President Donald Trump\u2019s early actions on health care signal his likely intention to wipe away some Biden-era programs to lower drug costs and expand coverage under public insurance programs.<\/p>\n
The orders he issued soon after reentering the White House have policymakers, health care executives, and patient advocates trying to read the tea leaves to determine what\u2019s to come. The directives, while less expansive than orders he issued at the beginning of his first term, provide a possible road map that health researchers say could increase the number of uninsured Americans and weaken safety net protections for low-income people.<\/p>\n
However, Trump\u2019s initial orders will have little immediate impact. His administration will have to take further regulatory steps to fully reverse Biden\u2019s policies, and the actions left unclear the direction the new president aims to steer the U.S. health care system.<\/p>\n
\u201cEveryone is looking for signals on what Trump might do on a host of health issues. On the early EOs, Trump doesn\u2019t show his cards,\u201d said Larry Levitt, executive vice president for health policy at KFF, the health policy research, polling, and news organization that includes KFF Health News.<\/p>\n
A flurry of executive orders and other actions Trump issued on his first day back in office included rescinding directives by his predecessor, former President Joe Biden, that had promoted lowering drug costs<\/a> and expanding coverage<\/a> under the Affordable Care Act and Medicaid<\/a>.<\/p>\n Executive orders \u201cas a general matter are nothing more than gussied up internal memoranda saying, \u2018Hey, agency, could you do something?\u2019\u201d said Nicholas Bagley<\/a>, a law professor at the University of Michigan. \u201cThere may be reason to be concerned, but it\u2019s down the line.\u201d<\/p>\n That\u2019s because making changes to established law like the ACA or programs like Medicaid generally requires new rulemaking or congressional action, either of which could take months. Trump has yet to win Senate confirmation for any of his picks to lead federal health agencies, including Robert F. Kennedy Jr., the anti-vaccine activist and former Democratic presidential candidate he has nominated the lead the Department of Health and Human Services. On Monday, he appointed Dorothy Fink<\/a>, a physician who directs the HHS Office on Women\u2019s Health<\/a>, as acting secretary for the department.<\/p>\n During Biden\u2019s term, his administration did implement changes consistent with his health orders, including lengthening the enrollment period for the ACA, increasing funding for groups that help people enroll, and supporting the Inflation Reduction Act, which boosted subsidies to help people buy coverage. After falling during the Trump administration, enrollment in ACA plans soared under Biden, hitting record highs each year. More than 24 million people<\/a> are enrolled in ACA plans for 2025.<\/p>\n The drug order Trump rescinded called on the Centers for Medicare & Medicaid Services to test ways to lower drug costs, such as setting a flat $2 copay for some generic drugs in Medicare, the health program for people 65 and older, and having states try to get better prices by banding together to buy certain expensive cell and gene therapies.<\/p>\n That might indicate Trump expects to do less on drug pricing<\/a> this term or even roll back drug price negotiation in Medicare.<\/p>\n The White House did not respond to a request for comment.<\/p>\n Biden\u2019s experiments in lowering drug prices didn\u2019t fully get off the ground,<\/a> said Joseph Antos of the American Enterprise Institute, a right-leaning research group. Antos said he\u2019s a bit puzzled by Trump\u2019s executive order ending the pilot programs, given that he has backed the idea<\/a> of tying drug costs in the U.S. to lower prices paid by other nations.<\/p>\n \u201cAs you know, Trump is a big fan of that,\u201d Antos said. \u201cLowering drug prices is an easy thing for people to identify with.\u201d<\/p>\n In other moves, Trump also rescinded Biden orders on racial and gender equity and issued an order asserting that there are only two sexes, male and female. HHS under the Biden administration supported gender-affirming health care for transgender people and provided guidance on civil rights protections for transgender youths. Trump\u2019s missive on gender has intensified concerns within the LGBTQ+ community that he will seek to restrict such care.<\/p>\n \u201cThe administration has forecast that it will fail to protect and will seek to discriminate against transgender people and anyone else it considers an \u2018other,\u2019\u201d said Omar Gonzalez-Pagan, senior counsel and health care strategist at Lambda Legal, a civil rights advocacy group. \u201cWe stand ready to respond to the administration\u2019s discriminatory acts, as we have previously done to much success, and to defend the ability of transgender people to access the care that they need, including through Medicaid and Medicare.\u201d<\/p>\n Trump also halted new regulations that were under development until they are reviewed by the new administration. He could abandon some proposals that were yet to be finalized by the Biden administration, including expanded coverage of anti-obesity medications through Medicare and Medicaid and a rule that would limit nicotine levels in tobacco products, Katie Keith, a Georgetown University professor who was deputy director of the White House Gender Policy Council under Biden, wrote in an article<\/a> for Health Affairs Forefront.<\/p>\n \u201cInterestingly, he did not disturb President Biden\u2019s three executive orders and a presidential memorandum on reproductive health care,\u201d she wrote.<\/p>\n However, Trump instructed top brass in his administration to look for additional orders or memorandums to rescind. (He revoked the Biden order<\/a> that created the Gender Policy Council.)<\/p>\n Democrats criticized Trump\u2019s health actions. A spokesman for the Democratic National Committee, Alex Floyd, said in a statement that \u201cTrump is again proving that he lied to the American people and doesn\u2019t care about lowering costs \u2014 only what\u2019s best for himself and his ultra-rich friends.\u201d<\/p>\n Trump\u2019s decision to end a Biden-era executive order aimed at improving the ACA and Medicaid probably portends coming cuts and changes to both programs, some policy experts say. His administration previously opened the door to work requirements in Medicaid \u2014 the federal-state program for low-income adults, children, and the disabled \u2014 and previously issued guidance enabling states to cap federal Medicaid funding. Medicaid and the related Children\u2019s Health Insurance Program cover more than 79 million people.<\/a><\/p>\n \u201cMedicaid will be a focus because it\u2019s become so sprawling,\u201d said Chris Pope, a senior fellow at the Manhattan Institute, a conservative policy group. \u201cIt\u2019s grown after the pandemic. Provisions have expanded, such as using social determinants of health.\u201d<\/p>\n The administration may reevaluate steps taken by the Biden administration to allow Medicaid to pay for everyday expenses some states have argued affect its beneficiaries\u2019 health, including air conditioners, meals, and housing.<\/p>\n One of Trump\u2019s directives orders agencies to deliver emergency price relief and \u201celiminate unnecessary administrative expenses and rent-seeking practices that increase healthcare costs.\u201d (Rent-seeking is an economic concept describing efforts to exploit the political system for financial gain without creating other benefits for society.)<\/p>\n \u201cIt is not clear what this refers to, and it will be interesting to see how agencies respond,\u201d Keith wrote in her Health Affairs article.<\/p>\n Policy experts like Edwin Park at Georgetown University have also noted that, separately, Republicans are working on budget proposals<\/a> that could lead to large cuts in Medicaid funding, in part to pay for tax cuts.<\/p>\n Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a left-leaning research group, also pointed to Congress: \u201cOn one hand, what we see coming from the executive orders by Trump is important because it shows us the direction they are going with policy changes. But the other track is that on the Hill, there are active conversations about what goes into budget legislation. They are considering some pretty huge cuts to Medicaid.\u201d<\/p>\n\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n