Since taking office for his second term on Jan. 20, 2025, President Donald Trump has issued a series of executive orders (EOs) aimed at undoing several health care policies implemented by the Biden administration, indicating his intent to reshape the federal government’s approach to health care. While most of these initial actions require further regulatory or legislative steps to fully implement, they mark a clear shift in federal health care priorities and lay the groundwork for Trump’s “Make America Healthy Again” agenda.
Initial Rescissions of Executive Orders and Actions
President Trump’s first EO in his second term, “Initial Recissions of Harmful Executive Orders and Actions,” reversed 78 executive actions and orders taken by former President Joe Biden covering a range of issues, including diversity, equity and inclusion (DEI), climate policy, immigration and labor. Trump highlighted that the Biden administration had embedded “deeply unpopular, inflationary, illegal and radical practices within every agency and office of the federal government.” He said revoking these EOs would begin the process of making the United States “fair, safe and prosperous” and is the first of many steps he plans to take to “repair U.S. institutions and the economy.” In the health care space, President Trump first focused on rescinding certain provisions related to drug pricing, COVID-19 measures and the Affordable Care Act (ACA).
Drug Pricing
President Trump’s EO revoked the “Lowering Prescription Drug Costs for Americans” (EO 14087), which directed the Center for Medicare and Medicaid Innovation (CMMI) to create new payment and delivery models to be tested. CMMI later announced three models, although they are all in various stages of development:
- Cell and Gene Therapy (CGT) Access Model– Under the voluntary model, state Medicaid agencies would reach outcome-based agreements with manufacturers for high-cost cell and gene therapies. The reimbursement for the drug would be based on the observed outcome of the drug’s usage in patients, and negative health outcomes would result in the drug manufacturer passing on rebates to the state Medicaid agency. The model had received criticism from many Republican lawmakers, including now House Energy and Commerce Chairman Brett Guthrie (R-KY), who said the model would hinder innovation and prevent states from developing independent value-based arrangements to help alleviate the high costs of cell and gene therapies. The CGT Access Model began on Jan. 1 and would run through Dec. 21, 2030, pending no further action.
- Medicare $2 Drug List Model– The model encouraged Medicare prescription drug plans to offer a co-payment for certain low-cost generic drugs capped at $2 a month per drug. The Centers for Medicare and Medicaid Services (CMS) issued a Request for Information (RFI) for the proposed Medicare $2 Drug List last October and a sample list of over 200 generic drugs. The deadline for responses to the RFI was on Dec. 9.
- Accelerating Clinical Evidence (ACE) Model– The model aimed to reduce Medicare funding on drugs cleared by the Food and Drug Administration (FDA) under accelerated approval. It would include payment adjustments to providers for Medicare Part B drugs that were granted accelerated approval to potentially encourage faster completion of confirmatory trials by manufacturers. The ACE Model is still in development.
This rescission does not automatically reverse the models that were created pursuant to its direction, and it remains to be seen whether CMMI will continue forward with these models. President Trump has been vocal about wanting to reduce drug costs in the United States but has yet to formally announce specific plans to tackle high drug prices. Trump’s recission is likely to ensure that the new Department of Health and Human Services (HHS) leadership can prioritize new models or orders for drug pricing policies that are more aligned with the “Make America Healthy Again” agenda and Trump’s vision. Several stakeholders have already sent letters to the Trump transition team highlighting the importance of lowering drug costs.
ACA Provisions
President Trump also revoked the Biden administration’s EOs related to strengthening Medicaid and the ACA, likely to pave the way for the administration’s own reforms. Although he has softened his “repeal and replace” efforts, Republicans continue to look at reforms to the ACA, and specifically to Medicaid, to cut costs. President Trump rescinded the following Biden administration EOs:
- EO 14009 – “Strengthening Medicaid and the Affordable Care Act”
- Justified future regulations that imposed the standard disclaimer notice requirements on sellers of all forms of fixed-indemnity health insurance benefits.
- Directed HHS to consider establishing a Special Enrollment Period for uninsured and underinsured Americans who sought coverage through the federally facilitated Marketplace.
- Directed federal agencies to review relevant actions that may undermine protections for people with preexisting conditions, diminish coverage under Medicaid or the ACA, create unnecessary barriers to access health care coverage or reduce the affordability of coverage or financial assistance for coverage.
- EO 14070 – “Continuing to Strengthen Americans’ Access to Affordable, Quality Health Coverage”
- Directed federal agencies to identify ways to continue to expand the availability of affordable health coverage, improve the quality of coverage, strengthen benefits and help more Americans enroll in quality health coverage.
- Directed agencies to examine policies that help reduce the burden of medical debt and improve the linkages between the health care system and other stakeholders to address health-related needs.
Federal agencies took numerous actions to protect and strengthen Medicaid and the ACA as a result of Biden’s directives. The Biden administration attempted to rein in fixed-indemnity health insurance products by requiring marketers to include a disclaimer that warns consumers about the differences between supplemental health benefits and major medical insurance policies, although a U.S. District Court issued a ruling blocking the notice requirement late last year.
The Biden administration also worked to expand access to 12 months of Medicaid and Children’s Health Insurance Program (CHIP) coverage after pregnancy, which was detailed in CMS guidance and later made possible via a new state plan amendment established by the American Rescue Plan Act (ARPA), which was signed into law by former President Biden. The new option took effect in 2022 and was later made permanent by Congress through the Consolidated Appropriations Act of 2023. CMS continues to work with other states that have proposed adopting the option to extend postpartum coverage to 12 months.
CMS also worked to expand access to health insurance coverage through the Marketplaces by lengthening the annual open enrollment period, expanding Navigator duties and aiming to minimize the burden and confusion for individuals seeking coverage through its “Updating Payment Parameters, Section 1332 Waiver Implementing Regulations and Improving Health Insurance Markets for 2022 and Beyond” final rule. CMS also increased outreach and enrollment funding for organizations that help Americans apply for health care coverage through the ACA marketplace and Medicaid and CHIP. It also issued rules that aimed to improve the adequacy of ACA provider networks and correct a regulatory gap that prevented family members from accessing ACA subsidies. How these EO recissions play out will depend on how they interact with the existing regulations and litigation, and which policies the Trump administration reverses through regulation.
COVID-19 and Pandemic Preparedness
President Trump also revoked several Biden-era initiatives related to the COVID-19 pandemic response. Most of Biden’s COVID-19 EOs were aimed at bolstering COVID-19 research, testing, global cooperation and economic relief and were primarily issued at the height of the pandemic in 2021. Stakeholders have expressed concerns over Trump’s lack of focus on pandemic preparedness, especially as more bird flu cases continue to be reported.
Specifically, Trump’s EO revoked the following COVID-19-related directives from the Biden administration: (1) “Organizing and Mobilizing the United States Government to Provide a Unified and Effective Response to Combat COVID-19 and to Provide United States Leadership on Global Health and Security” (EO 13987); (2) “Ensuring an Equitable Pandemic Response and Recovery” (EO 13995); (3) “Establishing the COVID-19 Pandemic Testing Board and Ensuring a Sustainable Public Health Workforce for COVID-19 and Other Biological Threats” (EO 13996); (4) “Improving and Expanding Access to Care and Treatments for COVID-19” (EO 13997); (5) “Economic Relief Related to the COVID-19 Pandemic” (EO 13997) and (6) “Moving Beyond COVID-19 Vaccination Requirements for Federal Workers” (EO 14099).
These Biden-era COVID-19 EOs established the COVID-19 Response Coordinator role that would directly report to, advise and assist the president and federal health agencies to oversee and coordinate the federal response to COVID-19, focusing on supply distribution, vaccine delivery and racial disparities. They also established the COVID-19 Health Equity Task Force within HHS and a COVID-19 Pandemic Testing Board to coordinate federal efforts on COVID-19 testing, prioritize assistance to local authorities, expand testing access particularly for vulnerable populations and propose reforms for improved testing capacity and pandemic response. They also directed HHS to develop a plan for supporting accelerated development of novel therapies and promising treatments for COVID-19 and future high-consequence public health threats that can be easily manufactured, distributed and administered domestically and abroad. In addition, they directed the National Security Council (NSC) to take charge in global efforts to address COVID-19 and prepare for future biological threats.
Withdrawing the United States from the World Health Organization (WHO)
President Trump’s first health care-focused EO in his second term was a directive to withdraw the United States from the WHO. This EO declares the United States’ intent to fully sever ties with the WHO, pausing the transfer of any U.S. government funds, support or resources to the organization. It also directs the secretary of state and other federal agencies to reassign U.S. personnel and contractors working with the WHO, cease participation in pandemic agreements and develop partnerships with alternative global health organizations.
During his first term, Trump initiated a similar withdrawal process in 2020, criticizing the WHO’s handling of the pandemic and claiming it acted too slowly and was unduly influenced by China. He argued that the United States contributed disproportionately to the organization compared to other nations. Trump expressed frustration over what he perceived as the WHO’s failure to address critical reform issues.
The withdrawal process required a one-year notice and President Biden reversed the decision after taking office. Trump’s renewed withdrawal effort reflects his broader “America First” agenda, seeking to reshape U.S. participation in international organizations and agreements. Additionally, this EO directs a revision of the 2024 U.S. Global Health Security Strategy and outlines new biosecurity measures through the National Security Council, stressing Trump’s emphasis on prioritizing domestic pandemic preparedness over multilateral engagement. These actions may signal significant shifts in how the United States approaches global health diplomacy and pandemic response in Trump’s second term.
However, at a rally in Las Vegas on Jan. 25, Trump said he may consider rejoining the WHO, stating, “maybe we would consider doing it again. I don’t know. Maybe we would have to clean it up a little bit.” In the interim, the WHO is freezing recruitment and slashing travel in response to the U.S. withdrawal.
Enforcing the Hyde Amendment and “Mexico City Policy”
Days after the first wave of EOs, President Trump issued an EO that reaffirms the Hyde Amendment’s prohibition on using federal taxpayer dollars to fund or promote elective abortions. The Office of Management and Budget (OMB) is tasked with promulgating guidance to federal agencies to ensure compliance with this policy. The EO revokes two Biden-era EOs, “Protecting Access to Reproductive Healthcare Services” (EO 14076) and “Securing Access to Reproductive and Other Health Care Services” (EO 14079), which aimed to address potential heightened safety and security risks related to the provision of reproductive health care services and established an Interagency Task Force on Reproductive Health Care Access. The Biden-era EOs also directed agencies to ensure they were promoting compliance with nondiscrimination laws in obtaining medical care and advancing the ability to obtain reproductive health care services. Trump highlighted that the Biden administration “disregarded this established, commonsense policy by embedding forced taxpayer funding of elective abortions in a variety of federal programs.”
President Trump also issued a presidential memorandum reinstating the “Mexico City Policy,” which directed federal agencies to ensure U.S. taxpayer dollars do not fund organizations or programs that support or participate in the management of a program of coercive abortion or involuntary sterilization. The memo also directs agencies to implement a plan to extend the requirements of the reinstated memorandum to global health assistance furnished by all departments and agencies. Trump also rescinded a Biden-era memorandum titled “Protecting Women’s Health at Home and Abroad,” which aimed to ensure that women in the United States and abroad can access complete medical information, including with respect to their reproductive health. Specifically, it revoked Trump’s first establishment of the “Mexico City Policy” and directed the secretary of state to take steps to resume funding to the United Nations Population Fund and work with the administrator of the U.S. Agency for International Development (USAID) and other foreign assistance programs to ensure adequate funds are being directed to support women’s health needs abroad. It also directed HHS to review the Title X Rule and any regulations that impose undue restrictions on the use of federal funds or women’s access to complete medical information.
Protecting Children from Chemical and Surgical Mutilation
President Trump also issued an EO that establishes that it is the policy of the United States to end the use of federal funds, programs and resources to support or promote medical interventions aimed at altering a child’s biological sex, which the order refers to as “chemical and surgical mutilation.” It defines these procedures as using puberty blockers, hormone treatments and surgeries intended to change a child’s physical appearance to align with a gender identity different from their biological sex. Federal agencies are directed to end support for these practices across all areas of influence, including grants, research and health coverage programs.
The secretary of HHS is tasked with using regulatory and sub-regulatory actions to ensure compliance, which may include Medicare and Medicaid conditions of participation (CoP), mandatory drug use reviews, essential health benefits and quality and safety oversight. HHS must also rescind previous guidance promoting gender-affirming care titled, “HHS Notice and Guidance on Gender Affirming Care, Civil Rights and Patient Privacy,” and issue new guidance protecting whistleblowers who take action related to ensuring compliance with the order. Federal agencies providing research or education grants, such as medical schools, must also ensure funding is not used for procedures related to gender transitions in minors.
The EO also directs the Department of Defense to exclude coverage for these procedures under TRICARE and requires federal health insurance programs, including the Federal Employee Health Benefits Program, to exclude pediatric transgender surgeries and hormone treatments. The Department of Justice is instructed to prioritize enforcement of laws against female genital mutilation, investigate deceptive practices related to gender-transition procedures and propose legislation allowing individuals harmed by these procedures to seek legal action. Agencies must report progress on implementation within 60 days. The EO comes as many Republican lawmakers have sought to increase scrutiny of gender-affirming care for minors.
Regulatory Freeze Halts Biden’s Midnight Rulemaking
President Trump also implemented a governmentwide regulatory freeze upon taking office, halting progress on health care regulations proposed or finalized during the Biden administration. This 60-day freeze allows for the Trump administration to review and potentially scrap or modify Biden-era rules. This includes proposed updates to the Health Insurance Portability and Accountability Act (HIPAA) Security Rule and telehealth prescribing standards, the final rule on nurse staffing mandates and updates to the Medicare Advantage (MA) and Medicare Part D drug programs. This regulatory pause enables Trump’s team to assess the landscape and establish its own health care regulatory agenda.
On the Horizon
President Trump is expected to continue signing EOs that impact the health care industry. Trump has emphasized addressing chronic diseases, a priority echoed by Robert F. Kennedy Jr., his nominee for secretary of health and human services. His administration may also pursue Medicaid and ACA reforms, potentially revisiting coverage restrictions and work requirements. As these policies take shape, health care stakeholders will need to prepare for potential regulatory shifts and budgetary impacts. Our team will provide guidance and support to our clients in this evolving landscape.
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