As former President Donald Trump has clinched a second term with a victory, his health care priorities will differ somewhat from his first term, which focused heavily on repealing and replacing the Affordable Care Act (ACA). This time around, given his embrace of Robert F. Kennedy Jr. and the “Make America Healthy Again” movement, Trump will build on his criticisms of the pharmaceutical industry from his first term and will prioritize chronic disease prevention and management, food supply safety and domestic production of essential medicines to obtain independence from foreign adversaries in the medical supply chain. We anticipate that RFK Jr. and other close allies focusing on chronic illness and mental health will be a vital part of the second Trump administration.
Chronic Disease Prevention and Nutrition
Trump’s emphasis on the “Make America Healthy Again” movement comes as more people are looking to blame the pharmaceutical industry, ultra-processed food and environmental conditions for the rise in chronic diseases. At a campaign rally, he promised to give RFK Jr. a significant role in overseeing several issues related to health and food. Although many have expressed concerns over RFK Jr.’s rhetoric around vaccine hesitancy, RFK Jr. has promised to “not take vaccines away from anybody” and wants to improve the science of vaccine safety and efficacy. RFK Jr. also said Trump has given him three instructions, which include ending the corruption in regulatory agencies, returning to the gold standard of evidence-based agents in medicine, and ending the chronic disease epidemic with measurable impacts within two years.
Given Republicans’ continued frustration over federal health agencies after the COVID-19 pandemic and Trump’s desire to increase research into chronic disease prevention and management, Trump will likely look to reform and restructure key agencies within the Department of Health and Human Services (HHS), including the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA) and National Institutes of Health (NIH).
Specifically, Trump has pledged to take on the rise in chronic illnesses and its potential drivers, especially among children, which could result in notable shifts to the organization of federal health agencies that oversee research and drug development. On the campaign trail, Trump frequently discussed an unexplained and alarming growth in the prevalence of chronic illnesses and health problems, such as serious allergies, infertility, obesity, respiratory challenges, autism and auto-immune disorders. Trump emphasized that the United States spends hundreds of billions of dollars to treat chronic diseases rather than looking at what is causing them in the first place. He has noted that the public health establishment is “too close to Big Pharma” and “does not want to ask the tough questions about what is happening to children’s health.” Trump has promised that if Big Pharma continues to “defraud American patients and taxpayers or puts profits above people,” they would be investigated and held accountable.
Trump has also promised to establish a special presidential commission charged with investigating what is causing decades-long increases in chronic illnesses. He continues to question whether the causes are related to nutrition, environmental conditions, toxins and chemicals in the home and/or over-prescription of certain medications. He also promises to order the commission to publish recommendations to ensure children can have safe and healthy livelihoods.
In September, Sen. Ron Johnson (R-WI) held a roundtable with notable Trump allies, including RFK Jr. and Dr. Casey Means, a medical doctor and tech entrepreneur. At the event, RFK Jr. said the U.S. health care system profits off sick people and the United States has the sickest population while out-spending other countries. Dr. Means highlighted that 99% of farmland is sprayed with synthetic pesticides, but these chemicals are strongly linked to chronic health issues. She added that toxic chemicals, microplastics and heavy metals used in foods and water alter gene expression, the microbiome, gut lining and hormones. She also cited reports that each additional serving of ultra-processed food increases the risk of early mortality by 18%.
Calley Means, a notable ally of Trump and the sibling of Dr. Casey Means, has said Trump sees fixing the chronic disease epidemic as a “legacy item.” The Means previously laid out a sprawling argument in a book and various newsletters they published for the desire to remove sugary drinks and ultra-processed food from the Supplemental Nutrition Assistance Program (SNAP), cut federal funding for scientists with conflicts of interest, and split food and drug oversight into different agencies. Calley Means has also proposed an immediate end to direct-to-consumer pharmaceutical advertising, which could occur through an executive order (EO). Although not all ideas have been agreed to by Trump, his close relationships with allies pushing for addressing and preventing chronic diseases are telling of potential policy proposals.
Supply Chain Safety and Domestic Production
Trump’s approach to pharmaceutical, food and medical device supply chains emphasizes the importance of strengthening domestic production and addressing vulnerabilities. His second administration will look to boost the procurement of essential medicines within the United States and identify weaknesses in the pharmaceutical supply chain, especially in sourcing active pharmaceutical ingredients (APIs) and other critical drugs from foreign adversaries. Trump will continue efforts to implement high tariffs on Chinese goods and seek other actions to decouple the United States and China economies to keep supply chains domestic. He has pledged to bring manufacturing jobs back to the United States, especially essential goods and medicine. He will seek to increase the promotion of domestic manufacturing to protect the safety and stability of the supply chain, especially after the COVID-19 pandemic.
Specifically, Trump has highlighted that as part of his plan to obtain total independence from China, he would phase in tariffs and import restrictions to bring back production of all essential medicines to the United States. In office, he signed EO 13944 on Ensuring Essential Medicines, Medical Countermeasures, and Critical Inputs Are Made in the United States to begin this process in 2020. Although the Biden administration did not follow through with the provisions in the EO, it would require federal agencies to “Buy American” by facilitating the domestic production of medicines and medical devices that the FDA designates as “essential” to public health, and requiring federal agencies buy medicines and medical devices that are entirely “produced in the United States.” Trump has pledged that securing the supply chain and domestic production of essential goods will be one of his top priorities as president.
Trump proposes a 60% tariff on Chinese goods and phasing out Chinese imports of essential goods, as well as a 20% tariff on most other imports. He has highlighted that “U.S.-based manufacturers will also be rewarded with expanded research and development tax credits to help build the sprawling, state-of-the art-plants our country needs to be an industrial superpower in the modern world.” He said he will also appoint a “manufacturing ambassador, whose sole task will be to go around the world and convince major manufacturers to move their production to the United States.” Domestic production of packaging and materials would be a priority for the Trump administration, and he has committed to creating more domestic sources for materials that are currently being imported from foreign adversaries such as China.
Rallying Against High Drug Prices
A second Trump administration is expected to adopt an assertive stance on prescription drug pricing, building on his first-term initiatives focused on transparency and cost reduction. He may use the Medicare drug price negotiation provisions within the Inflation Reduction Act (IRA) to secure lower drug prices, which he previously indicated his support for. Trump is not expected to expand these negotiations into the commercial insurance market, keeping his focus on Medicare. Although he has broadly criticized the IRA, he likely will retain its Medicare drug pricing provisions.
A second Trump administration may explore additional caps on high-cost medications for Medicare beneficiaries, building on the insulin price cap introduced for seniors during his first term. Trump does not plan to reinstate the Most Favored Nation (MFN) policy, which would have tied Medicare payments to the lowest prices in other high-income countries. Previously, he pledged to issue an EO to prevent the United States from paying the highest prices globally for prescription drugs, and he has promised to secure the best possible deal on drug pricing if reelected.
Trump’s past successes in transparency measures, such as a 2021 rule requiring hospitals to disclose prices, suggest he may further advocate for transparency in drug pricing. By pushing for more transparent pricing from health care providers and drug manufacturers, he aims to enhance market competition and consumer choice without extensive ACA expansion.
In addition to targeting prescription drug prices, a second Trump administration is expected to intensify its scrutiny of pharmacy benefit managers (PBMs) and insurers. Trump has consistently criticized PBMs for contributing to high prescription drug costs and a lack of transparency, a stance that led his first administration to issue an executive order aimed at requiring PBMs, pharmacies and health plan sponsors to pass drug manufacturer rebates directly to patients at the point of sale. Though this policy faced legal challenges and industry pushback, Trump’s campaign signals a return to similar measures, prioritizing policies to make PBM transactions more transparent and to ensure patients benefit from rebates, with the goal of expanding access and reducing out-of-pocket costs.
On the Horizon – Trump’s First 100 Days
In the first 100 days of the second Trump administration, he will likely issue a moratorium on new regulations from executive departments and independent agencies, coupled with a requirement that relevant agencies, such as HHS, postpone the effective date of regulations that were issued at the end of the Biden administration. Trump would need to move quickly to identify health-centered rulemaking that the administration has concerns over and prioritize which proposed or final rules they may work to amend or withdraw completely. Trump will also work to get HHS agency heads confirmed as quickly as possible, issuing nominations likely on his first day in office and pushing the new Senate majority leader to confirm nominees fast. Several names have been circulated to potentially lead HHS under a second Trump administration, although nothing concrete has been revealed.
This document is intended to provide you with general information regarding possible HHS policy in a Trump administration. The contents of this document are not intended to provide specific legal advice. If you have any questions about the contents of this document or if you need legal advice as to an issue, please contact the attorneys listed or your regular Brownstein Hyatt Farber Schreck, LLP attorney. This communication may be considered advertising in some jurisdictions. The information in this article is accurate as of the publication date. Because the law in this area is changing rapidly, and insights are not automatically updated, continued accuracy cannot be guaranteed.