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of the President of the United States, Donald Trump early action on health care has signaled his likely intent to scrap some Biden-era programs to lower drug costs and expand Social Security coverage.
The orders he issued soon after reentering the White House have politicians, health care leaders and patient advocates trying to read the tea leaves to determine what lies ahead. The directives, while less sweeping 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 safety nets for low-income people.
However, Trump's initial orders will not have an immediate impact. His administration will need to take additional regulatory steps to fully reverse Biden's policies, and the actions have left unclear the direction the new president aims to steer the US health care system.
“Everyone is looking for signs of what Trump can do on a host of health issues. In early EOs (executive orders), Trump is not showing his cards,” said Larry Levitt, executive vice president of health policy at KFF, the health policy research, polling and news organization that includes KFF Health News.
Excitement from executive orders and other actions Trump issued in his first days back in office included reversing directives from his predecessor, former President Joe Biden, that encouraged lower drug costs and expanded coverage The Affordable Care Act and Medicaid.
Executive orders “as a general matter are nothing more than tidy internal memoranda saying, 'Hey, agency, would you do something?'” said Nicholas Bagley, a law professor at the University of Michigan. “There may be cause for concern, but it's down the line.”
That's because making changes to established law like the ACA or programs like Medicaid typically require new rules to be created or congressional action, each of which can take months. Trump still hasn't won Confirmation by the Senate for any of his choices to lead federal health agencies, including Robert Kennedy Jrthe anti-vaccine activist and former Democratic presidential candidate whom he nominated to lead the Department of Health and Human Services (HHS). On Jan. 20, he named Dorothy Fink, a physician who leads the HHS Office of Women's Health, as the department's acting secretary.
During Biden's tenure, his administration introduced changes in line with his health mandates, including extending the enrollment period for the ACA, increasing funding for groups that help people enroll and supporting The Inflation Reduction Actwhich increased subsidies to help people buy coverage. After declining during the Trump administration, enrollment in ACA plans has soared under Biden, hitting record highs each year. More than 24 million people are enrolled in Affordable Care Act 2025 plans.
The drug order Trump rescinded urged the Centers for Medicare and Medicaid services to test ways to lower drug costs, such as setting a flat $2 copayment for some generic drugs in Medicare, the health program for people 65 and older, and for states to try to get better prices by band together to purchase certain expensive cell and gene therapies.
That could mean Trump expects to do less on drug pricing this term, or even cancel negotiations on Medicare drug prices.
The White House did not respond to a request for comment.
Biden's experiments to lower drug prices haven't fully begun, said Joseph Antos of the American Enterprise Institute, a right-wing think tank. Antos said he was a little puzzled by Trump's executive order ending the pilot programs, given that he supported the idea of tying U.S. drug costs to lower prices paid by other nations.
“As you know, Trump is a big fan of this,” Antos said. “Reducing drug prices is easy for people to identify with.”
In other moves, so has Trump overruled Biden's orders on racial and gender equality and issued an order stating 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 to protect the civil rights of transgender youth. Trump's gender message has fueled fears in the LGBTQ+ community that he will seek to curtail such care.
“The administration is predicting that it will fail to protect and seek to discriminate against transgender people and anyone else it considers 'other,'” said Omar Gonzalez-Pagan, senior counsel and health strategist at Lambda Legal, a civil rights group . “We stand ready to respond to the administration's discriminatory actions, as we have already done with great success, and to protect the ability of transgender people to access the care they need, including through Medicaid and Medicare.”
Trump also halted new regulations that were in the works until they could be reviewed by the new administration. He may abandon some proposals yet to be 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, said Katie Keith, a professor at the university at Georgetown, which was dep. director of the Gender Policy Council at the Biden White House, wrote in an article for Health Affairs Forefront.
“The interesting thing is that he did not violate President Biden's three executive orders and the presidential memorandum re reproductive health careshe wrote.
However, Trump has instructed senior leadership in his administration to seek additional orders or memorandums of rescission. (He canceled Biden's order which created the Gender Policy Council.)
Democrats have criticized Trump's health care actions. Democratic National Committee spokesman Alex Floyd said in a statement that “Trump has proven once again that he lied to the American people and doesn't care about spending cuts — only what's 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 guidelines allowing states to limit federal Medicaid funding. Medicaid and the related Children's Health Insurance Program cover more than 79 million people.
“Medicaid will be a focus because it has become so stretched,” said Chris Pope, a senior fellow at the Manhattan Institute, a conservative policy group. “It grew after the pandemic. Provisions have been expanded, such as the use of social determinants of health.
The administration may reevaluate steps taken by the Biden administration to allow Medicaid to pay for day-to-day expenses that some states say affect beneficiaries' health, including air conditioners, food and housing.
One of Trump's directives directs agencies to provide urgent price reductions and “elimination of unnecessary administrative costs and rent-seeking practices that drive up health care costs.” (Rent-seeking is an economic concept describing efforts to use the political system for financial gain without creating other benefits for society.)
“It's not clear what this refers to, and it will be interesting to see how the agencies respond,” Keith wrote in his Health Matters article.
Policy experts such as Georgetown University's Edwin Park also noted that separately, Republicans are working on budget proposals that could lead to major cuts to Medicaid funding, in part to pay for tax cuts.
Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a left-leaning think tank, also pointed to Congress: “On the one hand, what we're seeing is coming from Trump's executive orders is important because it shows us the direction they are going with policy changes. But the other way is that there are active conversations on the Hill about what goes into the budget legislation. They're looking at some pretty big cuts to Medicaid.”
