Weekly Checkup
September 13, 2024
Regulating Health Care: Considering Trump and Harris’ Approaches
On Tuesday evening, many Americans watched as former President Donald Trump and Vice President Kamala Harris took to the stage to debate the issues of the day. Both candidates spoke at length, but many remain unsure – and for good reason – of the candidates’ actual policy plans, particularly on the issue of health care. Because we aren’t likely to receive any sort of briefing within the next few months of what the candidates are likely to do in the Oval Office, we will have to look at their policy records in office to get a better picture. The Federal Register is a good place to start. Let’s review the health care-associated regulatory costs Trump and Biden have accumulated during their presidencies to better understand what a Trump or Harris Administration approach to health care regulation may look like.
First, let’s cover Trump’s presidency. His administration’s total finalized health care regulatory costs were $44.8 billion across 127 finalized regulations, with an associated 160.7 million total paperwork hours. Here are some of the highlights:
The three largest regulatory cost adds under the Trump Administration, totaling $51 billion:
- Transparency in coverage regulation ($34.5 billion)
- 21st Century Cures Act: Interpretability, Information blocking, and the ONC Health IT Certification Program ($12 billion)
- Medicare and Medicaid Programs, Clinical Laboratory Improvement Amendments, and Patient Protection and Affordable Care Act; Addition Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency ($4.5 billion)
The three largest regulatory cost saves under the Trump Administration, totaling -$15.3 billion:
- Medicare and Medicaid Programs; Regulatory Provision to Promote Program Efficiency, Transparency, and Burden Reduction; Fire Safety Requirements for Certain Dialysis Facilities; Hospital and Critical Access Hospital Changes to Promote Innovation (-$9.2 billion)
- Nondiscrimination in Health and Health Education Programs or Activities, Delegation of Authority (-$3.4 billion)
- Medicare Program: Revision to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019 (-$2.7 billion)
The Biden Administration’s current finalized health care regulatory costs are $142.2 billion across 120 finalized regulations, with an associated 21 million total paperwork hours.
The three largest regulatory cost adds under the Biden Administration, totaling $91.2 billion:
- Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting ($43.1 billion)
- Medicaid Program; Medicaid and Children’s Health Insurance Programs Managed Care Access, Finance, and Quality ($27.8 billion)
- Medicaid Program; Streamlining the Medicaid, Children’s Health Insurance Program, and Basics Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes ($20.3 billion)
The three largest regulatory cost saves under the Biden Administration, totaling -$10.1 billion:
- Medical Devices; Quality System Regulation Amendments (-$5.3 billion)
- Partial Filing of Prescriptions for Schedule II Controlled Substances (-$2.7 billion)
- Medicare and Medicaid Programs; Policy and Regulatory Changes to the Omnibus COVID-19 Health Care Staff Vaccination Requirements; Additional Policy and Regulatory Changes to the Requirement for Long-Term Care Facilities and Intermediate Care Facilities (-$2.1 billion)
Assuming the Biden Administration’s approach to health care regulation is a relatively accurate representation of what the country may also expect of a Harris Administration, these data highlight two takeaways.
First, putting aside for a second the high regulatory costs associated with the nation’s response to COVID-19 in 2020, the Trump Administration eliminated regulatory costs by a net $5.8 billion (although with roughly 3 million additional paperwork hours) between 2017 and 2019. On the other hand, between now and the end of the COVID-19 pandemic in May of last year, the Biden Administration imposed roughly $121 billion in health care regulatory costs (while reducing net paperwork hours by 16 million). To put these numbers in perspective, in two years, the Biden Administration imposed costs that were more than 20 times greater than the savings achieved by the Trump Administration in three years.
Second, it’s reasonable to assume a Trump Administration approach to health care regulation might involve notable reductions to net costs, while a Harris Administration approach would likely involve significant increases to net costs.
To better understand the difference between the Trump and Biden-Harris Administrations, check out the graph below. Also be sure to read Dan Goldbeck’s Week in Regulation, which provides a running tally of the administrative regulatory burden.
Chart Review: Increase in Annual Cholera Cases Worldwide
Parth Dahima, Health Care Data Analyst
The World Health Organization recently reported a 71-percent increase in global cholera deaths in 2023 compared to 2022. With a 13-percent increase in cases from 2022 to 2023, officials are calling for increased diagnostic testing and oral cholera vaccines to mitigate the spread of the disease. There is significant variation in the severity of these outbreaks based on region, however, as Africa and the Eastern Mediterranean account for the vast majority of the increases in cases and deaths.
The charts below demonstrate the regional breakdown of cholera, divided by category into cases and deaths. Africa leads the world in cases and deaths, and while it has fewer total cases than the Eastern Mediterranean region – which accounts for 61 percent of total cases – it maintains nearly five times the number of deaths. Southeast Asia, the Americas, and Europe account for a small percentage of total cases and deaths.
Sources:
https://www.who.int/news/item/04-09-2024-data-show-marked-increase-in-annual-cholera-deaths
