Trump Executive Orders Explained

How has President Trump’s recent executive orders reshaped the US healthcare system? Below, I summarize the healthcare-related Executive Orders that were released this week:

• ACA premium subsidies will be reduced: Trump rescinded Biden’s executive order that led to longer enrollment periods for Affordable Care Act plans in most states. In short, in 2021, temporary subsidies were passed as part of the American Rescue Plan Act (ARPA). In 2022, the Inflation Reduction Act (IRA) extended these subsidies for an additional 3 years However, President Trump rescinded these additional subsidies.
• CMMI drug pricing models on hold. The Center for Medicare and Medicaid Innovation (CMMI) planned to implement 3 drug pricing models which aimed to cap out-of-pocket costs for generic drugs, lower reimbursement for drugs approved via expedited approvals, and implement outcomes-based contracts for cell and gene therapies. Additional details on these models is below.
• US withdraws from the World Health Organization. President Trump withdrew from the World Health Organization (WHO). Clearly this puts at risk international efforts to fight infectious disease. The Trump administration claims that these funds could be better used to fund health care in the U.S.
• Weakening COVID-19 pandemic preparedness. President Trump revoked several of former President Biden’s policies that were aimed at tackling the COVID-19 pandemic and preparing the country for future infectious disease outbreaks. 
• Rollback of Diversity, Equity and Inclusion (DEI) initiatives. AJMC reports that a recent “…Senate committee hearing emphasized the need for racial, ethnic, and gender diversity among providers for the best patient outcomes and trusted provider-patient relationships.” However, Trump’s executive orders have rolled back much of the current DEI efforts inside and outside of healthcare. It’s unclear if government data collection around DEI will also be paused.
• Federal health agency communication blackout. NBC reports that President Trump has requested a pause in federal health agency “public communications” through Feb. 1. NBC reports that “America’s health agencies, including the CDC, FDA and the NIH, routinely release information on food recalls, drug and medical device approvals, as well as updates on evolving public health threats including natural disasters and infectious diseases.” It’s unclear if this communication will continue over the next 10 days.
• Some IRA provisions remain intact. IRA initiatives related to patient cost sharing (e.g., $35 insulin cap, the $2000 annual cap on prescription drug costs) and Medicare’s drug price negotiation remain in place. 

For more information, STAT News and AJMC have additional information.

Recently Rescinded CMMI drug pricing models

• State Medicaid Programs for Costly Therapies: Allows states to pool resources for outcomes based contracting for cell & gene therapies
• Medicare Payments for Accelerated Approvals: Reduced payments for drugs granted FDA accelerated approval to incentivize confirmatory trials
• Flat $2 Co-pay for Generics: Encouraging Medicare drug plans to standardize and reduce co-pays for common generic medications