Trump Likely to Undo Several of Biden’s Executive Orders on Health

Passing laws to overturn Democrats’ healthcare initiatives might take a while, but there are plenty of Biden administration health policies that the Trump administration may undo in relatively short order, according to health policy experts.

Membership in the World Health Organization (WHO) and participation in the Paris climate accords — two international groups Trump also withdrew the U.S. from in his first term and that Biden then reinstated — are two examples of Biden policies that Trump could rescind fairly quickly, Leighton Ku, PhD, MPH, director of the Center for Health Policy Research at George Washington University, said in a phone interview.

“Those are things Trump could go and turn around,” he said, adding that “The president has special powers relating to treaties and such … We know in general, it’s a relatively high priority on the president’s [agenda] to consider and revoke as many Biden policies as possible. Biden did the same thing to a lot of Trump policies.”

One other executive order that likely will be rescinded fairly quickly is the one about securing access to reproductive healthcare services, Michael Abrams, managing partner of the consulting firm Numerof & Associates, said in a phone call. “That’s a goner — that’s my nominee and the one most likely to be immediately rescinded, and that will not surprise anyone,” he said.

On the other hand, Trump will likely want his own version of the Biden executive order on strengthening access to high quality contraception and family planning services, Abrams said. “He’ll take it and make it over in a Republican format … Probably from the Republicans’ point of view, it needs to be about making supportive resources available for families who are looking for alternatives.”

There’s also an order on advancing biotechnology and biomanufacturing innovation that relates to the newly created Advanced Research Projects Agency for Health (ARPA-H). “In the 2 years since the signing [of the executive order], ARPA-H has barely gotten off the ground,” said Abrams. “I don’t think looking at government for innovation is going to make sense to Trump … There’s a good chance he’ll kill it. A lot of it is the government handing out grants to entrepreneurs who think they have a good idea, and I think from the Republicans’ point of view, those decisions need to be made by the market.”

Another Biden executive order was on strengthening Medicaid and the Affordable Care Act (ACA). “Trump holds no affection for the ACA but killing this would have negative public relations [consequences],” Abrams said. Instead, he thinks the president-elect will just let expire the enhanced premium subsidies, which will be in effect until the end of next year unless Congress renews them. The subsidies’ expiration “will make the ACA much less attractive, which is probably the goal he’s got … He doesn’t have to take any more heat for killing this thing.”

Executive orders aren’t the only tool that Trump has at his disposal, Ku said. “Some things may be doable in a subtler [way] — you don’t name a leader for a given agency, or you appoint someone as head who is well-known as a critic to that agency. That’s where I think he’d exert a lot more influence.”

“There’s the potential for rearranging many offices — if the office is created by statute, then the president can’t explicitly eliminate it but he could say, ‘I’m not naming anyone to head that agency’ and transfer all the staff away, so in principle the office could exist but no one is there,” Ku continued. One example of this is with HHS’s Office of the Assistant Secretary for Planning and Evaluation. “The office still exists but they gut the office — that has happened in multiple Republican administrations,” he said. And Robert F. Kennedy, Jr., who is rumored to be under consideration for a higher-up healthcare role in the administration — including possibly overseeing the FDA — “has said he’d like to do away with large parts” of that agency, he added.

The process of creating an executive order isn’t always a simple one, said Mark O’Gorman, PhD, professor of political science at Maryville College in Maryville, Tennessee. “If the executive order runs up against U.S. code or other regulations created by a department or agency, it becomes much more complex,” he said. “Think about trying to build a Jenga set — you have to keep stacking and unwinding. You’ll have to have extra meetings. The legal process has to kick in.” If, for instance, Trump’s executive order on a healthcare issue is rescinding one of Biden’s, “Is it [affecting] HHS? They’ll have to weigh in.”

A second layer of unwinding anything done by the previous administration or a previous Congress is political and economic. O’Gorman gave the example of the Inflation Reduction Act, which included hundreds of millions of dollars to create more climate-friendly manufacturing plants and processes.

“I know that the Trump administration is trying to think about a way to unwind some of that,” he said. “However, they probably will have limited success in stopping the implementation of these manufacturing plants, in no small part because the Republican congressmen in districts where these manufacturing plants are being built are already pushing back, saying, ‘Don’t stop the building. This is infrastructure; this is something that helps bring jobs to my district.'”

On the other hand, O’Gorman said he has heard that the Trump administration is interested in rolling back subsidies for energy reduction programs or implementing renewable energy. “That’s something that I think the Trump allies believe they can target well because all they’re dealing with there is cash. They’re not necessarily stopping a shovel-ready program or a building halfway through.”