Fact-Checking Trump's Ability to Erase Biden’s Health Legacy: What’s at Stake?

President Donald Trump's recent executive orders signal his intent to reverse many of Biden's healthcare initiatives, but significant obstacles remain. Here’s what you need to know about the implications and feasibility of dismantling Biden's "health legacy."

Key Highlights of Trump’s Early Healthcare Moves:

1. Targeting Biden’s Drug Cost Measures:

   • Biden’s administration promoted initiatives like $2 copays for some Medicare drugs and state collaboration to lower costs on expensive treatments.
   • Trump rescinded these experimental programs, but he hasn’t proposed alternatives yet.
   • Lowering drug costs remains popular with voters, making Trump’s moves politically risky.

2. Revisiting Medicaid Expansion and ACA Coverage:

   • Biden expanded Medicaid and ACA enrollment, reaching record levels of over 24 million people in ACA plans for 2025.
   • Trump previously supported Medicaid work requirements and capped federal funding for states. He may revisit such cuts.

3. Gender and Racial Equity Rollbacks:

   • Trump rescinded Biden’s orders supporting gender-affirming care and racial equity in healthcare.
   • LGBTQ+ advocates are concerned about reduced protections and access to transgender healthcare.

4. Broader Regulatory Freeze:

   • Trump halted new rules under development by the Biden administration, including expanding Medicare coverage for anti-obesity drugs and reducing nicotine levels in tobacco.

Barriers to Immediate Change:

• Regulatory Process: Significant reversals require lengthy rule-making procedures and public commentary periods.
• Congressional Approval: Medicaid reforms or funding cuts often need Congressional support, where Trump faces opposition from Democrats and some moderate Republicans.
• Legal Challenges: Advocacy groups have a history of successfully challenging Trump-era healthcare changes in court.

Potential Outcomes for Biden’s Health Policies:

• Biden’s expanded ACA subsidies and Medicaid provisions may face scaling back if Trump’s administration reduces federal funding or reinstates work requirements.
• Drug pricing negotiations under Medicare could be deprioritized or reversed entirely.
• Protections for marginalized groups (racial minorities, transgender individuals) may erode, based on Trump’s executive orders and policy focus.

Critiques and Responses:

• Democratic Perspective: Democrats argue Trump’s actions prioritize the wealthy at the expense of low-income Americans. Medicaid cuts, in particular, could impact over 79 million people.
• Republican Perspective: Conservative think tanks like the Manhattan Institute highlight concerns about Medicaid’s growing scope post-pandemic, with debates over funding non-medical determinants of health, such as housing or air conditioning.
• Expert Opinions:
  • Larry Levitt (KFF): Early actions provide few concrete answers about Trump’s overall healthcare agenda.
  • Nicholas Bagley (University of Michigan): Executive orders are more symbolic without concrete follow-through.