Donald Trump’s health care plans and policies as President

WASHINGTON – Republican Donald Trump became president, marking a new era for federal health agencies and the industries they control.

The president-elect campaigned on promises to shake up public health agencies, overhaul federal health care programs and cut high costs throughout the system. Trump said he was ready for campaign aides like Robert F. Kennedy Jr. ‘will go crazy’ on health, medicine and food policy.

Trump repeated that promise in his victory speech. “We might add a few names, like Robert F. Kennedy Jr.,” Trump told supporters. “And he’s going to help America get healthy again… He’s a great guy and he really means something that he wants to do and we’re going to let him go for it.”

While health care took a back seat to Trump’s campaign rhetoric aimed at propping up the economy and fighting illegal immigration, his Democratic opponent Kamala Harris made it a central part of her speech. Both promised to strengthen the Medicare program, which covers millions of seniors, and reduce high health care costs. But they differed on details. Although Harris called health care, including reproductive rights, fundamental freedoms, Trump’s position continued to shift during the campaign.

Survey published by Associated Press showed that health care is overshadowed in voters’ minds by the economy and immigration. Abortion was the top issue for 11% of voters surveyed, and health care for 8%, compared with 39% who chose the economy and 20% who chose immigration.

Trump has said he will not sign legislation restricting abortion nationwide, but he has vowed to take other measures that will determine who gets health care and who can refuse it. The president-elect said he would ban federal funding for gender-affirming care and ban it entirely for minors. He also vowed to protect religious freedoms, which during his first presidency included allowing some employers refuse to cover contraceptives based on their religious beliefs.

Trump has made clear he doesn’t want to return to one of the defining battles of his first term, the failed attempt to repeal the Affordable Care Act. Instead, Trump and congressional Republicans have said they want to reduce ACA spending and possibly let the current expanded tax breaks expire.

Trump will have a Republican Senate to help implement his agenda and confirm his nominees, as the GOP has won the seats it needs to regain its majority in the Senate.

A number of the Biden administration’s unfulfilled priorities hang in the balance. President Biden and Vice President Harris have sought to address Americans’ medical debt, expand access to mental health care and speed up Medicare negotiations on high-cost drugs.

With Trump set to take office in January, a new set of priorities is on the table.

Vaccines and public health

Trump has promised to form a presidential commission to investigate the “staggering” rise in chronic diseases, examining food policy, environmental factors, federal health agencies and perhaps the pharmaceutical industry itself.

While the president-elect leaned heavily toward “Make America Healthy Again“While calling for public health reforms, he has previously eschewed the idea promoted by MAHA leaders like RFK Jr. that vaccines play a role in chronic disease. But campaign officials have signaled in recent weeks that the second administration is increasingly open to unproven theories about the risks of vaccines.

Trump transition co-chair Howard Lutnick told CNN days before the election that while RFK Jr. would not be appointed to lead the Department of Health and Human Services, he would be able to oversee efforts to reduce the number of vaccines on the recommended schedule. Lutnick and others have also talked about re-evaluating liability protections for pharmaceutical companies developing vaccines.

GOP lawmakers have already discussed large-scale restructuring two public health agencies: the Centers for Disease Control and Prevention and the National Institutes of Health. For the CDC, this includes splitting the agency into two divisions, one dedicated to responding to infectious diseases and the other to preventing chronic diseases. The latter is increasingly a focus of the Trump campaign.

For both the CDC and the Food and Drug Administration, potential reforms could also focus on overhauling food and nutrition policies, an effort that has found much bipartisan support.

Reproductive rights

Trump has distanced himself from calls from some conservatives for nationwide restrictions on abortion and vowed during the presidential debate to veto such a ban if it reaches his desk.

But abortion rights advocates say there are many other ways to reduce access to abortion and reproductive care during Trump’s presidency, such as through exemptions from coverage for religiously affiliated employers. Trump’s FDA could also revise guidance allowing the abortion pill mifepristone to be mailed to patients. Mifepristone is used in most abortions.

Threats to deliver mifepristone by mail are also quickly coming from the courts. Three state attorneys general joined a case over mifepristone regulations that the Supreme Court sent back to a Texas district court; their arguments center around the legality of mailing abortion pills. according to an unclear law this has not been observed for decades. The Trump Justice Department may defend the FDA in this case in the coming years.

Trump also promised to protect access to in vitro fertilization and mandate insurance coverage for the procedure.

Changing the form of health insurance

GOP lawmakers and policy experts have proposed a number of potential ways to reform the ACA and signaled desire for a major overhaul. Many Republicans oppose expanded tax breaks that keep ACA premiums low and are set to expire next year.

Vice President-elect J.D. Vance suggested the administration would allow insurers to categorize enrollees into different risk groups and offer different plans based on those health risks. While this could lead to cheaper plans for healthier and younger Americans, policy experts warn that older adults and people with chronic health problems could see their premiums rise sharply.

A second Trump administration could also renew his earlier efforts to offer shorter-term health insurance plans. These insurance options — expanded during Trump’s first term and then narrowed by Biden — do not necessarily cover everything required under ACA plans. A KFF study 2018 for example, found that 71 percent were not covered for prescription drugs.

Trump did not discuss Medicaid specifically during his campaign and specifically excluded it from promises that he would not cut spending on Medicare and Social Security.

But under the first Trump administration, Medicaid underwent a number of significant changes, such as an attempt to allow states to impose work requirements for some beneficiaries. Officials have released guidance on how states can implement work requirements for coverage, and approved 13 waivers to roll them out.

In 2020, the program also gave states the option to convert a portion of their Medicaid funding into block grants.

Prohibition on gender-affirming care

Trump has repeatedly promised to ban federal funding for reassignment operations. His website promises that on his first day in office, he will issue an executive order “directing every federal agency to end all programs that promote the concept of sex and gender transition at any age.”

The legality of bans on gender-affirming care, at least under state law, will soon be reviewed by the Supreme Court. There will be a trial hear arguments about the Tennessee ban Dec. 4, but will likely make a decision once Trump takes office.

Elderly care

In the final days of the campaign, Trump proposed tax breaks that would support long-term caregivers. While he did not provide details about who would be eligible for the program or the potential cost of the plan, at least 53 million Americans say they are caring for sick family members. This number is expected to rise in the coming years as the baby boomer generation ages.

The proposal also falls in line with a number of other tax cut plans unveiled by Trump and his broader promises to “strengthen” Medicare and lower costs.

Some GOP policy experts have suggested those costs could be controlled by encouraging more seniors to choose private Medicare Advantage plans. Separately, others have suggested changing the law to allow older people to contribute to health savings accounts as long as they are enrolled in Medicare.

Reduced drug prices

Trump has long complained about the high costs Americans pay for prescription drugs and the freebies from other developed countries that pay much lower prices. But he refused his signature most favored nation offer lower costs, and it’s unclear how it would work under Biden’s Inflation Reduction Act, which allows Medicare to directly negotiate prices for certain drugs.

His campaign pledged to push for greater price transparency, echoing his administration’s early efforts to require hospitals to publish their prices. GOP leaders also called for more transparency in negotiations between Medicare officials and drug companies as part of the IRA process.

Trump also made cracking down on pharmacy benefit managers a top priority in his first administration. Some of those efforts, such as a rule to eliminate rebates drug makers pay to PBMs, have failed or been rescinded by Biden.

This story is developing and will be updated.