February 1, 2025
President Trump issues historic number of executive actions in first two weeks of new administration
It’s been a very busy two weeks in the second Trump Administration, especially when it comes to executive actions. From topics ranging from border security and birthright citizenship to minors’ access to transgender health care services and climate policy, President Trump has issued almost 70 executive actions since taking office on January 20. While the aggressive, proactive nature of the actions is unprecedented, many are being quickly challenged in the courts. While executive actions are noteworthy, the long-term implications and impact of each action will vary. In order for many of the proposed policy changes to become law, Congress will need to pass legislation. Nonetheless, several health care executive orders have been issued and garnered headlines. Here is a summary of some of the high-profile health care executive actions:
- Affordable Care Act – President Trump rescinded Biden executive actions to allow for longer enrollment periods and extra funding for programs that encourage enrollment. While repeal of the ACA won’t happen, the new administration will clearly not be looking to expand it and it’s very likely that premium subsidies will not be extended beyond 2025.
- Prescription Drug Pricing – While the Biden Administration announced the next 15 drugs that will be subject to Medicare drug price negotiation and price setting for 2027 applicability just before leaving office, President Trump rescinded the Biden executive action to lower prescription costs. What does that mean? It doesn’t end demonstrations and projects that are currently underway (such as the Center for Medicare & Medicaid Innovation’s Cell and Gene Therapy Access model). However, other programs that did not get off the ground will not move forward. In regard to the CMMI Cell and Gene Therapy Access Model (which has already begun to facilitate value-based pricing communications between gene therapy manufacturers and CMMI on behalf of state Medicaid agencies), we’ll need to keep an eye on CMS and CMMI leadership changes and how powerful Republican congressional leaders, including House Energy & Commerce Committee Chair Brett Guthrie (R-KY), will weigh in on the topic. Guthrie has publicly opposed the Cell & Gene Therapy Access Model, citing concerns that it consolidates power at the federal agency level.
- U.S. withdrawal from the World Health Organization (WHO) – President Trump instructed U.S. officials to withdrawal from the WHO, citing its alleged mishandling of the COVID pandemic and questions regarding financial irregularities. If this order becomes reality, the WHO will lose substantial funding. The U.S. contributed about $1.3 billion in 2022 and 2023. Public health advocates warn that withdrawal from the organization will eliminate any U.S. opportunity to shape WHO’s agenda and put the global health infrastructure at risk if another pandemic emerges. Others believe many of the WHO’s formal positions and programs run contrary to the Trump Administration’s agenda and, in an age of increased pressure to reduce costs, the price tag is too steep.
- Transgender health care – Following through on campaign promises, President Trump signed an executive order that seeks to end transgender medical treatments for children and teenagers under the age of 19. He also signed separate orders banning openly transgender troops serving in the military and an order stating that the federal government recognizes two sexes, male and female.
- Abortion – While the President has not pledged to support a national abortion ban, he did sign orders restricting government funding of abortion both here in the U.S. and around the world. Former President Biden issued several orders expanding U.S. support for abortion access, so it’s likely that there will continue to be a rollback of Biden’s abortion rights actions. President Trump and Vice President J.D. Vance also addressed an estimated 200,000 abortion opponents at the annual March for Life just five days after the inauguration, signaling a major shift from the Biden-Harris Administration. It will continue to be important to watch HHS leadership confirmations and appointments to key positions to predict future action or inaction on this topic.
Robert F. Kennedy Jr. grilled by Senate Finance Committee in first confirmation hearing: What are the key takeaways?
Democrats on the Senate Finance Committee took on RFK Jr. over issues ranging from prescription drug prices to vaccines, from the value of Medicaid and food policy, in a tense confirmation hearing on Wednesday, January 29. On various issues, Kennedy deferred to the President’s position, even on issues where he has publicly disagreed. Democrats pressed Kennedy on what he would do to ensure abortion access, particularly to mifepristone (the “abortion pill”), with Kennedy stating that the President has only asked him to investigate the safety of the medication, not restrict access. Kennedy said “Medicaid is not working” for Americans, spoke of the success of the Medicare Advantage program and pledged “radical transparency” if he is confirmed to the HHS Secretary position. He would not commit to preserving every personnel position in HHS, echoing the Administration’s push to reform agencies and the federal workforce generally. After meeting with most U.S. senators, Kennedy said he sees areas of agreement and common ground, including pharmacy benefit manager (PBM) reform and protection of rural health care access. He often attempted to redirect the conversation to the country’s chronic disease problem, especially when it comes to the health of children. “There is no such thing as Republican children and Democratic children,” he said. Kennedy’s path to confirmation will ultimately be determined on the U.S. Senate floor, as the Senate Finance Committee is expected to advance his nomination on a party-line vote. In addition, the Thursday courtesy hearing in front of the Senate Health, Education, Labor and Pensions Committee (HELP) raised additional questions and concerns from some members.
Gridiron’s take: It wasn’t a great two days for RFK. He seemed flustered and often appeared to confuse basic details surrounding Medicare and Medicaid. It didn’t shore up or assure any Democrats who may have initially been open to supporting this nomination. It will come down to a handful of Senate Republicans. Who to watch? Susan Collins (ME), Lisa Murkowski (AK), Dr. Bill Cassidy (LA) and Mitch McConnell (KY). If all 4 vote “no”, RFK is not confirmed. However, the vote counting will take place well before a floor vote is scheduled. If there are 4 firm “no” votes in the GOP caucus and no Democrats are open to voting “yes”, the nomination could be withdrawn.
Trump Administration signals general support for Medicare Drug Negotiation, but seeks input from stakeholders
On Wednesday, January 29, CMS issued a statement reiterating the new administration’s plan to continue to seek ways to reduce drug costs. “Lowering the cost of prescription drugs for Americans is a top priority of President Trump and his Administration.” The statement referenced that CMS released the list of 15 drugs selected for the second cycle of the Medicare Drug Price Negotiation Program on January 17. The Trump CMS team said they are “committed to incorporating lessons learned to date from the program and to considering opportunities to bring greater transparency in the Negotiation Program.” While the statement is evidence that the Trump Administration is not likely to prioritize repeal of price negotiation/price setting of prescription drugs in Medicare, it does open the door for changes in how the government approaches the negotiation process. Given past public comments in support of government negotiation in Medicare drug pricing by both President Trump and Vice President J.D. Vance, a major policy change on negotiation was not expected. However, given Republican control of both the U.S. House and Senate, some changes to the drug pricing provisions within the Inflation Reduction Act (IRA) could be addressed as early as this spring in Congress.
Health Policy Snippets
- New national poll highlights America’s diverse views on various health policy issues. A new poll from the Kaiser Family Foundation finds divergent views on how policymakers should handle various health policy issues—with some areas of bipartisan agreement and other areas where Americans remain philosophically divided. A vast majority of Americans (both Democrats and Republicans) have favorable views of the Medicare and Medicaid programs (with Medicare getting slightly higher favorability percentages). The public generally supports greater “transparency” in the health care process (although the specifics of “transparency” weren’t clearly outlined), and most of those surveyed have a pessimistic view on whether health care will be more affordable in the future. The survey also spotlighted some conflicting views on issues, with a sizeable majority supporting expanding the number of drugs subject to price setting in Medicare, yet almost 60% of those surveyed said repealing the law that allows the government to negotiate Medicare prices should be a priority for the new Congress.
Gridiron’s take: Always take public opinion polls with a grain of salt, especially when dealing with complex issues. - Federal and state lawmakers continue push to reform prior authorization. It’s an age-old struggle between health insurers, patients, health care providers and other stakeholders—how can insurers’ coveted prior authorization (PA) programs be reformed? On the federal level, Rep. Jeff Van Drew (R-NJ) has introduced legislation that would effectively ban prior authorization in employer health plans, while North Carolina lawmakers are preparing to file legislation that would drastically restrict the ability of insurers to implement PA programs. While banning PA is unlikely to garner enough support at either the federal or state level, there seems to be more momentum to consider restrictions and guidelines on the practice. Physician groups have long argued that while some PA tools can be effective, many times it leads to negative clinical outcomes. Legislation moves more quickly at the state level, where legislators in 10 states passed some form of PA legislation in 2024 and nine states, plus the District of Columbia, passed bills in 2023.