Centene executives do not expect a second Trump administration to be able to push through major changes to Medicaid.
Speaking to investors on Dec. 12, Jon Dinesman, vice president of external affairs, told investors that while legislators are likely to propose block grants and other changes to the Medicaid program, he does not expect them to be passed.
Republicans will hold majorities in both the Senate and House in 2025. GOP leaders are eyeing cuts to Medicaid spending, including block grants and work requirements, to offset the costs of extending Donald Trump's 2017 tax cuts, according to the Washington Post. The tax program is set to expire at the end of 2025.
Though Republicans hold a "trifecta" between the executive and legislative branches, they will hold a very narrow majority in the House — making any major changes difficult, according to Mr. Dinesman.
"These aren't new concepts, but they've been historically [a] hard sell politically. With such a slim margin in the House, the way forward for these alternate funding mechanisms will be incredibly difficult," he said.
Centene is the largest Medicaid managed care organization and the largest insurer on the ACA marketplace.
Here are three things to know about Centene's outlook on the policy environment:
- Though major reform is unlikely during Mr. Trump's term, according to Mr. Dinesman, it's important to recognize significant shifts in voter alignment.
"When it comes to healthcare, the Republican, MAGA coalition is more dependent on government subsidies for affordability than ever before. So much so, that in the past few years, we have seen a shift in the popularity of Medicaid."
Ballot initiatives to expand Medicaid have passed, even in Republican strongholds like Nebraska, Missouri and Oklahoma, Mr. Dinesman said.
"Medicaid has never been more popular, nor has it ever had more bipartisan support than it does today," he said. - Though Centene executives do not expect major changes to Medicaid, they do expect the Trump administration to seek out ways to reduce spending in the program, Mr. Dinesman said.
The president-elect plans to create a Department of Government Efficiency, aimed at cutting federal spending. The focus on efficiency creates an opportunity for managed care plans, according to Mr. Dinesman.
"One of the value-adds Centene has brought to states is bending the cost curve," he said. "We do have every intention of doing more of this at the federal level. " - Centene expects expanded tax credits for marketplace plans to stick around in some form, Mr. Dineman said.
Enhanced subsidies for marketplace coverage, part of the Inflation Reduction Act, are set to sunset at the end of 2025. The subsidies have spurred record-high enrollment in the marketplace.
Cutting subsidies would force Republicans to "grapple with some challenging optics," Mr. Dinemain said.
If the subsidies are allowed to expire, uninsured rates will increase, though the effect varies by state. In some Republican stronghold states, which have not expanded Medicaid, uninsured rates could rise by more than 30% without enhanced subsidies, Mr. Dineman said.
"These optics, along with our discussions with government partners, are why we're skeptical [enhanced subsidies] will be eliminated entirely," he said.