Healthcare Finance
Ken Perez: Trump’s second administration promises a shakeup around health policy
Published
February 21, 2025
9:18 am
|
Updated
April 2, 2025
12:42 pm
What a difference eight years can make. On Jan. 20, 2017, his first day in office as the nation’s 45th president, Donald Trump issued just one executive order (EO), scaling back parts of the Affordable Care Act (ACA). It set the stage for Congress’ subsequent repeal, via the Tax Cuts and Jobs Act of 2017, of the so-called “individual mandate” that required most Americans to have health insurance or pay a tax penalty. Healthcare had been a central issue in the 2016 presidential election, and it was front and center as Trump took office in 2017.
A flurry of presidential actions
The story was quite different during Trump’s first week in office as the nation’s 47th president. During Jan. 20-27, he issued 67 presidential actions — 46 on Jan. 20 alone — including 37 EOs and 30 memoranda and proclamations.a Of these EOs, three impacted healthcare. Eleven focused on the economy — voters’ top issue during the 2024 election according to multiple public opinion polls. Nine pertained to the federal government, and eight concerned immigration.
EO 14148, “Initial Rescissions of Harmful Executive Orders and Actions,” revoked 78 EOs of President Joe Biden, including three EOs that looked at ways to lower the cost of prescription drugs for people on Medicare and Medicaid, enhance the Affordable Care Act (ACA) and strengthen protections for Medicaid enrollees.b The impact of the Trump EO will be limited, because the three Biden EOs were largely limited to exploratory activities and generally had not implemented policies.
EO 14155, “Withdrawing the United States from the World Health Organization,” starts the process of withdrawing from the WHO, contending that the organization mishandled the COVID-19 pandemic and objecting to the disproportionate level of financial support demanded by the WHO from the United States.c
EO 14182, “Enforcing the Hyde Amendment,” reinforces Congress’ Hyde Amendment, which prohibits the use of federal funds to cover abortion and related healthcare, with limited exceptions.d Saliently, the order rescinds two Biden EOs that sought ways to expand access to reproductive and emergency healthcare after the Supreme Court overturned Roe v. Wade.
It is important to remember that EOs are often mostly symbolic and issued for public relations purposes, can be overturned by the courts, are subject to congressional oversight and can be easily revoked, just as Trump has done.
Trump and the ACA
In addition to healthcare taking a backseat to other issues such as immigration, Trump’s view of the ACA has evolved.
In a Nov. 23, 2023, Truth Social post, Trump argued for the repeal or termination of the ACA:
The cost of Obamacare is out of control, plus, it’s not good Healthcare. I’m seriously looking at alternatives. We had a couple of Republican Senators who campaigned for 6 years against it, and then raised their hands not to terminate it. It was a low point for the Republican Party, but we should never give up!
Then in a Dec. 25, 2023, Truth Social post, he said that he would create an alternative to the ACA:
Obamacare is too expensive, and otherwise, not good healthcare. I will come up with a much better, and less expensive, alternative!e
But on March 26, 2024, Trump seemed to abandon the idea of repealing the ACA and instead promised to improve it, writing in Truth Social (with caps as written):
I’m not running to terminate the ACA … I’m running to … MAKE THE ACA, or OBAMACARE, AS IT IS KNOWN, MUCH BETTER, STRONGER, AND FAR LESS EXPENSIVE. IN OTHER WORDS, MAKE THE ACA MUCH, MUCH, MUCH BETTER FOR FAR LESS MONEY (OR COST) TO OUR GREST (sic) AMERICAN CITIZENS…”
Conclusion
Trump, who famously observed, “Nobody knew health care could be so complicated,” clearly has shifted his attention to non-healthcare issues.f Consequently, health policy will be driven by Congress and Trump’s health appointees, some of whom still awaited Senate confirmation as of March 25:
- Robert F. Kennedy, Jr., for Secretary of HHS (confirmed by the Senate on Feb. 13)
- Susan Monarez for director of the Centers for Disease Control and Prevention (nominated on March 25)
- Jay Bhattacharya, MD, PhD, for director of the National Institutes of Health (confirmed by the Senate)
- Martin Makary, MD, for commissioner of the Food and Drug Administration (confirmed by the Senate)
- Mehmet Oz, MD, for administrator of CMS (approved by the Senate Finance Committee)
- Janette Nesheiwat, MD, for surgeon general (awaiting Senate hearing)
A group of Associated Press writers described these individuals as “medical contrarians and health care critics,” and observed, “Trump’s nominees don’t have experience running large bureaucratic agencies, but they know how to talk about health on TV.”g Thus, it is clear that there will not only be lively debates but also uncertainty around health policy under the second Trump administration.
footnotes
a. Whitehouse.gov, “Presidential actions,” page accessed Feb. 17, 2025.
b. Executive Office of the President, “Initial rescissions of harmful executive orders and actions,” Federal Register, Jan. 20, 2025.
c. Executive Office of the President, “Withdrawing the United States from the World Health Organization,” Federal Register, Jan. 20, 2025.
d. Executive Office of the President, “Enforcing the Hyde Amendment,” Federal Register, Jan. 24, 2025.
e. Fortinsky, S., “Trump vows to replace ObamaCare with his own alternative,” The Hill, Dec. 25, 2023.
f. Liptak, K., “Trump: ‘Nobody knew health care could be so complicated,’” CNN, Feb. 28, 2017.
g. Stobbe, M., et al., “Meet the health care critics Trump picked to lead top U.S. health agencies under RFK Jr.,” PBS News, Nov. 27, 2024.
