A lot of president-elect Donald Trump’s cupboard nominees have a transparent goal on federal governance: minimize, slash and burn.
Tesla CEO Elon Musk and former biopharma govt Vivek Ramaswamy, each of whom Trump introduced would lead a brand new Division of Authorities Effectivity, have been probably the most vocal proponents of these concepts and plan to chop $500 billion in federal spending whereas eliminating an enormous swath of the federal government workforce.
Trump additionally named Linda McMahon of professional wrestling fame to function secretary of the Division of Training, an company he’s pledged to shut totally. McMahon has little earlier expertise in schooling, and Senate Republicans launched a invoice final week that will demolish the division.
Whether or not or not these nominees are confirmed, it’s clear the incoming Trump administration isn’t planning to hold on with enterprise as ordinary. And Trump’s tendency to faucet loyalists — relatively than profession bureaucrats — for management positions may additionally deliver outside-the-box approaches to the nation’s high tier of presidency administration.
The land of Kennedy and Oz
Final week, Trump named heart specialist and TV host Dr. Mehmet Oz to function administrator of CMS, a place charged with main insurance coverage applications together with Medicare and Medicaid that cowl greater than 160 million Individuals. Robert F. Kennedy Jr., a vaccine skeptic who was picked to change into secretary of HHS, may change into Oz’s boss.
The pair met prior to now when Kennedy appeared on Oz’s present. And the duo have been in lock step in the case of tackling persistent ailments on the federal companies.
“Dr. Oz will work carefully with Robert F. Kennedy Jr. to tackle the sickness industrial complicated, and all of the horrible persistent ailments left in its wake,” Trump stated in a Reality Social assertion final week.
Oz, a Harvard and Penn Faculty of Drugs grad, has no authorities expertise outdoors of a failed 2022 Senate run in Pennsylvania. In the meantime, Kennedy, a lawyer, has no medical experience.
CMS and NIH modifications
If Oz is confirmed to steer CMS, he’ll have the ability to affect the way forward for the Medicare drug worth negotiation program, which is already underway with the primary wave of worth modifications set to enter impact in 2026. Whereas Vice President Kamala Harris promised to speed up the tempo of this system by ramping up the variety of medicine going through worth negotiations, Trump’s stance on the problem has been much less clear.
Throughout his Senate marketing campaign, Oz criticized pharma for excessive insulin costs and stated he has “taken on Massive Pharma.” Kennedy, too, has publicly condemned steep worth hikes in the previous couple of years. Extra not too long ago, he supported drug worth caps “in order that firms can’t cost Individuals considerably greater than Europeans pay.”
Nonetheless, marketing campaign data reveal a cozier relationship between Oz and Massive Pharma. Bristol Myers Squibb, J&J and AbbVie contributed hundreds of {dollars} to his marketing campaign, in line with Bloomberg, whereas Pfizer CEO Albert Bourla additionally made a contribution.
CMS is scheduled to launch 15 extra Half D medicine up for worth negotiations by Feb. 1, 2025, however Oz may probably modify or delay this system, in line with Bloomberg.
Kennedy is gunning for larger modifications to the Nationwide Institutes of Well being. On the primary day of the brand new Trump administration, Kennedy desires to switch 600 NIH workers, he stated throughout an occasion in Arizona earlier this month.
“We have to act quick, and we wish to have these individuals in place on Jan. 20 in order that on Jan. 21, 600 individuals are going to stroll into workplaces at NIH, and 600 individuals are going to depart,” he stated.
Whereas operating as an impartial for president final yr, Kennedy particularly indicated he needed to exchange NIH scientists that have been centered on infectious ailments equivalent to COVID-19 and reorient the company to sort out persistent ailments like diabetes and weight problems.
“We’re going to offer infectious illness a break for about eight years,” he stated in November 2023 to an anti-vaccine crowd at an occasion in Georgia.
Additional, Kennedy desires to vary rules “in order that NIH funds can’t go to researchers with conflicts of curiosity,” he wrote in a September op-ed.
It’s unlikely Kennedy can induce all these modifications himself, nevertheless, as Congress controls the purse strings for NIH. Nonetheless, there could also be help for institutional modifications among the many Republican-controlled Home and Senate. Actually, a bunch of Republicans have already known as on NIH reform to “streamline” the company and scale back its footprint from 27 institutes to15 whereas offering “readability and transparency on funding traces.”
New FDA
The FDA is already endeavor a major restructuring plan beneath commissioner Dr. Robert Califf, however Trump appointees are eyeing additional change, as effectively. Ramaswamy, who was previously CEO of pharma firm Roivant, hopes to loosen rules within the drug improvement course of.
Final week, he known as out the FDA’s “micromanagement” of the regulatory course of for holding again innovation and elevating boundaries for smaller biotechs in comparison with larger pharma firms.
Kennedy has additionally known as for reform to the drug person charges pharma firms pay after they apply for a brand new approval, which complement a major chunk of the FDA’s funds.
Whereas neither Ramaswamy or Kennedy have publicized a concrete plan to reform the FDA, their criticisms and guarantees to brush out quite a few staff point out the potential for upheaval on the company.
Pharma promoting
One in every of Kennedy’s most clear-cut targets is to “ban pharmaceutical promoting on TV.”
“There are solely two international locations on the planet that enable pharmaceutical promoting on the airwaves,” Kennedy stated simply previous to the election. “And we now have the very best illness fee and purchase extra medicine, and so they’re dearer than anyplace on the planet.”
Pharma promoting is large enterprise within the U.S. — advertising {dollars} for the highest 10 largest advert spends reached $3 billion final yr. Pharma firms are additionally pushing even additional into the DTC area with their very own telehealth platforms.
As head of HHS, Kennedy received’t have the ability to accomplish a ban with out laws, in line with specialists. The FDA not too long ago enhanced pharma advert rules, requiring drugmakers to make sure uncomfortable side effects are offered in “a transparent, conspicuous and impartial method” for TV adverts.
Medicare Benefit for All
Oz may additionally rock the Medicare boat. Throughout his 2022 Senate run, Oz campaigned to increase privately-run Medicare Benefit plans to all Individuals, paid for by payroll taxes — usually an unpopular place amongst Republicans.
As an alternative of the standard fee-for-service Medicare mannequin, MA plans — which already cowl about one-third of Medicare recipients — obtain a hard and fast quantity per member monthly. Most embrace drug protection, and a few provide holistic wellness providers outdoors of conventional Medicare. Presently, there are fewer MA plan choices as a consequence of fee cuts beneath the Biden administration, and extra cost cuts are scheduled for 2025.
