Montana's and Louisiana's expansion of Medicaid under the ACA to low-income adults in 2016, along with expansion proposals by Republican governors in Oklahoma, South Dakota, Utah and other red states, made it seem like the momentum for extending coverage in the 19 holdout states was irresistible. Hospital leaders hoping to reduce uncompensated-care costs were cautiously optimistic. The only question seemed to be whether state leaders could win federal approval for adding conservative patient-responsibility features. Now Medicaid expansion appears dead, and premium contributions and work requirements for beneficiaries are a near certainty.
Throughout the year, top Republicans led by House Speaker Paul Ryan talked up turning Medicare into a defined-contribution, “premium support” program, and converting Medicaid into a capped, state block-grant program. Democrats and many health policy wonks scoffed, noting the political popularity of both programs and that candidate Trump had repeatedly said he wouldn't touch them.
But immediately after the election, Trump's team announced plans to “modernize” Medicare, and House Budget Committee Chairman Dr. Tom Price—now Trump's nominee for HHS secretary—said congressional Republicans would push quickly for dramatic restructuring of Medicare and Medicaid.
“It's amazing to me Republicans would even contemplate major changes in two of the most popular programs we have,” said Tom Daschle, the former Democratic Senate majority leader who helped craft the ACA.
On prescription drugs, many observers thought policymakers were getting ready to take action to curb rapidly rising prices, following scandals over big price increases for older products such as Mylan's EpiPen and mounting concern over dizzying prices for specialty drugs.
Clinton proposed a federal review process to determine if “outlier” price increases for long-established prescription drugs were justified. Bipartisan groups of lawmakers proposed bills to make it easier to bring generic products to market and require drugmakers to tell HHS in advance why a price increase of more than 10% is justified. Trump also criticized high drug prices and called for giving consumers access to cheaper drugs from foreign countries.
But all bets are off with business-friendly Republicans in complete control of the government, though the president-elect did say in December that “I'm going to bring down drug prices.” Democrats who had hoped to insert drug-cost provisions into the 21st Century Cures Act passed in December got nowhere.
“The issue has gone quiet,” said Ceci Connolly, CEO of the Alliance of Community Health Plans. “We are very worried that the issue of unsustainable drug prices is falling off the national agenda.”
2016 was a year when sure things turned out to be illusory. It could happen again.