8 Targets of Trump's Second-Term Healthcare Agenda

A 'dizzying array' of actions in the first seven weeks of President Donald Trump's second term.

In prior years, the Medicaid unwinding dominated healthcare headlines. Would the resumption of post-pandemic eligibility verifications trigger the disenrollment of millions of Americans? In the words of the Magic 8-Ball: "It is (was) decidedly so."

In the first few months of 2025, there is a new unwinding — the reversal of wide swaths of U.S. healthcare policy now that Administration has transitioned from Biden-Harris to Trump-Vance. As Health Affairs notes, the first 50 days of Trump's second term represent a "dizzying array" of executive orders and announcements in the multiple areas. HealthLeaders has coalesced these into eight major policy areas:

1. Cost: Hospital and prescription drug transparency
2. Public Health: Global and domestic policy
3. Chronic Conditions: The Make America Healthy Again Commission
4. Reproduction and Gender/Sexuality: Fertility, discrimination
5. Telehealth: Controlled substances
6. Prevention and Prescription Drugs: ACA litigation and price negotiation
7. SDOH: Funding for Medicaid waivers
8. ACA: Navigator funding and the first Marketplace regulations

The nitty-gritty of this list ranges from cost transparency and negotiation to public, reproductive and social health to what the future holds for the ACA and its now-booming Marketplace.

1. Cost: Hospital and prescription drug transparency

A new executive order and fact sheet continues actions from both Trump's first term and the Biden Administration.

• During the first Trump Administration, an executive order and HHS rule required hospitals to post their prices publicly. For health plans, HHS, Department of Labor, and Department of Treasury rules required consumer-facing pricing tools.
• The Biden Administration added rules in 2021 and 2023 for hospital noncompliance, enforcement, and penalties.
• The second Trump Administration seeks tougher hospital oversight. This includes the posting of actual versus estimated prices, which are to be standardized and comparable across hospitals, health plans, and insurers.
• The new administration also requires health plans to publish prescription drug price with possible new enforcement actions.

2. Public Health: Global and domestic policy

The Trump Administration is shifting U.S. public health agenda significantly and in multiple areas:

• Global public health: The planned withdrawal from the World Health Organization and the dismantling of the United States Agency for International Development (USAID). The latter affects everything from HIV, malaria and other transmissible diseases to food security.
• Vaccine mandates: The reinstatement of more than 8,000 servicemembers discharged for refusing COVID-19 vaccine mandates and a federal funds withhold that mandate student vaccinations.
• Vaccine funding and research: A variety of actions that have slowed FDA and CDC vaccine recommendations, could fund CDC research into a vaccine-autism link despite existing lack of evidence, and cancel development a $590 million Moderna bird flu vaccine.
• Public information: Access is being restored to multiple public health websites and datasets — HHS, CDC, FDA, the Youth Risk Behavior and National Assisted Reproductive Technologies Surveillance Systems, as well as HIV and LGBTQ youth health disparity pages — after a Trump Administration pulldown with litigation still in progress.

3. Chronic Conditions: The Make America Healthy Again Commission

A February 13 executive order established the Make America Healthy Again (MAHA) Commission to understand and reduce chronic conditions, including among children. MAHA Commission requirements include a Make Our Children Healthy Again Assessment and Strategy that will assess "threats" posed by prescription medications (e.g., anti-depressants, weight-loss drugs). It will also assess how effective certain federal health data and metrics are (e.g., National Survey of Children's Health).

New HHS Secretary Robert F. Kennedy, Jr. will chair the cabinet-level MAHA Commission, which will include leaders from the FDA, CDC, and the National Institutes of Health (NIH).

4. Reproduction and Gender/Sexuality: Fertility, care, discrimination

Multiple executive orders look to affect the following:

• In Vitro Fertilization (IVF): Added protections to "aggressively reduce out-of-pocket and health plan costs for IVF treatment" — policies that may not extend to same-sex couples or single Americans.
• Gender dysphoria treatment: A disruption of evidence-based gender-affirming care, particularly for minors, which "could enable health care discrimination against transgender people."
• Federal definitions: HHS proposals for sex and related terms going forward, which "could have widespread implications for agency operations."

5. Telehealth: Controlled substances

HHS and DOJ extended the effective dates of two Biden Administration rules that will clarify when providers can prescribe select controlled substances to patients via telehealth. One rule pertains to Buprenorphine and other drugs used to treat opioid use disorder, the other to schedule II-V prescriptions by Veterans Affairs providers. The new effective date is Mar. 21, 2025.

6. SDOH: Funding for Medicaid waivers

HHS rolled back Biden Administration guidance that funded social drivers of health (SDOH) benefits in Medicaid and CHIP. Existing waivers may continue but the approval of future waivers is unclear. Medicaid waivers have become a proving ground for SDOH benefit expansion and could continue to be for even more enrollees. KFF reports that — even after the eligibility redeterminations that disenrolled more than 25 million people — overall Medicaid and CHIP enrollment is 10 million higher than before the COVID-19 pandemic.

7. Prevention and Prescription Drugs: ACA litigation and price negotiation

The Trump Administration is defending some Biden-era lawsuits. The most significant examples are the:

• ACA's preventive services coverage mandate, with a Supreme Court decision expected this summer
• Medicare drug price negotiation program, currently with the Third Circuit Court of Appeals.

The Administration is holding on other lawsuits, including those related to short-term, limited duration health insurance (STLDI). HealthLeaders previously covered the Obama-Trump-Biden do-si-do over STLDI term lengths and differing opinions about the effect these policies could have on the ACA Marketplace risk pool.

8. ACA: Navigator funding and the first Marketplace regulations

Speaking of the ACA, it will be one of the most closely watched healthcare policy areas of the second Trump Administration. Before last week, it was suspected though not yet known how Trump's "concepts of a plan" for U.S. healthcare coverage would play out. Now we know.

First was the announcement that HHS would significantly reduce funding for Marketplace and Medicaid navigators who help consumers select plans — from a Biden Administration annual high of $100 million to $10 million. Next came the first major healthcare regulation of Trump's second term, one that Health Affairs characterizes as a move to "restrict marketplace eligibility, enrollment, and affordability.

More on that next week as HealthLeaders digs into the HHS proposed Marketplace Integrity and Affordability rule.