President Trump began his second term Monday with a sweeping order aimed at reversing dozens of former President Biden’s top priorities, from regulations aimed at lowering health care costs, to coronavirus outreach, Affordable Care Act expansions, and protections against gender-based discrimination.
The “initial rescissions” order, signed in front of cheering crowds at the Capital One Arena, revokes dozens of Biden administration policies that the new White House called inflammatory, inflationary, and possibly illegal. They include an October 2022 order to test Medicare and Medicaid models that could lower health care costs, an extension, Biden said, of his administration’s signature achievement to negotiate drug prices in the Inflation Reduction Act.
Trump is also peeling back certain Biden administration efforts to expand access to Covid-19 treatments and vaccines, the 2021 formation of a Gender Policy Council, and multiple gender and sex discrimination protections. He ordered federal workers to return to their offices full time, and he froze federal hiring, with some exceptions.
Separately, Trump ordered the U.S. to begin the process of withdrawing from the World Health Organization, which he blames for mishandling the Covid-19 pandemic.
Trump’s broad proclamations, like any president’s executive orders, generally begin the process of regulations and rulemaking at federal agencies. The reversals could meet legal challenges or congressional intervention. Several of Biden’s orders were tied to laws passed by Congress.
Affordable Care Act
Trump rescinded Biden’s executive order that led to longer enrollment periods for Affordable Care Act plans in most states and extra funding for the third parties that help people enroll in ACA insurance. Those measures helped the Biden administration nearly double ACA enrollment to about 24 million people, though those gains were mostly due to the extra government subsidies that lowered the cost of ACA premiums.
Drug pricing
Trump also rescinded an executive order that prompted the Center for Medicare and Medicaid Innovation to create three drug pricing experiments that haven’t gotten fully off the ground yet.
The first model aimed to help state Medicaid programs pay for cell and gene therapies that are highly effective but expensive. The idea was to create multi-state purchasing agreements that would allow states to not pay for drugs if they were ineffective.
CMMI has started the process of enrolling states in the pilot program, and the application is supposed to be open through Feb. 28.
The second experiment tests having Medicare pay less for drugs that receive accelerated approvals from the Food and Drug Administration. Accelerated approvals make promising drugs available to patients sooner, before it’s fully proven that the medicines actually work. The reduced payments would, theoretically, incentivize drugmakers to finish studying the medicines through confirmatory trials.
The final pilot project is designed to encourage Medicare prescription drug plans to offer generic drugs for common chronic conditions for a flat, $2 copay. The goal was to standardize copays for generic drugs and encourage patients to continue taking medications.
The expected pick to run CMMI under the Trump administration is former White House and Department of Health and Human Services aide Abe Sutton.
Covid-19
Trump revoked several Biden policies aimed at tackling the Covid-19 pandemic and preparing the country for future infectious disease outbreaks. All were issued in 2021 in the midst of the crisis, and were meant to bolster Covid-19 testing, research into treatments, provide economic relief, and enhance cooperation with other countries in the event of another pandemic.
Gender and sex discrimination
The president, as he’d promised on the campaign trail and during his inauguration speech, also targeted a number of health and education policies that establish protections for LGBTQ+ people and transgender individuals in particular.
“It will henceforth be the official policy of the United States government that there are only two genders, male and female,” Trump said during his inauguration speech.
The orders rescinded on Monday include a 2022 policy against discriminating against people on the basis of sexual or gender identity that ordered support for LGBTQ+ students and instructed officials to end programs promoting so-called conversion therapy both domestically and internationally. Trump similarly rescinded orders from Biden to promote protections on the basis of sex and gender identity in schools.
Trump also axed a 2021 Biden order to establish the Gender Policy Council, initially chaired by Jennifer Klein, an Obama and Clinton administration alum.