medicare policy agendas. So then who might have a little more influence? Well, whoever is deputy secretary or , um, the counselors to the secretary or the deputy admin, principal, deputy administrator at CMS or the head of the Innovation Center. Um , and while we know some of those roles right now, we don't know most of them who's gonna fill most of them. So that's, that's really what I'm trying to say. Now, with respect to the career personnel, the, the bureaucracy , um, the president and the , um, department of government efficiency, as it were, has made no secret about , um, how they feel about , um, the career bureaucracy in Washington within the health community and more broadly. And I think there's a lot of reason for, to expect that this administration is going to set its own course, not withstanding the advice that they get from the career bureaucracy. How's that for a diplomatic answer?
Speaker 2:Yeah, no, I'm gonna hold that. As I said, I'm coming back. I'm coming back in a , in a couple of months, you know, as we get into the new year , um, because it is true, as you said at the beginning, that this was not, I guess a quote unquote healthcare election per se. However, we know that there are still many healthcare crises issues around
Speaker 3:Yeah,
Speaker 2:People are still getting covid and dying from covid. We have access to healthcare challenges still to this day. Reproductive health is, and was discussed through the campaign. And so let me highlight a couple things that I did here, I think that you did here on the campaign and how that intersects into what might be a healthcare and therefore a health law agenda. Right ? So one thing, it's widely expected that tax reform will be a major priority for this incoming administration. That being said, what healthcare issues could be included in that forthcoming tax bill? Again, there's still a crisis. We still have access issues, we still have resource challenges in making sure that we have enough clinicians to support this healthcare structure. So with that, what do you think could be, and then what do you think should be included in the tax bill?
Speaker 3:Well, you're, you're absolutely right . And when you talk about , um, tax priorities, I, I think that is one of the things that was more , much more central in the campaign. Um, economic change through fiscal policy , uh, and particularly extending and expanding the , um, president's, the president elects , um, tax bill, that was a signature achievement of, of the first Trump administration. Um, many of those provisions in that tax legislation were , um, established for a period of years, like five years , uh, in most cases. So those are set to expire. They're going to have to be extended. Um, so priority number one, I think coming outta the gate, if it's not Im immigration, and it may be , um, then right close behind it will, or, or maybe even ahead, will be dealing with some kind of tax extenders. Now, within that, what's the relevance of that for healthcare? Well , I'll say it's twofold. First of all, a lot of tax policy , um, is relevant to healthcare. Just think about health savings accounts as one example, or , um, affordable Care Act premium tax credits as another. Um , but , um, also there's a lot of indirect relevance, because every time we enact tax cuts, and not only are we talking about extending tax cuts that are set to expire, but also expanding, for example, like on tipped wages that the president campaigned on , um, that costs a lot of money, and that has to, that will run headlong into Republican commitment to control deficits. And so Congress will be looking for ways to offset that reduction in revenues through spending decreases. And when they look at programs for spending decreases, the largest target is entitlement programs. And that's Medicare, Medicaid, social security, the president elect was very specific and the campaign about Medicare and social security being off the table, he did not say as much about Medicaid. And I believe that when he talks about Medicare, he doesn't really mean , um, things like provider payments and other things that can save a lot of money. Um, he means things that directly impact beneficiaries like age of eligibility or how much they pay in premiums or other things that are really much more , um, pocketbook issues for , um, Medicare beneficiaries. So we're, what we're expecting, what I'm expecting is to see , um, almost immediately out of the gate, like starting in February, is an attempt to do something called reconciliation, which is a budget , um, procedural opportunity for Congress to enact legislation that is intended , uh, to rightsize the budget or spending or the deficit more specifically. And it is exempt from the filibuster in the Senate. And so that is something that is a tool that Republicans and Democrats alike use to get , um, policy priorities through the Senate without , um, running into the obstacle of the filibuster. Democrats have used it repeatedly in the last , um, couple of years , uh, last four years , uh, to advance their priorities. Um, the Affordable Care Act notably, was enacted using reconciliation as a tool. Um, and so that is the tool that Republicans will use, and they will, it will be a hugely partisan affair without any participation from Democrats. Democrats will strategically choose to sit that one out. Um, and that's the legislative vehicle that Republicans will try to use to advance their tax policies, but also to include offsetting , um, Medicare and Medicaid payment changes. And one of the things that we might see in there on Medicare, for example, is , um, expansion of site neutral payment policies, which could , um, save a lot of money for the government, be used to offset the reduction in revenues from the, from the tax cuts , um, but also be a direct broadside to the hospital community.
Speaker 2:And, and here's where I look to make sure that the conversation about savings is linked to the conversation about healthcare outcomes. What I worry about in, in the years that I've been in this business is savings on one end has a direct line to less positive outcomes for the patients on the other end, which means more stress and strain on the healthcare system because we have more readmissions and we have more folks who are delaying care and coming in and , and sicker. And when I, when I look at Medicare and Medicaid, which may be, as you said, the place where there is some savings, and I know that the trust fund is predicted to be depleted in 20 36, 1 could argue 2036, well , that's a healthy bite away from where we are now. Maybe folks would just take a punt and not go there. But as you linked the fact that you have to go there in order to balance out the , the, the tax cuts that the tax reform that was promised, then I sort of worry about the squeeze on the patients. And again, that means the community that is served by the members of this association and the, the larger health law community, more strain on the providers, right? And , um, and the margins, particularly on the Medicaid side for the providers. And when you throw in on the long-term care side, the margins get thinner and thinner, harder and harder for the providers to do what we expect them to do. And so I I I , do you expect that the imbalance of, that the voice of the patients and the voice of the provider community will be heard and might sort of mitigate or adjust in some way? Uh, the , as far as the tax cuts may go.
Speaker 3:Well, you're hitting on a really good point there, David, for sure. Less money available in healthcare programs like Medicare and Medicaid will strain providers , um, particularly if those, if the focus of that less money is coming from money directed to providers through reduced payments and the likes. Um, and while many providers are mission driven and will are committed to continuing to provide services , um, they're also running businesses and there's limits to how much they can continue to , um, conduct business as usual in the face of diminishing revenues. And so , um, yes, a byproduct of payment reductions may in fact be direct impact on , uh, beneficiaries. But do I think that the beneficiary community , um, is likely to come out in opposition to provider payment reductions? I do not. Um, I think for sure the hospital community and the physician community, and for sure, the pharmaceutical industry is gearing up for , um, major lobbying contests to oppose , um, fear changes. Uh, but it's going to fall to the major stakeholders within the healthcare sector to really make that case, make that fight. And let me just connect a couple of dots. This again, I'm just gonna come back to why personnel matter. Um, in the last administration, one of the things that , um, um, really influenced the president's success or lack thereof on prescription drug pricing was , um, who he had as advisors. And he had drawn a number of advisors from the pharma industry into his administration. And to the extent that people like that , uh, once again populate this administration, they're going to have an outsized voice in the future of policy direction.
Speaker 2:Yes. An outside voice. So, so let me just say there, in the area of drug pricing, the last Congress, there was some discussion not only in the area of pre of , of drug pricing, also about PBM reform, lots of discussion, not a lot of action per se, but a lot of discussion and discussions about private equity in , in healthcare. Do you expect these conversations, and therefore perhaps some action in the area of drug pricing and PBM reform and even what may or may happen around how healthcare is being , uh, provided for this , uh, in , in this year and beyond and with private equity, do you expect these conversations to continue? And if so, any potential action or results from 'em ?
Speaker 3:Well, yeah, for sure. I, I expect the topic of drug pricing and certainly PBM reforms to continue to be very prominent issues. We happen to have a , um, bipartisan bicameral set of bills pending before Congress right now, pending before the hundred 18th Congress , um, that reflect a lot of compromise. Again, bipartisan both chambers on PBM reforms. Now it's possible, although I would say at this juncture, probably unlikely that that gets across the finish line in 2024. If it does, then that will probably be the end of PBM reforms , um, for a little while. But if it doesn't, then I would expect that to come back up again in 2025. And , um, for details on where there's common themes among Democrats and Republicans, you can look at the, the bills that are currently pending before Congress. There's a lots of, lot of common interest in , um, increasing transparency, increasing oversight, eliminating things like spread pricing on prescription drug pricing. To talk about that for a minute. That's the source of a lot of speculation because President Biden very famously was able to actually enact prescription drug pricing legislation in the Inflation Reduction Act that allowed negotiation between the government and pharmaceutical manufacturers on how much Medicare pays for drugs. Um, Trump 1.0 talked a lot about Medicare prescription drug pricing and took some steps, but ultimately wasn't able to achieve the legislative success that the Biden administration accomplished. So the big question is, what does the Trump administration do with the in Inflation Reduction Act? Um, now if memory serves, maybe one Republican representative voted for the Inflation reduction Act, I think it got through with no Republican support. So that could lead a lot of people to speculate. Well, Republicans are opposed, and they generally are. But if we learned one thing from Trump 1.0 , it is that the president-elect has his own opinions about , um, the role of pharmaceuticals and prescription drug pricing. And certainly his HHS secretary has been very outspoken on that topic too. And President-elect Trump doesn't follow traditional Republican playbooks, particularly when it comes to , um, being , um, cozy with the prescription drug industry. And so , um, he may try to attack the Inflation Reduction Act , um, because it's not his and because he wants to put his own mark on it , um, but it really does achieve a lot of what he talked about trying to accomplish in his first administration. So my sense would be, I don't expect Congress to really , um, try to repeal the Inflation Reduction Act. Instead, I expect the administration to try to put its own mark on how it rolls out the Inflation Reduction Act, some of the processes, how drugs are selected, how negotiations are conducted , um, maybe also really notably which lawsuits from pharma, the D-O-G-D-O-J chooses to actually , um, fight versus not fight , uh, because now they're gonna be in charge of the Department of Justice. And then I expect the administration to put forward some of its own policy priorities in Trump 1.0. They tried to put forward , um, uh, importation provisions and , um, uh, most favored nation types of policy proposals. So you may see this administration try to go a little bit further on prescription drug pricing to really say , um, that they were the ones who got their arms around prescription drug pricing. Um , the last thing I'm gonna point out on this topic , um, is three 40 B drug discounts. That's one that the hospital community in particular is really concerned about. It's one that the first Trump administration tried to , um, make some headway on by , uh, through the hospital outpatient prospective payment system by reducing how much Part B , part B pays for prescription drugs that are subject to three 40 B discounts. They were , um, um, those proposals were undone by , um, federal courts. They may take another run at that and see if they're able to, to make more headway or , um, look at a list of other policy proposals. Very interestingly, there's some things going on in in states right now around three 40 B policy. Um, California and Minnesota , um, just , uh, are poised to take some really serious actions. Now, whether this administration might look to traditionally blue states for guidance, I don't know, but their , um, their , um, proposals that might line up with their objectives. So it'll be really interesting to see where they go, but I think that's an area of grave concern for the provider community.
Speaker 2:Well , three 40 B seems to be the hot issue de your , in any administration, it seems to be the one that is ever elastic and the gift that keeps on giving. So folks need to keep an eye in that space.
Speaker 3:Um, um, can I tell you a , a little funny anecdote? Mm-hmm <affirmative> . Before we move on , um, I have a very dear friend who used to be , um, lead counsel for the House Energy and Commerce Committee, which has jurisdiction over a lot of healthcare policy, including three 40 B. And this is going quite a few years back. I, myself was involved in some three 40 B advocacy, and I was , um, talking to my friend who was in a decision making role for the committee about , um, this , um, particular proposal. And he just mocked me to no end over this really, truly esoteric , um, policy that is gained its name from a obscure section of the Public Health Service Act. It's Section three 40 B. If people don't know the origins of why we call it three 40 B , um, and to this day, he still brings up those stories of our conversations about three 40 B, and as you pointed out, it's probably what the most hotly debated health policy issues right now. So I feel completely vindicated in having , um, uh, pressed him on three 40 B policy way back then when it was not, and still, especially now, is not an obscure health policy idea.
Speaker 2:No, not at all. And, you know, from a hospital point of view, on any given day, it's a lifeline in making the margins. So it's , uh, it's an important, important policy issue. You know , one of the things I kind of go back to that this is not a healthcare election, and this is not Trump 1 0 1, yet there's still a little dejavu in this for me. And that centers around the a CA , the Affordable Care Act. And even though there was a little bit less rhetoric this time during the election, we still heard some conversations about whether or not it's gonna be repealed. Is that still on the table? You know, the country, whether it's Medicare patients paying more or less for their drugs , uh, or , or the citizenry losing access to healthcare insurance. People don't like to lose things. So I, I'm wondering what you're hearing and what you believe might be happening this time around with the a CA .
Speaker 3:Well, I'll say that a lot of us , uh, rolled our eyes and got a little chuckle , um, about his response in the Trump Paris debate where he was challenged on whether he would go after the a CA again. And he , uh, kind of humorously talked about the concepts of a plan , uh, the plan that never seems to emerge. And then he in some ways , um, brought it up on Meet the Press recently. Again, I think , um, the Republican Party has moved way beyond the repeal and replace ideas that, or, or priorities that really governed 2017. I don't expect that to really be the focus. At the same point we're in, as I said, a really unprecedented , uh, moment where we have a former president coming back into power. And the that is relevant because I think there's a lot of instances where we can look at things that the Trump administration advanced or tried to advance in , um, you know, when they were in power that were undone by the Biden administration that are going to be redone by this administration. And examples of that could be , uh, more permissive permissiveness around short-term , uh, duration. Short , short-term , um, limited duration insurance plans or association health plans, more turning of the dial or tweaks to , uh, mandatory preventative benefits. For example, there was just a , a rule put out shortly bef a proposed rule put out by the , um, Biden administration shortly before the election, having to do with contraceptives and emergency contraceptives and requiring over the counter coverage for those. And, and those are the kinds of things where I think a Trump administration could make a lot of administrative change to the Affordable Care Act. Um, but I don't expect a lot of , um, I don't expect them to try to replace it with an alternative , uh, policy that covers tens of millions of people.
Speaker 2:In that vein, do you expect to hear anything about at the federal level about access and, and reproductive health ?
Speaker 3:Yes, for sure. Although, as we've seen, that's a tricky one for this administration, tricky line for this administration to walk. Um, the President elect has really , um, uh, tried to have it both ways on the issue of access to abortion and, and maybe successfully has found that , um, line to walk. Um, and I think this administration is going to , um, look very carefully at all of those , um, policy ideas, so as not to be perceived as coming out too hard on issues that are really important to , um, particularly women who , um, on, on those particular issues. Um, he made a real point of saying, look, we did it with , um, we, we did what we needed to do by pushing these decisions back down to the states. And I think , um, on some level he's gonna maybe try to be done with, with that.
Speaker 2:Well , we're gonna park that one for , uh, a couple of months we come back. 'cause I, I suspect in January, or at least leading up to the State of the Union, maybe maybe we'll hear something in this space. I, I , I, I, I agree. I think this is a place he doesn't want to go, but I don't know if he , he and the administration will be able to escape it , um, given the landscape , uh, that we currently have and the potential cases that, or the cases that are currently out there. But let me do two more things in the time that we have. One, I wanted to go back because payment reform has been the topic du jour in any administration for 20, 30 plus years. And the CMS Innovation Center has been at the center of that opportunity for folks to be creative , um, don't know what is likely to happen to the Innovation Center. What do you think, have you heard or what do you speculate , um, because I know it has funded a lot of reform over the, over the past cycles that somewhat argue, argue has been helpful in understanding how best to pay for healthcare in this country?
Speaker 3:Yeah. Well , uh, I will say for sure , um, congressional Republicans have highlighted what they perceive as a lack of progress in the Innovation center and have been sharply critical of Biden administration models on , uh, coming through the administration, excuse me, coming through the Innovation Center. Um, and at the same time when somebody , um, takes over the keys to the administration and they see that they have billions of dollars to spend , uh, all of a sudden they become , um, fans of the innovation center and the opportunities that , um, spending billions of dollars can afford. But again, this is where I'm gonna come back to personnel matter people matter and who get , who gets put in charge of the innovation center is really gonna matter on what kinds of policy directions we see at the Innovation Center. I think a couple of themes are probably, we can probably predict at this point. Um, one is you have an HHS secretary and, and , um, nominee and also a CMS administrator nominee who are very concerned about chronic disease, who are very focused on , um, the role that food and nutrition plays in chronic disease. And that's one example where you might see the innovation center start to design models that , uh, allow for experimentation on , uh, nutritional services or , um, that are keen , specifically focused on chronic disease management. So those are things that we're looking out for.
Speaker 2:And when I hear those magic words of food and nutrition, and yes, the, the folks have been named, that is the central to , um, some of their discussions and statements and activities over their , um, careers where I become hopeful. Those two phrases, food and nutrition, are part and parcel of social determinants of health. And while nobody talks about that and didn't during the campaign, my hopefulness comes in, you can't disassociate food and nutrition from housing from where you live and what's in your community and transportation. And so I am hopeful that this, those elements may be part and parcel of a larger discussion of improving the health outcomes and, and, and in the area of chronic disease to be able to minimize the impact and allow folks to avoid aging into or cycling into those, those spiraling , um, disease states. So I've, I've got a sliver that maybe this is the door to, to allow folks to be healthier and to be maintained in a healthy state longer.
Speaker 3:Well, health health policy happens to be one of those areas, David, where Republican and Democrats very often will work together. There's a lot of commonality of interest. We just are probably gonna call it something very different than equity and social determinants of health.
Speaker 2:I'm, I'm happy to change my terms as long as we get the outcomes that allow folks to be healthier longer. I'm with you.
Speaker 3:That's a commonly held goal.
Speaker 2:Well, here's one that , um, the outside of sort of where the patients sit and that's in the industry itself, and that's the area of what is and might stop happening in the area of antitrust enforcement. It's been up and down , um, very active during the Biden administration. Do you think that the Trump administration is gonna take a different view on antitrust enforcement?
Speaker 3:For sure. They're gonna take a different view. Um, and this is a good opportunity for me to maybe come back to , um, something you raised earlier and we skirted past , and that's the role of private equity in healthcare. Um, for sure, this administration is gonna take a different view. I don't think , um, there's much likelihood that any administration would be as assertive on antitrust , uh, and , um, um, well, particularly on a , on antitrust than , than the Biden administration and Lena Kahn . Um, so again, who gets put in charge of the FTC is gonna be hugely relevant, but I wouldn't just assume that it's going to swing entirely to the other side. And it's gonna be the wild wild west because this president and , and this administration , um, has a lot of opinions about the role of powerful corporations and corporations become powerful when there's a lot of , uh, consolidation and , um, um, a a lot of imbalance and market power. And I think that this administration is gonna have a lot of its own concerns about that. And it's going to tackle those maybe a little bit differently, maybe a little bit less aggressively, maybe a little bit more selectively. Um, but they're nonetheless gonna look at it. And I think the same goes for , um, private equity. Now you can look at who have been some of the biggest critics of , um, the, the growing role of private equity investment in, in healthcare. And they've been , um, folks like Senator Elizabeth Warren and Senator , uh, Markey , both from Massachusetts and for sure they're considered very liberal progressive democrats. Um, but I think it would be foolish to just assume that that therefore makes it a liberal progressive priority. Um, I think there are a lot of Republicans, Senator Grassley is one Republican who , um, have also been critical of the role of private equity. Um, some of their solutions may be a little different, but I think that the scrutiny will continue to be there. And so , um, I think it's gonna be very interesting to watch what this FTC and Department of Justice does on both of those matters.
Speaker 2:So I'll pick up on that last word. Interesting. Yes , interesting time as we watch that. Interesting time ahead. Um, I would say on balance, maybe for today as we're having this conversation, a little more optimism than pessimism with the , uh, the opportunities that there will be some change and opportunities to make sure that , uh, that we stay connected to monitor and share this information with folks. So I would say as we end our discussion with Eric today, I want to thank you, Eric for sharing your time with us and with the , the listening audience. For those listening to this podcast, please remember to stay connected to A HLA because we will continue to bring to you the latest updates and activities related to healthcare in the new administration. We will help you navigate these changes and challenges so that you can deliver the best legal advice and counsel to your clients and colleagues. So again, thank you, Eric. There's still more to discuss. I will be back. We will be back. But I want to thank you for joining us today.
Speaker 3:Always a pleasure, David and I look forward to the next conversation.
Speaker 1:Thank you for listening. If you enjoyed this episode, be sure to subscribe to a HLA speaking of health law wherever you get your podcasts. To learn more about a HLA and the educational resources available to the health law community , visit American health law org .