January 24, 2025 |
President Donald Trump’s initial health care policy actions indicate a potential rollback of key Biden-era initiatives aimed at reducing drug costs and expanding access to public health insurance programs.
Observers in the health care sector, including policymakers, executives, and advocates, are closely monitoring these developments to predict Trump’s broader agenda. The executive orders, while less sweeping than those from the start of his first term, suggest changes that could lead to more uninsured Americans and reduced protections for low-income groups, according to health policy experts.
However, these actions will not have an immediate impact, as additional regulatory steps or legislative measures are required to fully dismantle Biden’s policies. The direction of Trump’s health care strategy remains ambiguous.
“Everyone is looking for clues about Trump’s intentions on health care issues. So far, his executive orders don’t reveal much,” said Larry Levitt, executive vice president for health policy at KFF.
Executive Orders: A First Step
On his first day back in office, Trump issued several executive orders, including reversals of Biden-era initiatives to lower prescription drug costs and enhance enrollment in Affordable Care Act (ACA) and Medicaid programs. Experts note these orders primarily serve as guidance for federal agencies to begin exploring potential changes. Actual implementation could take months and might face regulatory or legal hurdles.
Notably, Trump rescinded a Biden directive encouraging lower drug prices through Medicare pilot programs, such as capping copays for generic drugs and pooling state resources to negotiate better prices for gene and cell therapies. The move raises questions about Trump’s commitment to drug pricing reforms, despite his previous support for aligning U.S. drug costs with those in other countries.
Broader Implications for Medicaid and ACA
During Biden’s presidency, ACA enrollment reached record levels, aided by extended enrollment periods and enhanced subsidies under the Inflation Reduction Act. Trump’s actions, including rolling back Medicaid expansion efforts, could reverse some of these gains. His administration’s previous support for Medicaid work requirements and capped federal funding suggests potential budget cuts or structural changes to the program, which currently covers over 79 million Americans.
“Medicaid’s growth, particularly during the pandemic, has made it a likely focus for reform,” said Chris Pope of the Manhattan Institute.
Trump’s executive orders also direct agencies to find ways to reduce health care costs, though the specifics remain unclear. Experts like Katie Keith, a professor at Georgetown University, suggest these directives could signal reevaluations of Biden-era proposals, such as Medicaid coverage for social determinants of health, including housing and nutrition.
Controversial Actions on Gender and Equity Policies
Trump also reversed Biden’s executive orders promoting racial and gender equity and issued a directive recognizing only two sexes. These actions have raised concerns among LGBTQ+ advocates, who fear restrictions on gender-affirming care and civil rights protections for transgender individuals.
“The administration’s moves signal a troubling lack of commitment to protecting transgender individuals,” said Omar Gonzalez-Pagan of Lambda Legal.
Political Reactions and Congressional Challenges
Democrats criticized Trump’s health policy actions as prioritizing political gains over public well-being. Meanwhile, Republicans are reportedly exploring budget proposals that could include Medicaid cuts to fund tax reductions.
“What we’re seeing from the executive orders provides insight into the administration’s policy priorities, but congressional decisions on budget legislation will be equally significant,” said Sarah Lueck of the Center on Budget and Policy Priorities.
What’s Next?
Trump’s early moves suggest a potential shift in U.S. health care policy, but the full impact depends on forthcoming regulatory actions, agency responses, and congressional debates. For now, the future of health care under the Trump administration remains uncertain, leaving stakeholders bracing for further developments.