That of American President Donald Trump first actions in health care signal his likely intention to erase some Biden-era programs aimed at lowering drug costs and expanding coverage of public insurance programs.
The orders he issued shortly after returning to the White House have policymakers, health care officials and patient advocates trying to read the tea leaves to determine what will happen next. The guidelines, while less expansive than the orders he issued early in his first term, provide a possible road map that health researchers say could increase the number of uninsured Americans and weaken protections for safety nets for low-income people.
However, Trump’s initial directives will have little immediate impact. His administration will need to take additional regulatory steps to completely reverse Biden’s policies, and these actions do not provide a clear direction as to the direction the new president wants to take America’s healthcare system.
“Everyone is looking for signals about what Trump might do on a host of health issues. In the first executive orders, Trump is not showing his cards,” said Larry Levitt, executive vice president for health policy at KFF, the health policy research, polling and news organization. which includes KFF Health News.
A burst of decrees and other actions taken by Trump in his first days back in office included reversing directives from his predecessor, former President Joe Biden, that had favored lowering drug costs and expanding coverage under the scheme. the affordable care act and Medicaid.
Executive orders “usually are nothing more than bogus internal memoranda saying, ‘Hey, agency, could you do something?’ said Nicholas Bagley, a law professor at the University of Michigan. “There may be reason to be concerned, but it’s felt.”
It’s because make changes to established law such as the ACA or programs such as Medicaid typically require new rules or congressional action, which could take months. Trump hasn’t won yet Senate confirmation for one of his picks to lead federal health agencies, including Robert F. Kennedy Jr.the anti-vaccine activist and former Democratic presidential candidate whom he appointed to head the Department of Health and Human Services (HHS). On January 20, he named Dorothy Fink, a doctor who heads the HHS Office of Women’s Health, as the department’s acting secretary.
During Biden’s term, his administration implemented changes consistent with his health care orders, including extending the ACA sign-up period, increasing funding for groups that help people sign up and supporting the inflation reduction lawwhich increased subsidies to help people buy coverage. After falling under the Trump administration, enrollment in ACA plans has soared under Biden, reaching record levels each year. More than 24 million people are enrolled in Affordable Care Act plans for 2025.
Drug order rescinded by Trump called on Centers for Medicare and Medicaid Services testing ways to reduce drug costs, such as setting a flat $2 copayment for certain generic drugs in Medicare, the health program for people 65 and older, and asking states to try to get better prices by banding together to purchase certain expensive cell and gene therapies.
This could indicate that Trump expects to do less on drug prices this year, or even roll back negotiations on drug prices under Medicare.
The White House did not respond to a request for comment.
Biden’s experiments to lower drug prices have not fully taken off, said Joseph Antos of the American Enterprise Institute, a right-wing research group. Antos said he was a little perplexed by Trump’s executive order ending the pilot programs, given that he has supported the idea of tying U.S. drug costs to lower prices paid by other countries .
“As you know, Trump is a big fan of it,” Antos said. “Lower drug prices are something people can easily relate to. »
By other measures, Trump too canceled Biden’s orders on racial and gender equity and issued an order affirming that there are only two sexes, male and female. HHS, under the Biden administration, has supported gender-affirming health care for transgender people and provided guidance on protecting the civil rights of transgender youth. Trump’s missive on gender intensified concerns within the LGBTQ+ community that he would seek to restrict such care.
“The administration anticipated that it would fail to protect and seek to discriminate against transgender people and anyone else it considers ‘other,’” said Omar Gonzalez-Pagan, senior attorney and care strategist health at Lambda Legal, a civil rights group. . “We are prepared to respond to the administration’s discriminatory actions, as we have done with great success, and to defend the ability of transgender people to access the care they need, including through Medicaid and Medicare. »
Trump also suspended new regulations being developed until they could be reviewed by the new administration. He could abandon some proposals that had not yet been finalized by the Biden administration, including expanded coverage of anti-obesity drugs through Medicare and Medicaid and a rule that would limit nicotine levels in tobacco products, Katie Keith, assistant professor at Georgetown University. director of the White House Gender Policy Council under Biden, wrote in an article for Health Affairs Forefront.
“Interestingly, he did not disrupt President Biden’s three executive orders and a presidential memorandum on reproductive health care“, she wrote.
However, Trump has asked his administration’s top brass to seek additional orders or memorandums to rescind. (He revoked the Biden order who created the Gender Policy Council.)
Democrats have criticized Trump’s actions on health care. A spokesperson for the Democratic National Committee, Alex Floyd, said in a statement that “Trump once again proves that he lied to the American people and that he doesn’t care about cutting costs – only what is best for him and his ultra-rich friends.”
Trump’s decision to end a Biden-era executive order aimed at improving the Affordable Care Act and Medicaid likely foreshadows coming cuts and changes to both programs, some policy experts say. His administration previously opened the door to work requirements in Medicaid — the federal-state program for low-income adults, children and people with disabilities — and previously issued guidance allowing states to cap federal Medicaid funding. Medicaid and the associated Children’s Health Insurance Program cover more than 79 million people.
“Medicaid will be a priority because it has become so sprawling,” said Chris Pope, a senior fellow at the Manhattan Institute, a conservative policy group. “It gained momentum after the pandemic. The provisions have expanded, such as the use of social determinants of health.
The administration could reevaluate steps the Biden administration has taken to allow Medicaid to pay for everyday expenses some states say affect the health of its beneficiaries, including air conditioners, meals and housing.
One of Trump’s directives directs agencies to provide emergency price reductions and “eliminate unnecessary administrative expenditures and rent-seeking practices that increase health care costs.” (Rent seeking is an economic concept describing efforts to exploit the political system for financial gain without creating other benefits for society.)
“It’s unclear exactly what this refers to, and it will be interesting to see how agencies respond,” Keith wrote in his Health Affairs article.
Policy experts like Edwin Park of Georgetown University have also noted that, separately, Republicans are working on budget proposals that could lead to significant reductions in Medicaid funding, in part to finance tax cuts.
Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a left-leaning research group, also pointed the finger at Congress: “On the one hand, what we’re seeing coming from the Trump’s executive orders is important because it shows us the direction they are going with political changes. But the other track is that on the Hill, there are active discussions about what goes into budget legislation. They’re looking at some pretty significant cuts to Medicaid.