How Trump’s Agenda 47, plus Project 2025, offer clues into possible health-care policy changes

November 14, 2024 ndowd

Much remains to be seen, but clues aplenty can be found not only in advisor Robert F. Kennedy Jr.’s promises to help Trump “Make America Healthy Again,” but in Trump’s own Agenda 47 and in Project 2025, the Heritage Foundation’s 500-page conservative policy plan to reshape the federal government. Because while Trump has distanced himself from the latter, he shares numerous ties with its architects, many of whom worked in his last administration and on his transition team or campaign.

Below, a glimpse into what might be in store for the U.S., health-wise, according to these two documents.

Trump may ban abortion pills and so-called “abortion tourism”

Without getting specific, the Trump administration says it “will oppose late term abortion,” according to the official GOP platform that Trump’s website links to through his brief Agenda 47 points. It will do this, it says, “while supporting mothers and policies that advance prenatal care, access to birth control, and IVF (fertility treatments).”

Project 2025 goes further, suggesting that the Centers for Disease Control and Prevention should stop “promoting abortion as health care,” and that all research and vaccine-creation involving embryonic stem cells or fetal cells “be prohibited as a matter of law and policy” (several vaccines are made by growing viruses in fetal embryo cells from tissue obtained by legally aborted fetuses). It also wants the Department of Health and Human Services to accurately report “exactly how many abortions take place within its borders, at what gestational age of the child, for what reason, the mother’s state of residence, and by what method.” This, it explains, is because “liberal states have now become sanctuaries for abortion tourism,” using a conservative talking-point phrase to refer to the 171,000 women who had to cross state borders to either have an abortion or obtain abortion pills in the wake of Roe v. Wade being overturned.

Further, the document calls for the FDA to reverse its approval of abortion pills and to stop “mail-order abortions,” and to prohibit Planned Parenthood from receiving Medicaid funds, stating that “abortion is not health care.” The American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization, though, disagree, calling abortion an “essential” part of health care.

Trump wants to further restrict the rights of transgender individuals

“Republicans will end left-wing gender insanity,” promises Agenda 47. “We will keep men out of women’s sports,” a reference to transgender women and girls being included in sports that align with their gender identity, “ban taxpayer funding for sex change surgeries,” which would end life-saving treatment for transgender individuals who rely on the state for care, and “stop taxpayer-funded schools from promoting gender transition.” That could mean anything from allowing students to use the bathroom that aligns with their gender identity to allowing teachers or counselors to consult with children about their gender identity without alerting parents, to prevent unwanted disclosures.

Trump promises to cut federal funding for any school “pushing… radical gender ideology,” which, as GLAAD explains, “is a malicious rhetorical construct that falsely asserts that LGBTQ—notably trans—people are an ideological movement rather than an intrinsic identity,” and that the term is “just one example of anti-LGBTQ online hate and disinformation.”

Further, Trump says he will “reverse Biden’s radical rewrite of Title IX Education Regulations,” referring to new policy, which went into effect in August, that expands Title IX civil rights protections to LGBTQ students, expands the definition of sexual harassment at schools and colleges, and adds safeguards for victims.

Agenda 47 also says Trump will ask Congress to pass a bill ensuring the U.S. government only recognizes two genders—male and female, both assigned at birth. He says he will also investigate “Big Pharma” and “big hospital networks” to see if they illegally marketed hormones and puberty blockers—both used in gender-affirming care for minors with gender dysphoria, the latter as an off-label use that’s reversible—”which are in no way licensed or approved for this use.” But, while it’s true that puberty blockers (used for decades to treat “precocious,” or early, puberty) are not approved for use in gender-affirming care, off-label uses of drugs are legal and common. Gender-affirming care for minors—despite being endorsed by the American Academy of Pediatrics, the Pediatric Endocrine Society, and the American Psychological Association—is currently banned or severely limited in 20 states.

Seniors could face more expensive Medicare

Trump says he “will not cut one penny from Medicare,” and will work with seniors “in order to allow them to be active and healthy.”

While Project 2025 doesn’t propose cuts to Medicare, some of its proposals may increase costs for beneficiaries—including a proposal to make Medicare Advantage the default plan, ending the Medicare Part D price negotiation program and effectively privatizing the program. Critics of that plan, including the Center for Economic and Policy Research (CEPR), say there’s not sufficient evidence that Medicare Advantage delivers better outcomes for patients than traditional Medicare. (Regarding Medicaid, Project 2025 proposes cuts but doesn’t call for its full elimination.)

Trump, through the GOP platform, pledges to “protect seniors” and support “increased focus on chronic disease prevention and management, long-term care, and benefit flexibility.” Further, notes the platform, “We will expand access to primary care and support policies that help seniors remain in their homes and maintain financial security, shifting resources into “at-home senior care,” support the end of care worker shortages, and support unpaid family caregivers with tax credits.

Trump wants to end to drug shortages, with more accountability for “Big Pharma” and the CDC

Trump, through his agenda, pledges to end pharmaceutical shortages and “return the manufacture of life-saving drugs to the United States” by restoring his 2020 Executive Order 13944. “American doctors should never have to give a patient a drug from an unapproved facility in China or India,” he notes on his website. “We can and must produce these essential medicines at home.”

Further, Trump wants to hold the pharmaceutical industry accountable for chronic childhood illness—and while he does not get more specific. Trump also says he’ll hold the pharmaceutical industry responsible for drug addiction, especially the opioid crisis.

Project 2025 wants to lower prescription drug costs. “Specifically,” it notes, “the FDA should prohibit pharmaceutical companies from purposely sitting on their legally available right to be the first to sell generic versions of their drugs.” This apparently refers to the practice, by brand-name pharmaceutical manufacturers, of seeking “to delay generic competitors from entering the market,” according to the Commonwealth Fund, a nonprofit that aims to improve U.S. health care. “Strategies include obtaining and listing additional patents on their drugs with the Food and Drug Administration (FDA), engaging in strategic settlements of patent litigation, and restricting generic manufacturers’ access to drug samples.”

It also says it aims to disentangle the CDC from what it says has been a practice of accepting pharmaceutical contributions, since the ’90s, through the “loophole” of the nonprofit CDC Foundation.

“The money started flowing immediately: From 2014 through 2018, the CDC Foundation received $79.6 million from pharmaceutical corporations like Pfizer, Biogen, and Merck,” notes the policy plan. “This practice presents a stark conflict of interest that should be banned.”