Photo illustration: Tiffany Herring/Axios; Photo: Scott Olson/Getty Images
A second Trump presidency would provide an opportunity to pursue what former President Trump sees as unfinished business in health policy, including implementing a "Most Favored Nation" policy on drug pricing and possibly overhauling Medicaid.
Why it matters: Experts say Trump and his policy advisers would juggle these priorities with new initiatives like restricting gender-affirming care and potentially promoting new health coverage arrangements that would compete with the Affordable Care Act.
Here's an issue-by-issue breakdown of what could happen:
Drug prices: Trump focused heavily on lowering drug prices during his presidency, though the biggest proposals never took effect.
- One of the most ambitious ones involved the "Most Favored Nation" rule, which would have matched U.S. prices for certain drugs with the lower amount paid for the drug in other wealthy countries. It ran into stiff opposition from the pharmaceutical industry and didn't get past the drawing board.
- Trump has continued to push for the policy and touted it for his second term on his campaign website.
- "He probably cares the most about reducing drug prices," Theo Merkel, director of the private health reform initiative at Paragon Health Institute, said of Trump's priorities.
- Merkel, who worked on health policy at the National Economic Council while Trump was in office, said that "there was a lot of creativity" around policies aimed at lowering drug costs, such as reimportation and biosimilar approvals, and that he could see more of that resurfacing.
- One wild card: Trump has not made clear whether he would try to repeal or dial back Democrats' drug price negotiations in the Inflation Reduction Act.
Medicaid: The Republican platform calls for no cuts to Medicare, but it's silent on Medicaid, leaving the door open to big changes to the safety net program.
- The Heritage Foundation's Project 2025 calls for caps on Medicaid spending.
- The House Republican Study Committee calls for block grants.
- That doesn't guarantee Trump would embrace those changes, which for one thing would require full GOP control of Congress and even then could trigger pushback from some Republican governors.
- Smaller changes through executive action could include a return of work requirements, which Trump sought to implement in his first term.
ACA: Trump helped lead the GOP's failed repeal-replace push in his first year in office in 2017. As recently as last fall, he was doubling down on the idea, saying the GOP should "never give up."
- In March, though, he sought to walk back his comments, promising unspecified improvements rather than ending the law.
- A likely result if the GOP sweeps the elections would be letting the enhanced marketplace subsidies expire next year. Republicans have criticized the assistance that helps people afford premiums as costly handouts to insurance companies.
- "2017 should have taught Republicans a lesson," said Joe Antos, senior fellow emeritus at the American Enterprise Institute, saying he now expects "more targeted policies."
- There's also the possibility that Trump could revive ACA alternatives that he expanded while in office, such as association health plans and health reimbursement arrangements.
Medicare provider payments: Trump has repeatedly said there would be "no cuts" to Medicare.
- But as Republicans look to pay for priorities like extending the Trump tax cuts, they could look to squeeze savings in areas like site-neutral payments in Medicare, an idea boosted by Paragon as well as other groups on the right and left. It's not a cut to benefits, though it would reduce payments to hospitals.
Abortion: Trump has tried to take a softer approach on abortion in the aftermath of the Supreme Court's Dobbs decision, backing away from a national abortion ban and repeatedly saying that the issue should be left up to the states.
- Whether that remains the case if the GOP sweeps Congress is an open question, since there's been intense pressure from antiabortion groups for a national federal policy restricting abortion.
- Trump did say during the recent presidential debate that he supported the Supreme Court's decision to retain access to the abortion pill mifepristone.
- In his 2016 RNC platform, Trump called for a national abortion ban after 20 weeks.
- The 2024 platform does not include any language around a national ban but does say that states can pass laws that allow for a fetus to be considered a person.
Gender-affirming care: Banning gender-affirming care has been a priority in many GOP-led states, and Trump plans to take that further with national policies, per his campaign website.
- Trump says he would sign an executive order asking all federal agencies to stop promoting sex and gender transitions and pass a federal law that prohibits gender-affirming care for minors in all 50 states.
- He would also ask Congress to ban federal funds from being used for these procedures.
