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WASHINGTON — President Trump began his second term Monday with a sweeping executive order aimed at undoing dozens of former President Biden’s top priorities, from regulations aimed at lowering health care costs to the spread of the coronavirus, expansions of the Affordable Care Act and protections against gender-based discrimination.
The “first repeal order,” signed before cheering crowds at Capital One Arena, rescinds dozens of Biden administration policies that the new White House called inflammatory, inflationary and possibly illegal. They include an order from October 2022 to test Medicare and Medicaid models that could lower health care costs, an extension, Biden said, of his administration’s signature achievement of negotiating drug prices in the Inflation Reduction Act.
Trump is also scrapping certain Biden administration efforts to expand access to Covid-19 treatments and vaccines, the 2021 creation of a Gender Policy Council and multiple gender and sex discrimination protections. He ordered federal employees to return to their offices full-time, and he froze federal hiring, with few exceptions.
In addition, Trump ordered the US 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, typically begin the process of rulemaking and rulemaking at federal agencies. The reversals could face 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Trump rescinded Biden’s executive order that led to longer enrollment periods for Affordable Care Act plans in most states and additional funding for the third parties that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, although those gains were mainly due to the additional 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Trump also rescinded an executive order that prompted the Center for Medicare and Medicaid Innovation to set up three drug pricing experiments that have not yet fully gotten off the ground. It is unclear whether CMMI will continue to pursue them under the new administration.
The first model was intended 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 prevent states from paying for drugs if they were ineffective.
CMMI has begun enrolling states in the pilot program, and applications should be open through February 28.
The second experiment will test whether Medicare pays less for drugs that receive accelerated approval from the Food and Drug Administration. Accelerated approvals ensure that promising drugs are available to patients more quickly, before the drugs are fully proven to work. The lower payments would, in theory, encourage drugmakers to complete research on the drugs through confirmatory trials.
The latest pilot project aims to encourage Medicare prescription drug plans to offer generic drugs for common chronic conditions for a flat fee of $2. The goal was to standardize generic drug copays and encourage patients to take medications to continue using.
The expected choice to lead CMMI under the Trump administration is former White House and Department of Health and Human Services aide Abe Sutton.
COVID-19
Trump has rescinded several of Biden’s policies aimed at tackling the Covid-19 pandemic and preparing the country for future infectious disease outbreaks. All were issued in 2021, in the middle of the crisis, and were intended to support Covid-19 testing, research treatments, provide economic relief and improve cooperation with other countries in the event of a new pandemic .
Gender and sex discrimination
The president also focused, as he promised during his campaign and during his inauguration speech, on a number of health and education policies that provide protections for LGBTQ+ people and transgender people 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 Monday include a 2022 policy against discriminating against people based on sexual or gender identity, ordering support for LGBTQ+ students and instructing officials to end programs that promote so-called conversion therapy, both nationally and internationally . Trump similarly rescinded Biden’s orders to promote protections based on sex and gender identity in schools.
Trump also scrapped a 2021 Biden order to create the Gender Policy Council, initially chaired by Jennifer Klein, an alum of the Obama and Clinton administrations.