Communications Director, Connecticut Hospital Association
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Modern Healthcare – Wednesday, January 22, 2025
By Bridget Early
President Donald Trump has rescinded a set of insurance, drug pricing and public health executive orders that laid the groundwork for former President Joe Biden’s major healthcare policy priorities, and started establishing his own agenda.
Trump was prolific with executive orders in his first term and kicked off his second term with similar vigor. In all, Trump nixed 78 of Biden’s executive orders Monday, and issued a handful of his own executive orders on global health and nondiscrimination compliance.
Executive orders are a directive from the president to federal agencies on how the government should manage a particular issue. Presidents are granted the authority under Article II of the Constitution to issue the orders, which don’t require the input of Congress and carry the force of law.
While many executive orders are effective immediately, they often take time and resources to fully implement. Congress can undercut executive orders by passing legislation that guts them— for instance by removing funding needed to carry them out — or by making them difficult to implement. Courts can declare the orders unconstitutional.
Issuing day-one executive orders has become standard operating procedure for the past several presidents, said Susan Dudley, a professor at George Washington University and former administrator of the White House Office of Information and Regulatory Affairs.
Biden issued nine executive orders on his first day, several of which reversed policies from Trump’s first term.
“These are administrations with very different views about what government should do,” Dudley said.
Here are the actions Trump took Monday affecting healthcare.
Marketplace insurance
Trump rescinded a January 2022 executive order that reopened federal health insurance exchanges for open enrollment for a special enrollment period. Biden’s now-scrapped order had also directed states to reexamine Medicaid work requirements and other policies that made it difficult to enroll in or pay for coverage.
Almost three million people signed up for new coverage during that period, according to an agency report on that special enrollment period.
Experts have predicted that work requirements and other coverage restrictions could return during a second Trump administration.
Public health and pandemic management
Trump rescinded five Biden executive orders related to the COVID-19 pandemic.
The orders directed the executive branch to implement new pandemic management strategies and tasked the Health and Human Services Department with creating a COVID-19 health equity task force to respond to the disproportionate impact on marginalized populations.
Biden’s orders also laid out a uniform COVID-19 testing protocol and tasked public health workers with executing nationwide testing, including creating a no-cost testing program for the public. The orders also increased funding to expand laboratory testing capacity.
Months after the orders were signed, the Biden administration announced $1.7 billion for the Centers for Disease Control and Prevention to track new virus variants, $4.8 billion for HHS to offer testing for the uninsured, and more than $6 billion to increase testing at community health centers.
Drug pricing
Trump rescinded a 2023 executive order directing the Center for Medicare and Medicaid Innovation to develop drug pricing models that would help lower the costs of expensive medications, require Medicare Part D plans to cover generics and improve access to gene therapy treatments.
The models were still in their infancy. CMMI was set to accept applications to participate in the Cell and Gene Therapy Access Model through the end of February. The model was supposed to help state Medicaid agencies pay for expensive sickle cell therapy treatments by setting up negotiations between CMS and manufacturers.
Nondiscrimination policies
Trump issued an executive order that requires federal agencies to use sex at birth, rather than gender, as a demographic category, and to ensure official documents include accurate information about people’s sex. He also overrode Biden’s orders that created additional protections for LGBTQ+ people in healthcare settings.
Federal agencies and employees will be required to enforce “laws governing sex-based rights, protections, opportunities, and accommodations,” the order said.
The order could upend Biden-era support for gender-affirming care payments under programs such as Medicaid, and could lead to a major change in access to healthcare for transgender people and other members of the LGBTQ+ community.
Reduced access to gender-affirming care has been tied to greater mental health issues and higher rates of suicide, particularly among young people.
World Health Organization
As a result of another order issued Monday, the U.S. is beginning the process of withdrawing from the World Health Organization. Trump made a similar push to leave WHO in his first term but did not finalize that decision.
The process of exiting the organization takes about a year, leaving WHO a small window to find a new top donor. The U.S. contributed a combined $1.3 billion to the organization in 2022 and 2023. Experts fear disease eradication and public health efforts spearheaded by WHO will be harmed without the U.S. as a backer, even as deadly outbreaks of HIV polio, Ebola and avian flu remain global health risks.
Artificial Intelligence
Trump eliminated a sweeping 2023 executive order tasking federal agencies with laying out a regulatory framework for AI safety and transparency.
Healthcare providers are increasingly using AI to treat more patients and increase provider revenues. Without the oversight Biden’s order, the industry likely will have more leeway in how it uses AI. The technology has resulted in high rates of alleged incorrect prior authorization denials, which heightened calls for oversight.