Health Policy in Flux: Trump Administration Updates

Additional reporting by: Pearl Steinzor, Julia Bonavitacola, Hayden Klein, Kyle Munz, Christina Mattina, Brooke McCormick, and Mary Caffrey.

February 25: House Passes Budget Resolution Cutting Billions From Medicaid Funding

The US House of Representatives narrowly passes a budget resolution (H Con Res 14, 119th Congress) that includes significant Medicaid cuts, advancing a Republican-led plan in a 217-215 vote. If enacted, the resolution would reduce Medicaid funding by approximately $880 billion over the next decade as part of a broader GOP effort to achieve $4.5 trillion in tax cuts. Following hours of debates, House leaders announced the proceedings were postponed, halting the vote for close to 90 minutes as representatives worked to sway stances at the last minute to secure the last 2 votes needed. The delay, which stretched well beyond the customary window of time, was met with calls for "regular order" from the packed floor, highlighting the challenges in locking down support for the Medicaid-cutting measure. With fewer than 20 votes left to cast, 1 of the 2 recorded Republican "nay" votes shifted to "yea" moments later.

February 21: Trump Administration’s Message to Supreme Court Puts New Wrinkle in Braidwood Case

The Braidwood Management v Becerra lawsuit is at the forefront of ongoing legal challenges to the Affordable Care Act's (ACA’s) requirement for private insurers to cover preventive services without cost sharing. Initially, the lawsuit contended that religious beliefs exempt them from covering services like HIV pre-exposure prophylaxis (PrEP) mandated by the ACA.

The case questions the authority of the US Preventive Services Task Force (USPSTF) to dictate covered services without Senate appointment, and has been elevated to the Supreme Court. The Trump administration's recent brief, aligning with Biden-era arguments, asserts that Robert F. Kennedy Jr's oversight suffices for USPSTF decisions, potentially influencing service coverage mandates. The outcome's implications span public health and insurance requirements, affecting numerous preventive services nationwide, pending the court's decision amid evolving administrative stances.

5 Key Health Care Moments During President Trump's First Month Back in Office

During his first month back in office, President Trump enacted significant health care changes, signaling a sharp policy shift:

• Trump issued executive orders reversing Biden-era policies, including scaling back ACA provisions, rescinding CMS drug pricing initiatives, and withdrawing from the World Health Organization (WHO)
• Although a federal grant freeze ordered on January 27 was reversed 2 days later after federal judges blocked it, the concerns it raised about Medicaid funding linger, leaving states uncertain about future federal support
• FDA draft guidance on clinical trial diversity disappeared from the federal website following Trump’s executive order cutting diversity, equity, and inclusion (DEI) programs for more than a week before a court order required its restoration
• The Senate confirmed RFK Jr as HHS secretary in a near-party-line vote
• On February 19, the president signed an executive order to expand in vitro fertilization (IVF) access by reducing costs, but its implementation remains unclear, particularly for LGBTQ+ individuals, following rollbacks of federal DEI protections

February 20: Trump Endorses Budget That Would Slash Medicaid Funding

President Trump endorses a House Republican budget that includes $880 billion in cuts to Medicaid, highlighting the administration’s inconsistent stance on Medicaid and Medicare. Previously, he assured that funding would not be reduced. The proposed cuts could shift financial burdens to the states, jeopardizing coverage for millions, mainly rural and low-income populations, and affecting pediatric health care. States are already seeking approval to impose work requirements, which could further limit access. Additionally, the cuts would affect hospitals, community health centers, and nursing homes, potentially exacerbating staff shortages and facility closures. While the House budget aligns with Trump’s broader policy goals, Senate Republicans are expected to propose an alternative budget, setting up a political battle over the future of Medicaid funding.

February 19: Trump Signs Executive Order Aimed at Expanding IVF

The president signs an executive order aimed at expanding access to IVF by lowering costs and removing barriers, acknowledging the financial and emotional burden infertility places on families. The order calls for policy recommendations within 90 days to reduce out-of-pocket expenses but does not establish new rights or guarantees, leaving implementation dependent on existing laws and funding. The move follows legal debates over embryo rights and Trump’s campaign promise of free IVF coverage, although critics, including Democratic lawmakers, argue the order lacks substantive action and fails to ensure affordability. Additionally, concerns remain over whether LGBTQ+ individuals will benefit, given existing barriers to fertility care and Trump’s rollbacks on protections for transgender individuals and diversity initiatives.

February 13: Robert F. Kennedy Jr Confirmed as HHS Secretary, Nearly Along Party Lines

The Senate confirms Robert F. Kennedy Jr as HHS secretary in a 52-48 vote, following intense hearings that highlight his controversial stance on vaccines, lack of a clear plan for Medicare and Medicaid, and shifting abortion views. Although some Republicans hesitated, most backed him, except Senator Mitch McConnell (R, Kentucky), a polio survivor critical of Kennedy’s vaccine skepticism. Kennedy resigned from his antivaccine nonprofit and pledged transparency but continued citing flawed studies on vaccine safety. His nomination, initially met with mixed reactions, was ultimately advanced with commitments to healthier food policies and a “pro-American agenda.” Now confirmed, Kennedy faces major health care challenges, including clinical trial diversity, drug pricing, and health care access.

February 4: RFK Jr Confirmation for HHS Secretary Advances to Full Senate After Committee Votes

The Senate Finance Committee voted 14-13 along party lines to advance Robert F. Kennedy Jr’s nomination for HHS Secretary to the Senate floor, despite significant controversy surrounding his history of spreading misinformation on vaccines and public health. Kennedy faced tough questioning during his confirmation hearings, particularly regarding his policy knowledge and financial ties to vaccine litigation through the WisnerBaum law firm. Senators Elizabeth Warren (D, Massachusetts) and Ron Wyden (D, Oregon) raised concerns over potential conflicts of interest, arguing that Kennedy’s role could financially benefit his family. A pivotal vote came from Senator Bill Cassidy, MD (R, Louisiana), who, despite skepticism about Kennedy’s antivaccine stance, supported the nomination after securing commitments from the administration on shared policy priorities. With Republicans holding a 53-47 majority, Kennedy’s fate rested with the full Senate.

Braidwood Case Headed to Supreme Court, Coverage for Preventive Care in Jeopardy

Alterations to preventive care coverage may be in the cards as the Braidwood Management v Becerra case makes its way to the Supreme Court this year. HIV and oncology treatments are just a few preventive services at risk of being stripped from ACA mandates that all federally qualified health plans cover certain services at zero cost sharing. In 2023, Judge Reed O'Connor's ruling questioned the federal authority of the USPSTF to mandate coverage. With the impending Supreme Court hearing scheduled for April, it is possible that O’Connor's ruling will be upheld, rolling back requirements for coverage and affecting numerous preventive services added since 2010, despite assurances that insurers might still cover.

February 3: OIG Report Seeks Better Oversight, Records for FDA’s Accelerated Approvals

In the waning days of the Biden administration, a report from HHS' Office of the Inspector General (OIG) called for greater accountability of the FDA’s accelerated approval pathway, including better documentation of meetings between FDA staff and drug sponsors and “guardrails” that would flag when an accelerated approval council should weigh in on applications. The HHS OIG report, issued January 14, 2025, is being overshadowed by the uproar over President Trump’s firing of 18 inspectors general (IGs) across the federal government. The dismissals came without the required 30-day notice to Congress and included HHS IG Chrisi Grimm, who joined the office in 1999 and had led it since 2022. Most of the work of the OIG involves oversight of Medicare and Medicaid; its December 2024 report to Congress estimated audits would result in a recovery of $7.13 billion.

FDA Quietly Removes Draft Guidance on Diversity in Clinical Trials Following Executive Order on DEI

The FDA’s removal of draft guidance on diversity in clinical trials, following President Trump’s executive order restricting DEI programs and federal recognition of gender identity, sparks concern about the agency’s stance on clinical trial diversity requirements. The deleted guidance, initially released in June 2024, outlines Diversity Action Plans aimed at improving representation in clinical studies, detailing enrollment goals by race, ethnicity, sex, and age.

With the statutory deadline for final guidance approaching in June 2025, sponsors now face uncertainty regarding compliance expectations. The move raises broader concerns about the administration’s commitment to diversity in clinical research, particularly given historical disparities in trial participation. Industry stakeholders and policy makers now await clarification on whether the FDA will uphold its prior commitments or further shift regulatory priorities.

5 Key Takeaways From RFK Jr’s Confirmation Hearings

This week, Robert F. Kennedy Jr sat before the Senate for 2 hearings to decide the fate of his confirmation as HHS secretary. If confirmed, he would lead a federal agency responsible for overseeing the health care of millions of Americans, regulating access to drugs and vaccines, and managing disease outbreaks.

• He was questioned on his contributions to widespread vaccine misinformation, including vaccines for measles, polio, and COVID-19; in both hearings, he stated that he supports the use of vaccines, contrary to previous public statements he’s made
• He failed to acknowledge scientific evidence, including well-documented studies showing there is no link between vaccination and autism in children, and stumbled to provide clear answers when grilled about his role in perpetuating vaccine hesitancy during the 2019 measles outbreak in American Samoa, which led to more than 5700 cases and 83 deaths; Cassidy criticized him for having a financial interest in undermining vaccines
• His conflicting stances on abortion care has have been a growing topic of discussion leading up to the hearings, where he stated he will align with Trump’s position, that the issue should be left to the states, m,rkina marking g a drastic shift from his presidential campaign when he advocated for reproductive rights that directly conflicted with Trump’s policies
• DEI and equity concerns brought heated conversations as his past remarks suggesting Black Americans should follow a different vaccine schedule than White Americans were addressed; Kennedy defended his claim by citing studies on immune response variations by race, but experts, including Richard B. Kennedy, PhD, of Mayo Clinic, refuted the interpretation, stating that such data do not justify altering vaccine schedules
• The candidate demonstrated an unclear grasp of the distinctions between Medicaid, Medicare, and Medicare Advantage, particularly regarding their funding and structure, prompting senators to provide clarification throughout the session; if confirmed, Kennedy will oversee a $1.7 trillion agency responsible for multiple federal health programs and that administers government-funded health care for millions of Americans, including seniors, individuals with disabilities, and low-income patients who depend on Medicare, Medicaid, and the ACA marketplaces

January 29: RFK Jr Fails to Offer a Clear Medicaid, Medicare Strategy

During his confirmation hearing before the Senate Finance Committee, Kennedy faced scrutiny over his health care policy positions, particularly regarding Medicare and Medicaid. Cassidy pressed Kennedy on his plans for reforming Medicaid and integrating care for dual-eligible individuals, to which Kennedy acknowledged systemic issues but admitted he lacked a concrete strategy.

While advocating for transparency, value-based care, and innovations like telemedicine, Kennedy criticized Medicaid's inefficiencies but stopped short of proposing major cuts. Senator Maggie Hassan (D, New Hampshire) defended Medicaid's role in supporting vulnerable populations and offered corrections to remarks Kennedy mistakenly made regarding key functions of the programs' funding. Senator Mark Warner (D, Virginia) challenged Kennedy over his support of Trump's now-reversed federal funding freeze. Kennedy also addressed broader health concerns, including chronic disease and industry transparency, while facing bipartisan scrutiny over his past vaccine-related statements.

January 28: Trump’s Federal Grant Freeze Threatens Medicaid Funding

The Trump administration's freeze on federal financial assistance raises concerns among health care experts and state officials, particularly regarding its impact on Medicaid funding. Although the White House clarified that individual assistance programs like Medicare and Social Security are unaffected, Medicaid is not explicitly protected, leaving states uncertain about continued federal matching funds. The Office of Management and Budget's directive halts grant payments pending review, with no timeline for lifting the pause. In response, attorneys general from states like New York and California are planning legal action, arguing that the freeze threatens critical health care funding and could force states to cut services or delay provider payments. The lawsuit, backed by Senate Majority Leader Chuck Schumer (D, New York), aims to block what officials call an unconstitutional disruption of funds already approved by Congress.

January 23: Kennedy Reveals Key Decisions in Ethics Report as Confirmation Hearing Looms

Kennedy'a confirmation hearing for HHS secretary is set for January 29, with scrutiny over his financial interests and past vaccine skepticism potentially influencing the Senate’s decision. Although Kennedy has pledged to stop collecting fees from vaccine lawsuits involving the US government, he plans to retain a financial stake in a lawsuit against Merck’s vaccine against human papillomavirus, raising concerns about conflicts of interest. His past leadership in an antivaccine nonprofit and earnings from vaccine-related lawsuits—totaling over $2.5 million in recent years—are expected to be key points of contention. Additionally, Kennedy has agreed to terminate consulting agreements with law firms and divest from certain companies. The Senate will likely focus on his financial ties and past affiliations during the hearing, which could shape his chances of confirmation.

January 22: Executive Orders Suggest Swift Pivot in Managed Care and Health Policy

In his first actions as the 47th president, Donald Trump reversed several Biden-era health policies, including rescinding ACA enrollment expansions, withdrawing from the WHO, and halting drug pricing initiatives. Trump's rollback of ACA provisions, which had significantly increased enrollment and improved health outcomes for low-income individuals, threatens coverage and financial benefits for vulnerable populations. His elimination of 3 Center for Medicare and Medicaid Innovation (CMMI) drug pricing models halts planned reforms targeting cost reductions for generics and innovative therapies. The WHO withdrawal drew backlash for undermining global health surveillance, and the dismantling of pandemic preparedness efforts and DEI initiatives raised alarm among experts advocating for health equity.

Trump Reverses Some Biden Drug Pricing Initiatives, Potentially Impacting Medicare Costs

Trump’s second-term health care agenda is centered on reversing several Biden-era policies, including efforts to reduce prescription drug costs, expand the ACA, and strengthen Medicaid protections. Although Trump’s executive orders immediately rolled back initiatives such as extended ACA enrollment periods and experimental drug pricing models, experts suggest these changes will have little immediate impact on out-of-pocket costs for most Americans. Notably, key Biden policies—such as Medicare’s $35 insulin cap, $2000 annual out-of-pocket cap for Part D drugs, and drug price negotiations—remain intact, although Trump’s stance on their future is uncertain. The reversal of drug pricing pilots signals a potential shift in Trump’s health care priorities, raising questions about his commitment to addressing high health care costs. Experts suggested his approach may lean toward limiting government intervention while still acknowledging the need for cost control.