Trump's executive order blitz likely to hit health
Photo illustration: Sarah Grillo/Axios. Photo: Brendan Smialowski/AFP via Getty Images
President Trump's plan to issue a wave of executive orders, along with other administration guidance, will offer early clues about how disruptive his second term will be in the health world.
The big picture: Trump's early health agenda will emerge through rulemaking, appointments and executive orders that allow him to bypass Congress.
Here are some areas to watch:
Reproductive health
Trump is expected to quickly order the reinstatement of the so-called Mexico City policy that blocks NGOs abroad from receiving U.S. global health funding if they provide or promote abortion.
- Trump reinstated the policy in 2017, but also significantly expanded its reach so it also applied to PEPFAR, maternal and child health, malaria, nutrition and other U.S. programs, per KFF.
- Trump could also undo executive orders and memorandums issued by former President Biden, including dissolving the Interagency Task Force on Reproductive Healthcare Access and the White House Gender Policy Council, according to the Guttmacher Institute, a pro-abortion rights research organization.
- Another target could be nondiscrimination provisions of the Affordable Care Act, including protections on the basis of gender identity and sexual orientation.
Vaccine mandates
Candidate Trump repeatedly pledged to withhold federal funds from public school districts that have vaccine mandates, such as those for MMR, chickenpox and polio.
- While states typically set vaccine requirements, Trump's use of the bully pulpit could stoke further vaccine skepticism, with vax critic Robert F. Kennedy Jr. in line to become the nation's top health official.
- Conservatives generally have been in favor of dismantling vaccine requirements and barring CDC from issuing guidance on vaccines and masks.
Drug prices
During his first term, Trump sent shockwaves by proposing an international pricing index to tie Medicare drug prices to those paid in other countries.
- His campaign backed off that idea last year, and he has since directed much of his drug cost ire at PBMs. But it's possible Trump could revive the proposal in some form.
- There is also the question of how he handles the next round of Medicare drug price negotiations under the IRA, and if he seeks to make changes to how the program operates.
Global health
Trump also promised during the campaign to pull the U.S. out of the World Health Organization — a process he started during his first term but that Biden reversed on his first day in office.
- The U.S. is the WHO's top donor, contributing about $130 million a year to help cover its global health preparedness and response, as well as efforts to address HIV, tuberculosis, and childhood vaccination, per Devex.
- Trump's administration is also expected to cut U.S. funding to the U.N. Population Fund, repeating a move he made during his first term, when he accused it of supporting population control programs in China.
Immigration
While not technically health policy, Trump's immigration crackdown relies on Title 42, a pandemic-era health authority he invoked during his first term that allows for the rapid expulsion of migrants at the border and cuts off their ability to seek asylum.
- During a meeting with Senate Republicans this month, Trump immigration adviser Stephen Miller walked through orders that include reimplementing Title 42.
- The Biden administration kept the authority in effect at first, but it went away with the end of the COVID-19 health emergency.
