As the second Trump administration begins to take shape, top health officials must soon allocate resources and select policy priorities. While new administration officials will likely have a different approach to health policy than those preceding them, there is one area where President Trump, the Biden administration, and lawmakers from both parties have agreed in recent years: increasing consumer choice and competition in the healthcare market.
This commitment to pro-competition reforms was demonstrated in the first Trump administration, which took important steps to lower prescription drug prices, draw on untapped authorities in the Affordable Care Act to promote price transparency, and protect consumers from some unfair billing practices. President Trump’s first term also brought firm antitrust enforcement, as the FTC challenged several significant health care mergers. In early 2024, the outgoing Biden administration continued this important work and promoted further action through the appointment of the Chief Competition Officer within the Department of Health and Human Services (HHS). Complementary parallel appointments were also made for health care counsels and task forces at the Federal Trade Commission (FTC) and the Antitrust Division within the Department of Justice (DOJ-ATR). If President Trump aims to provide tangible benefits for workers and consumers struggling to afford needed health care, then his second administration should maintain these competition-focused positions and provide them greater resources to further improve pro-competition policies.
Why Competition Policy Is and Should Remain a Bipartisan Priority
Health care costs in the United States have long concerned policymakers and constituents alike. With health care costs accounting for roughly 17 percent ($4.5 billion) of total gross domestic product, and with the average family premium for an employer group health plan costing $25,572 a year, U.S. per capita health care spending far exceeds that of comparably developed countries. Time and again, researchers have demonstrated the cause of this high spending: high health care provider and drug prices, driven in large degree by increased vertical and horizontal consolidation and other anti-competitive business practices. Americans do not use more medical services than do people in other countries, they simply pay a lot more for services.
In attempts to lower health care costs and increase consumer choice, policymakers on both sides of the aisle have long supported various pro-competition reforms. In addition to cost containment opportunities, competition can also improve efficiency, as organizations must optimize their operations in order to stay ahead of competitors. Furthermore, competition can incentivize innovation and improve quality, as competitors jockey to create better value services and goods for their customers. Competition may also improve access to health care services, as stakeholders enter new markets and offer more services to attract additional consumers. All of these competitive outcomes – lower costs, increased consumer choice, improved efficiency, greater innovation, and expanded access – align with the health care agenda of President Trump’s first term.
The Chief Competition Officer Has Laid a Foundation for Pro-Competition Reform
The Chief Competition Officer’s mandate is to identify, coordinate, and elevate opportunities within HHS and across agencies to promote competition in health care markets—in other words, to make health care a “good deal for the American people.”
Since their appointment in January of 2024, the Chief Competition Officer and the HHS competition team has gathered information and established cross-agency lines of communication to support future pro-competition policy reforms, oversight, and enforcement. To better understand current barriers to competition and anticompetitive conduct in the health care marketplace, HHS and the FTC issued a request for information (RFI) in February 2024 on group purchasing organizations (GPOs) and drug wholesalers. These agencies, along with DOJ-ATR, then released a joint RFI on health care consolidation in March. These RFIs received immense public participation, with thousands of individual and group stakeholders submitting comments. (These comments are available to the public: comments on GPO RFI and comments on consolidation RFI).
The health care competition tri-agencies – HHS, DOJ-ATR, and FTC – also solicited complaints and tips about health care competition and fairness through a new portal, available at HealthyCompetition.gov. The portal offers users examples to help identify anticompetitive conduct, including contract terms that block price transparency or restrict competition, different forms of price-fixing, and collusive behavior among purported competitors.
In addition to these public information collection efforts, the HHS Competition Officer has taken critical steps to establish data sharing agreements and processes between the three agencies to facilitate effective enforcement of antitrust laws in the health care market. Beyond internal information sharing and pro-competition work, the HHS competition team also supports the education of employers, consumers, and other stakeholders, and can weigh in on policy development within the agency to ensure competitive effects are considered.
By Leveraging the HHS Competition Officer and Fostering Collaboration Across Agencies, the Trump Administration Could Reduce Health Care Costs and Empower Consumers
The foundation for pro-competition reform has been laid, and the incoming administration can and should leverage this foundation. The Trump administration should continue to operate and fund the HHS Competition Officer, as well as the health care leads within DOJ-ATR and FTC, to deploy the collected information and translate this knowledge into evidence-based policy reforms and enforcement actions to lower prices for consumers.
To further spur pro-competition reform in the commercial health care market and benefit millions of workers and their families nationwide, the administration could also support collaboration with the Department of Labor (DOL). With oversight authority over the health care purchasers for Americans with employer-sponsored insurance, more than half of the US population, DOL is well-positioned to investigate barriers employers and workers face in health care markets. DOL could also help educate employers about how to be better shoppers (consistent with their fiduciary duties), as well as educate employers about where to file tips and complaints when they encounter anticompetitive conduct or lack choice due to consolidation.
A continued commitment to the HHS Competition Officer and similar engagement across other agencies would align with President Trump’s previous policy agenda and could effectuate Republicans’ long-standing objective to lower health care costs and increase choices for health care consumers.
