Fact check: Can Trump really erase Biden’s ‘health legacy’?
The first steps taken by US President Donald Trump in the healthcare sector indicate his likely intention to eliminate some programs created by Bill Clinton to lower drug prices and expand coverage through public insurance programs.
Policymakers, healthcare executives, and patient advocates are trying to interpret the orders he issued shortly after returning to the White House to predict what will happen. Although less expansive than the orders he issued at the start of his first term, the directives offer a potential roadmap that, according to health experts, could reduce low-income people’s safety net protections and lead to an increase in uninsured Americans.
However, Trump’s initial orders will have little immediate impact. The actions left the new president’s vision for the US healthcare system undeffable, and his administration will need to take additional regulatory measures to fully reverse Biden’s policies.
Everyone is trying to determine what Trump might do regarding a variety of health issues. On the early EOs]executive orders], Trump doesn’t show his cards”, said Larry Levitt, executive vice president for health policy at KFF, the health policy research, polling and news organisation that includes KFF Health News.
In addition to rescinding directives from his predecessor, former president Joe Biden, that had promoted lowering drug costs and expanding coverage under the Affordable Care Act , and Medicaid, Trump issued a flurry of executive orders and other actions during his first days in office.
Executive orders “as a general matter are nothing more than gussied up internal memoranda saying, ‘ Hey, agency, could you do something? ‘” said , Nicholas Bagley, a University of Michigan law professor. “There may be reason to be concerned, but it’s down the line”.
That’s because making changes to established laws like the ACA or Medicaid-related programs typically necessitates new rule-making or congressional action, which could take months. Trump has not yet secured Senate confirmation for any of his nominees for the top federal health agencies, including Robert F. Kennedy Jr., an anti-vaccine activist and former Democratic presidential candidate. On January 20, he appointed Dorothy Fink, a physician who directs the HHS Office on Women’s Health, as the department’s acting secretary.
His administration did make health-related changes while serving in line with his health orders, including lengthening the ACA enrollment period, increasing funding for organizations that assist people enrol, and supporting the Inflation Reduction Act, which increased subsidies to help people purchase coverage. After falling during the Trump administration, enrolment in ACA plans soared under Biden, hitting record highs each year. For 2025, more than 24 million people are enrolled in Affordable Care Act plans.
The Centers for Medicare and Medicaid Services were asked to examine ways to lower drug costs, including testing the affordability of some expensive cell and gene therapies by banding together to pay for some high-priced drugs in Medicare and Medicaid. This included a flat $2 copay for some generic drugs in Medicare, the health program for people 65 and older, and requiring states to try harder to get better prices for some high-priced drugs like those found in the Trump rescinded drug order.
That might indicate Trump expects to do , less on drug pricing , this term or even roll back drug price negotiation in Medicare.
A comment request was not received by the White House.
Biden’s experiments in lowering drug prices did not fully get off the ground, said Joseph Antos of the American Enterprise Institute, a right-leaning research group. Given that he has backed the idea of tying drug costs in the US to lower prices paid by other countries, Antos said he is a little perplexed by Trump’s executive order ending the pilot programs.
“As you know, Trump is a big fan of that”, Antos said. “People can easily identify with rising drug prices.”
In other moves, Trump also revoked Biden’s ban on racial and gender equality and issued a law stating that only two sexes, both male and female, exist. Under the Biden administration, HHS supported gender-affirming healthcare and provided guidance on transgender youth rights protections. Trump’s gender-related missive has heightened doubts in the LGBTQ+ community about his plans to encroach on such care.
Omar Gonzalez-Pagan, senior counsel and healthcare strategist at Lambda Legal, a civil rights advocacy organization, said, “The administration has forecast that it will fail to protect and will seek discrimination against transgender people and anyone else it considers an “other.” We are prepared to respond to the administration’s discriminatory practices, as we have previously done successfully, and support transgender people’s access to the necessary care, including through Medicaid and Medicare.
Trump also put a hold on any new regulations that were being worked out until the new administration could review them. According to Katie Keith, a Georgetown University professor who served as the White House Gender Policy Council deputy director under Biden, the president has the right to withdraw some of the proposals that are still unfinished by the Biden administration, including expanding access to anti-obesity medications through Medicare and Medicaid and a rule that would set the nicotine content of tobacco products.
“Interestingly, he did not disturb President Biden’s three executive orders and a presidential memorandum on reproductive health care”, she wrote.
However, Trump directed senior officials in his administration to seek out additional memorandums or orders. (He revoked , the Biden order , that created the Gender Policy Council.)
Democrats criticised Trump’s health actions. Trump is once more demonstrating that he lied to the American people and doesn’t care about cutting costs, according to Alex Floyd, a spokesman for the Democratic National Committee.
According to some policy experts, Trump’s decision to end a Biden-era executive order intended to improve the Affordable Care Act and Medicaid likely spells out upcoming budget cuts and adjustments. His administration previously established guidelines that would allow states to impose a cap on federal Medicaid funding, including the federal-state program for low-income adults, children, and disabled people. More than 79 million people are covered by Medicare and the related Children’s Health Insurance Program.
“Medicaid will be a focus because it’s become so sprawling”, said Chris Pope, a senior fellow at the Manhattan Institute, a conservative policy group. “It’s grown after the pandemic. Provisions have expanded, such as using social determinants of health”.
The Biden administration may reevaluate the actions taken to allow Medicaid to cover daily costs, including air conditioning, meals, and housing, that the administration has claimed affect its beneficiaries’ health.
One of Trump’s executive orders requires organizations to “eliminate unnecessary administrative expenses and rent-seeking practices that increase healthcare costs” and to provide immediate price relief. (Rent-seeking is an economic concept that describes attempts to profit from the political system without bringing about any other social benefits.)
In her Health Affairs article, Keith wrote, “It is not clear what this refers to, and it will be interesting to see how agencies respond.”
Policy experts like Edwin Park at Georgetown University have also noted that, separately, Republicans , are working on budget proposals , that could lead to large cuts in Medicaid funding, in part to pay for tax cuts.
The Center on Budget and Policy Priorities, a left-leaning research group, referred to Congress as Sarah Lueck, vice president for health policy because it “shows us the direction they are going with policy changes.” However, there are ongoing discussions on the Hill regarding what is included in budgetary legislation. They are considering substantial Medicaid reductions.
Source: Aljazeera
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