Donald Trump returned to the presidency last night, and the impacts for healthcare could be sweeping.
The 2024 election returns Republicans to the helm of health agencies, armed with plans to reshape federal health programs, reshape standards for healthcare, and push to lower prices. Trump said previously that he would allow some of his most outspoken campaign leaders, such as Robert F. Kennedy Jr., to “go wild” on health, medicine, and food policy.
In addition to wanting to tackle rising costs, Trump has also said he wants to improve the performance of U.S. health agencies. The slogan “Make America Healthy Again” was a facet of his campaign. He touched on it again in his victory speech last night, also name-dropping Kennedy.
Trump will likely head into his second term with a supportive Congress, as the GOP has regained the Senate and the Associated Press has not yet called which party will lead the House.
Here are some of the healthcare priorities Trump mentioned on the campaign trail.
1. Restructuring the CDC and Medicare
Priorities in a new Trump administration could include creating a presidential commission to probe what he says is a “stunning” rise in chronic illnesses, examining food policy, environmental factors, federal health care agencies, and the pharmaceutical industry itself.
Trump previously avoided aligning with the “MAHA” faction of Republicans, who have argued that vaccines play a role in chronic diseases. But many leaders of that belief now hold close roles in the Trump campaign. And on the campaign trail, Trump began to express that he was open to weighing potential risks of the shots.
There have also been talks about restructuring the Centers for Disease Control and Prevention and the National Institutes of Health. The CDC could be turned into two entities, one responsible for infectious disease outbreaks and the other on chronic illness prevention.
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2. Abortion policies and protections
Trump has distanced himself from some Republicans’ calls for national abortion restrictions, and previously vowed to veto one. He reiterated that during a presidential debate this fall. However, abortion access could still narrow in his second presidency.
The FDA under Trump could revise guidance that allows abortion pills to be sent to patients in the mail. The Justice Department under Trump would also likely be tasked with defending the FDA in a lawsuit against the abortion pill currently playing out in the lower courts.
He pledged to protect access to in vitro fertilization and mandate insurance coverage of the procedure.
3. The future of the ACA
Trump has signaled throughout his campaign that he doesn’t want to revisit efforts to repeal the Affordable Care Act, which was one of the defining features of his first presidency. But some members of his own party look ready to nix some portions, such as currently expanded tax credits that keep some customers’ premiums low.
A number of other significant updates to the ACA have already been floated by the GOP. Vice President-elect JD Vance has suggested that people on ACA plans could be divided by how expensive they are to their insurer, with cheaper plans offered to healthier, younger enrollees. This could lead to lower premiums for younger customers, but other enrollees could see their premiums balloon.
On the other hand, short-term health plans were embraced as a way to lower costs in Trump’s first term, and could make a return. Those short-term options offer customers limited coverage, though.
4. The future of Medicaid
There’s been no specific mention of Medicaid’s future under Trump, except in that he vowed not to cut it. However, Medicaid spending did drop under Trump’s watch, with his administration allowing some states to convert portions of their Medicaid funding into block grants.
Work requirements began for some of the program’s enrollees, in some states, and it is likely those waivers could be expanded to other states in the coming term.
Trump’s website has not been updated to include plans for specifics such as Medicaid, but it currently says he would bar minors from receiving gender-affirming care and deny state or federal funding for the care nationwide.
5. Prescription drug costs and health coverage
Last year’s Supreme Court decision in favor of religiously affiliated employers also granted them religious exemptions from having to cover some prescriptions on their worker’s insurance programs.
Democratic opponents have argued that this could lead some employers and even some providers from denying access to necessary medications under the guise of First Amendment rights.
Likewise, religiously affiliated hospitals receiving federal funding could receive new protections.
Trump had ambitious plans to tackle prescription drug costs in his first administration, but they largely amounted to nothing. His most ambitious proposal, called most-favored nations, never materialized.
President Biden’s Inflation Reduction Act allowed Medicare to begin negotiations with drugmakers last year, marking the first time Medicare has ever been given permission to do so. However, Trump’s campaign did not include any discussion of potentially using that process to their advantage.
GOP lawmakers instead have signaled they want more pricing transparency, a proposal some of them tried to force hospitals to comply with earlier this year when Democrats controlled Congress, albeit unsuccessfully.
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