WASHINGTON — Republican Donald Trump has been elected president, ushering in a new era for federal health agencies and the industries they oversee.
The president-elect campaigned on promises to reorganize public health agencies, rebuild federal health programs and reduce high costs across the system. President Trump said campaign aides like Robert F. Kennedy Jr. are ready to “run amok” on health, medical care and food policy.
Trump reiterated that promise in his victory speech. “We can add some names like Robert F. Kennedy Jr.,” Trump told supporters. “And he's going to help make America healthy again… He's a great guy and he's said there's something he really wants to do, so we're going to let him do it.”
While health care has taken a back seat to President Trump's campaign claims of stimulating the economy and cracking down on illegal immigration, Democratic opponent Kamala Harris has made it central. They promised to strengthen the Medicare program, which covers millions of seniors, and reduce high medical costs. However, opinions were divided on the details. While Harris portrayed health care, including reproductive rights, as a fundamental freedom, Trump's position continued to evolve during the campaign.
An Associated Press poll found that health care dwarfs the economy and immigration in voters' minds. Abortion was the top issue for 11% of voters surveyed, compared to 8% who chose health care, 39% who chose the economy, and 20% who chose immigration.
President Trump has said he will not sign any legislation restricting abortion nationwide, but he has promised other policies that will determine who gets health care and who can refuse it. The president-elect said he would ban federal funding for gender-affirming care and ban it entirely for minors. He has also pledged to protect religious freedom, including allowing certain employers to deny contraceptive coverage based on religious beliefs during his first presidency.
President Trump has signaled he doesn't want to revisit one of the defining battles of his first term in office: his failed effort to repeal the Affordable Care Act. Instead, President Trump and Congressional Republicans have said they want to reduce costs within the ACA and perhaps let the current enhanced tax credits expire.
Now that Republicans have won the seats they need to take back the Senate majority, President Trump will rely on Republicans in the Senate to help him implement policies and confirm nominees. The Associated Press has not yet revealed which party will control the House of Representatives.
Many of the Biden administration's unfinished priorities hang in the balance. President Biden and Vice President Harris aimed to tackle Americans' medical debt, expand access to behavioral health care and accelerate Medicare negotiations on high-cost drugs.
With President Trump set to take office in January, new priorities are on the table.
vaccines and public health
President Trump has created a presidential commission to investigate the “alarming” rise in chronic disease, promising to investigate food policy, environmental factors, federal health care agencies, and perhaps the pharmaceutical industry itself.
The president-elect has leaned heavily into a “Make America Healthy Again” argument that calls for public health reform, but until now he has backed away from the idea that vaccines play a role in chronic disease (promoted by MAHA leaders such as RFK Jr.). I've been avoiding it. But campaign surrogates have suggested in recent weeks that the second administration is becoming increasingly receptive to unproven theories about the risks of vaccines.
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Howard Lutnick, Trump's transition co-chairman, told CNN days before the election that RFK Jr. will not be tapped to lead the Department of Health and Human Services, but will reduce the number of vaccinations in line with the recommended schedule. He said he may oversee efforts to do so. Lutnick and others are also discussing reevaluating liability protections for pharmaceutical companies developing vaccines.
Republican lawmakers are already debating a major reorganization of two public health agencies: the Centers for Disease Control and Prevention and the National Institutes of Health. For the CDC, this includes separating the agency into two organizations, one for infectious disease response and one for chronic disease prevention. The latter has become a focus of the Trump campaign.
For both the CDC and the Food and Drug Administration, potential reforms could also focus on overhauling food and nutrition policy, an effort that has bipartisan support.
reproductive rights
President Trump has distanced himself from calls by some conservatives for nationwide abortion restrictions, promising during a presidential debate that he would veto such a ban if it came to his desk.
But abortion rights advocates say there are countless other ways that access to abortion and reproductive health care could be narrowed under President Trump's administration, including religious This includes exemptions from insurance coverage for related employers. The FDA under the Trump administration may also revise its guidelines to allow the abortion drug mifepristone to be mailed to patients. Mifepristone is used in the majority of abortions.
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Threats against mail-order sales of mifepristone are also coming quickly from the courts. Attorneys general from three states have joined the case regarding mifepristone regulation, which the Supreme Court remanded to the Texas District Court. Their argument centers on the legality of mailing abortion pills under an obscure law that hasn't been enforced for decades. The Trump administration's Justice Department may come to the FDA's defense in the coming years.
Separately, President Trump vowed to protect access to in vitro fertilization and require insurance coverage of the procedure.
Health insurance restructuring
Republican lawmakers and policy experts have laid out a number of possible ways to reform the ACA and signaled a desire for a major overhaul. Many Republicans oppose strengthening tax credits that keep ACA premiums low when they expire next year.
Vice President-elect J.D. Vance has suggested that the administration would allow insurance companies to separate enrollees into different risk pools and offer different plans based on their health risks. While this could make insurance cheaper for healthier, younger Americans, it could also raise premiums for older people and people with chronic health problems, policy experts say. is warning.
A second Trump administration may also revive previous efforts to offer shorter-term health care plans. These insurance options, which were extended during President Trump's first term and then scaled back by Biden, do not have to cover everything required by ACA plans. For example, a 2018 KFF study found that 71 percent did not have prescription drug coverage.
It is notable that Trump did not specifically discuss Medicaid during the campaign, specifically excluding it from his pledge not to cut spending for Medicare and Social Security programs.
But Medicaid underwent a number of significant changes during the Trump administration, including efforts to allow states to implement work requirements for some recipients. The agency issued guidance on how states can implement work requirements for coverage and approved 13 waivers to deploy them.
The program also introduced an option in 2020 for states to convert a portion of their Medicaid funds into block grants.
Except for gender-affirming care.
President Trump has repeatedly promised to ban federal funding for reassignment surgeries. On his website, he promises to issue an executive order on his first day in office “directing all federal agencies to discontinue all programs that promote the concept of gender and gender reassignment, regardless of age.”
The legality of bans on gender-affirming care, at least under state law, will soon be heard by the Supreme Court. The court will hear arguments on Tennessee's ban on December 4, but a decision is likely to be issued after President Trump takes office.
Elderly care
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Late in the campaign, Trump proposed a tax credit to support long-term care workers. He did not provide details about who would be eligible or the plan's potential cost, but said at least 53 million Americans are caring for a sick family member. That number is expected to rapidly increase in the coming years as the baby boomer generation ages.
The proposal parallels a number of other tax-cut plans announced by President Trump, as well as his broader pledge to “strengthen” Medicare and reduce costs.
Some Republican policy experts have suggested that these costs could be controlled by encouraging more seniors to choose privately managed Medicare Advantage plans. Separately, proposals have been floated to change the law to allow seniors to contribute to health savings accounts while enrolled in Medicare.
Lowering drug prices
President Trump has long lamented the high prices Americans pay for prescription drugs and how other developed countries are “freeloading” at much lower prices. But he has abandoned his signature most-favored-nation proposal to lower costs, and it remains unclear how he will work within the framework of Biden's Inflation Control Act, which would allow Medicare to directly negotiate certain drug prices. It's opaque.
His campaign has promised to push for more transparency around prices, reflecting his administration's first effort to require hospitals to post their prices. Republican leaders also called for more transparency in negotiations between Medicare officials and drug companies under the IRA process.
Trump also made cracking down on pharmacy benefit managers a top priority during his first administration. Some of these efforts have failed or been reversed by Biden, including a rule that would eliminate kickbacks that drug companies pay to PBMs.
This is a developing story and will be updated
