government

Trump is ready to tear into the ACA

Alex Brandon/AP

Federal health agencies are in disarray. The Trump administration on Friday fired scores of newer employees across CMS, NIH, CDC, and other agencies within HHS. My tireless colleagues have covered the terminations all weekend, finding out they’ve affected everyone from drug manufacturing inspectors and medical AI device reviewers to infectious disease watchers and insurance analysts who work on Medicare and Medicaid. (Reach out to us, securely with this form, if you’ve been affected.)

Within the changes, something else has become clear: The Trump administration is ready to go after the Affordable Care Act. On Friday, CMS said it was cutting funding for the ACA’s navigator program by 90%. Navigators help people sign up for health plans on the ACA marketplaces and elsewhere. Several people within CMS who work on the Affordable Care Act have been let go. And this appears to be just the tip of the iceberg: The White House is formulating a new rule (pretty much the only regulation being worked on within HHS right now) that is focused around “program integrity” for the ACA’s insurance marketplaces.

What could the “program integrity” rule entail? Katie Keith, a health policy scholar and attorney at Georgetown University, pointed out that the new director of the CMS agency that oversees ACA plans, Peter Nelson, has already laid out reforms he wants to see. Nelson previously was at a conservative think tank called the Center of the American Experiment, where he wrote about “fraudulent and improper enrollments” in ACA plans. He wants those enrollees to be subject to more income verification and restricted enrollment periods.

hospitals

Wading through the NIH cuts

Now that there’s a temporary national pause on the Trump administration’s cuts to research overhead payments from the National Institutes of Health, let’s assess what hangs in the balance for the country’s universities, research hospitals, and scientists. 

The NIH covers anywhere from 30% to 70% of research institutions’ “indirect costs” — which cover lab maintenance, facility upkeep, and other administrative expenses. This is separate from direct costs that cover the actual scientific research and people’s salaries. If those indirect costs get capped at 15%, as Trump tried to do, the government would be sucking up billions of dollars that Congress appropriated to NIH. A big question is: Where would those “savings” go? Back into funding more direct research? Or into a big pot that Elon Musk would just oversee?

Many universities wouldn’t struggle with a smaller cap on those indirect costs. Harvard, University of Texas, and Yale all have endowments in excess of $40 billion, which would put them at or near a Fortune 100 company. Losing $100 million or $200 million could be covered by the wealthiest institutions without really blinking an eye. Smaller universities and researchers would be hurt the most.

Perhaps more importantly is the ripple effect: Will scientists and academics want to work in the U.S. medical research system that is now being overseen by an administration that is so willing to take a hatchet to it? As Carl Bergstrom, a biology professor at the University of Washington, told my colleagues Angus Chen and Jonathan Wosen: “There’s a fire sale on American academics right now.” An Italian oncologist added: “I’m very worried for the progress of science. I think it will be a loss for everybody.” Read their latest.

watchdogs

Christi Grimm’s firing, in her own words

The Trump administration’s termination of nearly all inspectors general last month was the most controversial move toward the independent watchdogs in more than four decades. One of the fired IGs was Christi Grimm, who had been with HHS’ Office of Inspector General for 26 years.

Eight IGs are suing the Trump administration, alleging their ousters weren’t just controversial — they were illegal. On Friday, Grimm submitted her declaration in the case, where she said she found out she was fired while driving, as one of her colleagues read her the termination email. 

Grimm has been aggressively auditing Medicare Advantage — in her declaration, she touted her office’s recent report that found Medicare Advantage insurers are collecting billions of dollars from questionable diagnoses that are found in home visits (you can read more about that here). Now that she’s gone, more than 2,000 investigations are in purgatory. Read Grimm’s court filing here.