President Trump has started dismantling legislation introduced during the Biden administration, rolling back measures to expand Affordable Care Act (ACA) enrolment and to reduce drug prices for people covered by Medicare and Medicaid.
The ‘initial rescissions order’ – signed at the end of the first day of Trump’s new term – targets what it describes as “deeply unpopular, inflationary, illegal, and radical” policies introduced by Joe Biden.
Affordable Care Act
On the ACA – also known as Obamacare – Trump rescinded an executive order that extended enrolment windows, broadened eligibility criteria, and provided federal subsidies to reduce the cost of premiums and encouraged people to sign up for the programme. It also confirmed protections for patients with pre-existing conditions and beefed up non-discrimination policies in healthcare.
It is thought that around 24 million people signed up for health insurance via the ACA this year, and the impact of removing those incentives on enrolment into the ACA will be watched closely.
Democrats called the move an “attack” on the ACA, claiming that Trump’s priority is “ripping away affordable healthcare coverage for tens of millions of Americans and screwing over people with preexisting conditions.”
Drug pricing and Medicare
Another order halted ongoing pilot studies at the Centers for Medicare & Medicaid Services (CMS) that were testing payment and service delivery models for medicines.
The three studies – which have yet to get underway – were aimed at reducing prices to Medicare and Medicaid for drugs given accelerated approval by the FDA, looking at ways for the federal health insurance schemes to pay for expensive cell and gene therapies (CGT), and introducing a flat $2 copay for generic medicines used to treat common illnesses.
Artificial intelligence safeguards
A Biden executive order directing the Health and Human Services (HHS) department to develop safety, security, and equity standards for artificial intelligence, including in healthcare, has also been struck down.
The order required AI developers to share their algorithm training data with the federal government if they could pose a serious risk to public health and safety, and introduced a plan for “a safety programme to receive reports of – and act to remedy – harms or unsafe healthcare practices involving AI.”
Trump has so far not targeted any of Biden’s signature healthcare policies, including Medicare drug pricing negotiation powers, the $35 monthly cap on insulin copays, and the $2,000 annual cap on out-of-pocket spending on prescription drug costs.
More generally, the new policies also include the abandonment of diversity, equity, and inclusion measures in federal agencies – calling for all those who have been hired under those policies to be placed on leave as of this evening – along with proposals to impose a 10% tariff on goods entering the US from China from 1st February and – bizarrely – to rename the Gulf of Mexico the Gulf of America.
Meanwhile, more than 20 states have filed lawsuits against the executive order signed immediately after Trump’s inauguration that revoked automatic American citizenship for anyone born within US borders.
Trump’s executive order says: “It is the policy of the US to restore common sense to the federal government and unleash the potential of the American citizen. The revocations within this order will be the first of many steps the US federal government will take to repair our institutions and our economy.”
