What a Trump presidency could mean for healthcare

Public health

During his campaign, Trump made a number of public health promises, including pledging to form a presidential commission to investigate the "stunning" rise in chronic illnesses, examining policy on food, environmental factors, federal healthcare agencies, and more.

Trump has also signaled that he intends to give Robert F. Kennedy Jr., a noted vaccine skeptic, a major healthcare-related role in his administration.

"I'm going to let him go wild on health," Trump said at a rally on Sunday. "I'm going to let him go wild on the food. I'm going to let him go wild on medicines."

For his part, Kennedy said that Trump promised him "control of the public health agencies," including HHS, CDC, FDA, NIH, and the U.S. Department of Agriculture.

However, Trump transition co-chair Howard Lutnick said days before the election that Kennedy would not be selected as HHS secretary, but added that he could oversee efforts to cut down the number of vaccines on the recommended schedule.

Kennedy previously said in a post on X that one of his top priorities would be "to clean up" public health agencies, which he said, "have become sock puppets for the industries they're supposed to regulate."

"FDA's war on public health is about to end," including its "aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can't be patented by Pharma," Kennedy said.

Kennedy has also said he wants more than half of NIH's budget devoted to "preventive, alternative, and holistic approaches to health."

In addition, Kennedy said over the weekend that if Trump was elected, he would advise communities to stop adding fluoride to their drinking water. Kennedy has described fluoride as "an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders and thyroid disease." When asked about the idea in an interview Sunday, Trump said the idea "sounds OK to me."

According to CDC, fluoride helps make teeth "stronger and more resistant to decay" and drinking fluoridated water "reduces cavities by about 25% in children and adults."

The president doesn't have the power to ban fluoride in drinking water outright, as drinking water is a matter of local control rather than federal.

Similarly, vaccine policies are set at the state level, but states often look to FDA to evaluate vaccine safety and CDC for guidance on what vaccines should be given and when. An appointed CDC director could reject the recommendations given by external advisors who review evidence for vaccines, which experts say would result in a loss of expertise that doctors and state health officials rely on.

"The number of questions that you would have the burden on a clinician to figure it all out, or even on a state body to figure it all out, would be pretty high," said Anne Schuchat, former principal deputy director of CDC.

"If [Kennedy] starts to muck around into the scientific, evidence-based process of how to assess safety and efficacy, he can do tremendous damage," said Anand Parekh, chief medical advisor at the Bipartisan Policy Center.

Health insurance

While it's unclear whether Congress would attempt to repeal and replace the Affordable Care Act (ACA) as they did in 2017 during Trump's first term, Vice President-elect JD Vance has suggested the Trump administration would make some changes to the ACA, including allowing insurers to divide enrollees into different risk pools and offer different plans based on those health risks.

A second Trump administration could also revive previous efforts to offer more short-term health plans, which were extended during Trump's first term and narrowed by President Joe Biden.

Trump could also use his executive authority to undercut the ACA or restrict access to it. For example, Trump could reduce the budget for "navigators," which are outreach professionals who help people find and enroll in health plans. Trump could also reverse Biden's executive order from January 2021 that was aimed at strengthening Medicaid and the ACA.

Regarding Medicare, Trump's campaign noted enhancements to Medicare Advantage (MA) during his time as president, such as increasing telehealth access and expanding supplemental benefits for seniors with chronic diseases.

It's unclear whether more control of Medicare will be given to private insurers, however Joe Albanese, a senior policy analyst at Paragon Health Institute, a right-leaning research group, said "a Trump administration and GOP Congress would be more friendly" to the idea.

Trump also introduced in the final days of his campaign a proposal to implement tax credits that would support long-term caregivers. While he hasn't provided details on the plan or his plan to "strengthen" Medicare and bring down costs, some Republican policy experts suggested costs could be managed by incentivizing more seniors to choose MA plans or changing the law to allow seniors to contribute to health savings accounts while they're enrolled in Medicare.

Reproductive care

During his campaign, Trump distanced himself from some calls for national abortion restrictions and said he would veto such a ban if it ever came to his desk.

For his part, Vance said Trump's position is that states should determine their own abortion policy "and of course, doctors are going to decide the safety of drugs."

However, abortion rights advocates have said there are a number of ways a Trump administration could narrow abortion access and reproductive care, such as through insurance coverage exemptions for religiously affiliated employers.

FDA could also revise guidance that allows the abortion pill mifepristone — which is used in a majority of abortions — to be sent to patients in the mail. Vance said that he supported the Supreme Court's decision in a recent case over mifepristone availability that anti-abortion doctors didn't have standing to sue FDA over its decision to make the drug more available. However, Trump has previously said he'd be open to restrictions on the drug.

Regarding in-vitro fertilization, Trump said during his campaign he would protect access to the procedure and added he would mandate insurance companies cover it.

Drug prices

Trump has previously said that he believes Americans pay too much for prescription drugs. He said that other developed nations are "freeloading" by paying much lower prices.

However, Trump has abandoned his previous most-favored nations proposal to lower drug costs, and it's not yet clear how he will work within the Inflation Reduction Act, which allows Medicare to directly negotiate drug prices.

Trump also made cracking down on pharmacy benefit managers (PBMs) a top priority during his first term, and several of those efforts, including a rule to eliminate rebates drugmakers pay to PBMs, either failed or were reversed by Biden. (Owermohle, STAT, 11/6; Mandavilli, New York Times, 10/31; Stolberg, New York Times, 11/4; Armour, KFF Health News/Modern Healthcare, 11/4; Owens, Axios, 11/3; Lebowitz, NBC News, 11/2; Smith/Robles, Inside Health Policy [subscription required], 11/6; Karins, Inside Health Policy [subscription required], 11/6; Wanneh, Inside Health Policy [subscription required], 11/6; Lawrence, STAT+ [subscription required] 11/6; Armour, KFF Health News, 11/6)

Join us for a discussion about the state of the healthcare industry heading into 2025. We will unpack what leaders should know about the biggest trends in the industry — from the shifts upending care utilization to the impact of the new administration on health policy. Then we will dig into what the future holds for health system strategy in a world of constant disruption, rising costs, and evolving patient demand. Finally, we’ll explore the cross industry power dynamics shaping provider networks, pharmacy competition, and harnessing shared healthcare data.