A top priority will be the Patient Protection and Affordable Care Act (PPACA) healthcare reform law. (Nat. Biotechnol. 28, 385–386, 2010). Obamacare, as it is commonly known, appears extremely vulnerable as it has been chief among Republican bugbears since its enactment in 2010. But the full repeal-and-replace promised often by vociferous Republicans (including Trump) over the past several years may not be legislatively possible. And it would leave 20 million Americans with no access to health insurance. For biotech, a PPACA repeal would remove the nascent biosimilar approvals pathway that was created as part of Obamacare, and would reduce the number of US citizens who can afford new drugs. A brief policy outline posted to Trump's website two days after the election promised to replace the PPACA. But “the only honest answer is that no one really knows” what exactly will happen to President Obama's signature healthcare reform law, says Michael McCaughan, founder of health policy analysis firm Prevision Policy in Washington, DC. Congressional Republicans who long sought the law's repeal, “never expected to be in this position,” he says.
With Trump as president and Republicans controlling Congress, US federal spending will most probably shrink. Any cuts could have negative ramifications for the National Institutes of Health (NIH) and Obama-era NIH projects that require Congressional funding. Hopes that the new administration might embrace scientific rigor received an early blow when a climate change contrarian Myron Ebell of the Competitive Enterprise Institute in Washington, DC, was tapped by Trump to lead the transition at the US Environmental Protection Agency. As of mid-November Trump hadn't disclosed any actual policy positions related to the NIH, but during a radio interview with Michael Savage in October, he stated: “I hear so much about the NIH, and it's terrible.”
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