Fact check: Can Trump really erase Biden’s ‘health legacy’?

United States President Donald Trump’s early actions on healthcare signal his likely intention to wipe away some Biden-era programmes to lower drug costs and expand coverage under public insurance programmes.

The orders he issued soon after re-entering the White House have policymakers, healthcare executives and patient advocates trying to read the tea leaves to determine what’s to come. The directives, although less expansive than orders he issued at the beginning of his first term, provide a possible road map that health researchers say could increase the number of uninsured Americans and weaken safety net protections for low-income people.

However, Trump’s initial orders will have little immediate impact. His administration will have to take further regulatory steps to fully reverse Biden’s policies, and the actions left unclear the direction the new president aims to steer the US healthcare system.

“Everyone is looking for signals on what Trump might do on a host of health issues. On the early EOs [executive orders], Trump doesn’t show his cards,” said Larry Levitt, executive vice president for health policy at KFF, the health policy research, polling and news organisation that includes KFF Health News.A flurry of executive orders and other actions Trump issued on his first days back in office included rescinding directives by his predecessor, former President Joe Biden, that had promoted lowering drug costs and expanding coverage under the Affordable Care Act and Medicaid.During Biden’s term, his administration did implement changes consistent with his health orders, including lengthening the enrolment period for the ACA, increasing funding for groups that help people enrol and supporting the Inflation Reduction Act, which boosted subsidies to help people buy coverage. After falling during the Trump administration, enrolment in ACA plans soared under Biden, hitting record highs each year. More than 24 million people are enrolled in Affordable Care Act plans for 2025.

The White House did not respond to a request for comment.

Biden’s experiments in lowering drug prices did not fully get off the ground, said Joseph Antos of the American Enterprise Institute, a right-leaning research group. Antos said he’s a bit puzzled by Trump’s executive order ending the pilot programmes, given that he has backed the idea of tying drug costs in the US to lower prices paid by other nations.

“As you know, Trump is a big fan of that,” Antos said. “Lowering drug prices is an easy thing for people to identify with.”In other moves, Trump also rescinded Biden’s orders on racial and gender equity and issued an order asserting that there are only two sexes, male and female. HHS under the Biden administration supported gender-affirming healthcare for transgender people and provided guidance on civil rights protections for transgender youths. Trump’s missive on gender has intensified concerns within the LGBTQ+ community that he will seek to restrict such care.“The administration has forecast that it will fail to protect and will seek to discriminate against transgender people and anyone else it considers an ‘other’,” said Omar Gonzalez-Pagan, senior counsel and healthcare strategist at Lambda Legal, a civil rights advocacy group. “We stand ready to respond to the administration’s discriminatory acts, as we have previously done to much success, and to defend the ability of transgender people to access the care that they need, including through Medicaid and Medicare.”

Trump also halted new regulations that were under development until they can be reviewed by the new administration. He could abandon some proposals that were yet to be finalised by the Biden administration, including expanded coverage of anti-obesity medications through Medicare and Medicaid and a rule that would limit nicotine levels in tobacco products, Katie Keith, a Georgetown University professor who was deputy director of the White House Gender Policy Council under Biden, wrote in an article for Health Affairs Forefront.

“Interestingly, he did not disturb President Biden’s three executive orders and a presidential memorandum on reproductive health care,” she wrote.

However, Trump instructed top brass in his administration to look for additional orders or memorandums to rescind. (He revoked the Biden order that created the Gender Policy Council.)

Democrats criticised Trump’s health actions. A spokesman for the Democratic National Committee, Alex Floyd, said in a statement that “Trump is again proving that he lied to the American people and doesn’t care about lowering costs – only what’s best for himself and his ultra-rich friends”.Trump’s decision to end a Biden-era executive order aimed at improving the Affordable Care Act and Medicaid probably portends coming cuts and changes to both programmes, some policy experts say. His administration previously opened the door to work requirements in Medicaid – the federal-state programme for low-income adults, children, and disabled people – and previously issued guidance enabling states to cap federal Medicaid funding. Medicaid and the related Children’s Health Insurance Program cover more than 79 million people.

“Medicaid will be a focus because it’s become so sprawling,” said Chris Pope, a senior fellow at the Manhattan Institute, a conservative policy group. “It’s grown after the pandemic. Provisions have expanded, such as using social determinants of health.”

The administration may re-evaluate steps taken by the Biden administration to allow Medicaid to pay for everyday expenses some states have argued affect its beneficiaries’ health, including air conditioners, meals and housing.

One of Trump’s directives orders agencies to deliver emergency price relief and “eliminate unnecessary administrative expenses and rent-seeking practices that increase healthcare costs”. (Rent-seeking is an economic concept describing efforts to exploit the political system for financial gain without creating other benefits for society.)

“It is not clear what this refers to, and it will be interesting to see how agencies respond,” Keith wrote in her Health Affairs article.

Policy experts like Edwin Park at Georgetown University have also noted that, separately, Republicans are working on budget proposals that could lead to large cuts in Medicaid funding, in part to pay for tax cuts.

Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a left-leaning research group, also pointed to Congress: “On one hand, what we see coming from the executive orders by Trump is important because it shows us the direction they are going with policy changes. But the other track is that on the Hill, there are active conversations about what goes into budget legislation. They are considering some pretty huge cuts to Medicaid.”