With changes in Congressional leadership and a new presidential administration, healthcare policy and funding priorities may shift. As 2025 unfolds, it’s crucial for healthcare professionals and organizations to stay informed about potential changes that could shape the industry.
Ahead of these shifts, this post will highlight key areas to watch under the new administration and recent regulation developments that may set the stage for the beginning of 2025. Our goal is to help you navigate this evolving landscape with awareness and preparedness, recognizing there are no certainties.
- Affordable Care Act (ACA) Disruptions: While the Trump Administration has outlined clear goals to limit federal spending, the actual strategies for doing so are still uncertain. One anticipated area of focus is targeting ACA subsidies that were enhanced during the pandemic. If the enhanced subsidies are reduced or eliminated, the rate of uninsured individuals would be expected to increase. However, enhanced ACA subsidies will likely remain in place for at least part of 2025, so while broader changes may happen, they won’t be immediate. In the meantime, providers and state governments should be aware of potential gaps in care and leverage patient insight technology to understand how much of their populations may be impacted.
- Broader Medicare and Medicaid Changes: If President-elect Trump’s first term offers any insight into the future, his second administration may seek to reinstate work requirements to receive Medicaid benefits and cap Medicaid spending for states. These changes have the potential to impact allocations for Section 1115 Waivers, which provide states with funding to reform access to crucial behavioral and physical health resources. The potential changes that may be implemented by the new administration via the Department of Health and Human Services (HHS) are not yet clear, but the Centers for Medicare & Medicaid Services (CMS), where policies continue to evolve to better support longitudinal care through new CMS-approved Advanced Primary Care Management (APCM) codes, is a key agency to watch as the new administration takes shape. In the finalized 2025 Physician Fee Schedule, CMS added three new Healthcare Common Procedure Coding System (HCPCS) codes, which focus on physician interactions with patients at the time and place of their choosing and are billed monthly (instead of basing payment on a specific number of minutes spent with a patient).
- Evolution of Artificial Intelligence (AI) in Healthcare: As AI burgeons across all industries, federal and state governments will continue to shape policy and strategies for implementation. President-elect Trump indicated in November his intention to shift AI oversight toward industry self-governance to reduce government regulations. The healthcare industry could then hold more responsibility to innovate and create ethical guidelines in partnership with other healthcare entities. Organizations may be permitted to leverage AI and autonomous care delivery to save costs and streamline care.
- Continued Focus on Reducing Overprescribing and Addressing Opioid Use Disorder (OUD): While this grey area looms large, the continued prevalence of opioid use disorder is expected to require some continued level of focus from the federal government. In President-elect Trump’s first administration, he implemented plans to cut opioid prescription fills and keep dangerous drugs off the streets. While we await further potential changes and proposals in this space, continued studies on opioid use remain important for guiding future action. The Assistant Secretary for Planning and Evaluation (ASPE) Office of Behavioral Health, Disability, and Aging Policy recently highlighted trends in buprenorphine prescribing among women of reproductive age (20-49 years) in the U.S. from 2013 to 2022. The study found that the rate of buprenorphine prescriptions for OUD among this demographic increased by approximately 71% over the past decade, rising from 218 per 100,000 women in 2013 to 373 per 100,000 in 2022. The findings suggest that mid-level clinicians play a growing role in expanding OUD medication access.
At Bamboo Health, we’re committed to helping organizations navigate these potential changes with actionable insights and strategies. Contact us today to learn how our solutions can empower life-improving actions for everyone experiencing physical and behavioral health disorders.
