Summary
President Donald Trump began his presidency with a slew of executive orders (EOs), reversing many Biden-era directives and setting administrative priorities. The EOs cover a range of issues including health care; immigration; diversity, equity, inclusion, and accessibility (DEIA); climate change; and federal governance; among others.
Preview
In our note, we highlight key EOs likely to affect health policy. The EOs are organized into three categories: (1) an EO rescinding Biden-era EOs related to health care and policy approach (e.g., racial equity and other guiding principles for federal agencies); (2) several health-related EOs; and (3) multiple EOs on federal governance, including a regulatory freeze on all rulemaking. Actions include:
- Medicaid and ACA. President Trump rescinded Biden-era EOs to strengthen Medicaid and the Affordable Care Act, which established the 2021 Special Enrollment Period in response to the COVID-19 Public Health Emergency (PHE), and directives for federal agencies to identify ways to improve access to affordable, quality health coverage. The Biden Administration advanced these EOs through rulemaking, including (but not limited to) regulations addressing Medicaid managed care, Medicaid fee-for-service, and eligibility and enrollment processes for Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP).
- Prescription Drug Costs. President Trump rescinded a Biden-era EO to lower prescription drug costs, which prompted a reportfrom the Department of Health and Human Services (HHS) on options for Center for Medicare and Medicaid Innovation (CMMI) to test innovation payment and service delivery models for prescription drugs and a one-year update on the EO. CMMI also launched the Cell and Gene Therapy (CGT) Access Model to test outcomes based arrangements and increase access to such treatments in Medicaid, and issued a request for information (RFI) for the $2 Drug List Model (under development), which tests whether low copayment for commonly prescribed generic drugs can improve medication adherence and outcomes.
- Health Care Costs. President Trump signed an EO directing all executive departments and agencies to take actions intended to lower the cost-of-living – including, specifically, “eliminate unnecessary administrative expenses and rent-seeking practices that increase healthcare costs.” The EO does not define “rent-seeking practices,” but the Administration may be referring to pharmacy benefit managers based on President Trump’s recent comments “to knock out the middleman.” Other possibilities include policies to address anticompetitive practices, high prescription drug prices, and prior authorization. The directive regarding “unnecessary administrative expenses” could apply to a range of issues, such as program integrity, site-neutral payments, and greater flexibility for Medicare Advantage. As for next steps, the EO requires the Assistant to the President for Economy Policy to provide a status report to the President on implementation within 30 days (February 19).
- Rulemaking. President Trump issued a memorandum directing all executive departments and agencies to implement a regulatory freeze in which no rules may be issued or proposed until the agency head appointed or designated by the President after noon on January 20, 2025, reviews and approves the rule. The memorandum also directs federal agencies to consider postponing for 60 days the effective date of any rules that have been published in the Federal Register, or any rules that have been issued but have not taken effect. During this 60-day period, federal agencies could consider further delaying the rule beyond the initial 60 days. This memorandum creates uncertainty about the timing and applicability of rules.
Policy Implications
The EOs convey President Trump’s policy goals for his second administration. For the most part, they are statements of intent, generally based on campaign promises, which will inform the rulemaking and regulatory process. It may take months for these policies to take effect, and the public will likely have an opportunity to provide comments before they are finalized.
Some EOs are already facing legal challenges. Twenty-two states have sued to block the birthright citizenship EO in two separate lawsuits, filed in the Federal District Court in Massachusetts and the Western District of Washington. Multiple groups, including the American Public Health Association, have filed lawsuits against the “Department of Government Efficiency” (DOGE) EO to compel transparency about the new advisory committee’s operations. More lawsuits are likely to follow.
Next Steps
In the near term, a top priority for the Trump Administration is the confirmation process. Considering the delays in the confirmation hearing process, it could take some time before new rules implementing the EOs are proposed. President Trump also signed an EO directing a “regulatory freeze,” halting the rulemaking process until a department or agency head has been appointed or designated.
The confirmation hearing for Robert F. Kennedy Jr., President Trump’s pick to lead the Department of Health and Human Services (HHS), is on January 29. Whether Kennedy has the votes in the Senate remains to be seen. Hearings for other health-related appointments, such as Centers for Medicare and Medicaid Services (CMS) Administrator (Dr. Mehmet Oz is the nominee), have not yet been scheduled.