How a second Trump presidency could reshape US public health

Unlike immigration and the economy, health care was not a leading topic for Donald Trump during his 2024 campaign.
However, experts say many health-related policies he’s touched on at rallies, town halls and media interviews over the past few months could reshape the U.S. public health system.
That’s if the new administration can figure out how to implement them, said Stephanie Kennan, a former congressional staffer who worked on health policy for more than 25 years.
“There’s a lot of ideas floating around,” said Kennan, senior vice president of federal public affairs at McGuireWoods Consulting. But she said none had “gelled” or have been “worked through.”
Here are some of his proposed policies and how they could affect Americans in the next four years.
Although Trump frequently mentions his role in overturning Roe v. Wade, the president-elect has said he does not support a federal abortion ban.
“Everyone knows I would not support a federal abortion ban, under any circumstances, and would, in fact, veto it, because it is up to the states to decide based on the will of their voters (the will of the people!)” he wrote on X, formerly Twitter, on Oct. 1.
Trump has tried to distance himself from Project 2025, a policy blueprint released by the Heritage Foundation, a conservative think tank. The document says the Food and Drug Administration should reverse its approval of mifepristone, the drug used in almost two-thirds of abortions in the U.S. In August, Trump said he would not rule out taking away access.
Trump also said on the social media platform X that his administration will be “great for women and their reproductive rights.”
He vowed to protect in-vitro fertilization, or IVF, a medical procedure that helps people with fertility problems.
During interviews, Trump referred to a February ruling by the Alabama Supreme Court that said embryos created during IVF are “extrauterine children” and must be legally protected like any other child. The ruling sparked panic among families and at facilities across the country, with some temporarily pausing IVF procedures in fear of the decision’s implications.
At a town hall with Fox News moderator Harris Faulkner that was aimed at women, Trump said he was the “father of IVF” and wanted public and private insurance to cover the medical procedure.
But IVF is very expensive, Kennan said. While it would be nice to alleviate families of that financial burden, which can cost up to $30,000 per attempt, the administration would need to answer two important questions: Who would pay for it, and how?
“Somebody’s going to have to cover it,” she said. Promising coverage is “a strange statement to make if you understand anything about insurance.”
Republicans said they do not plan to eliminate the Affordable Care Act and would only change it if they could improve it to lower costs and improve coverage.
“There are a lot of parts of the Affordable Care Act that the American public is quite positive about,” said Carri Chan, a professor and faculty director of the health care and pharmaceutical management program at Columbia Business School.
Vice President Kamala Harris said during her sole televised debate with Trump in September that she planned to protect the ACA. Trump said he didn’t have specific policies for replacing it but had “concepts of a plan.”
Several days later in an interview with NBC News, Sen. JD Vance, Trump’s vice president-elect, said the new administration intends to reorganize the program based on individual health needs.
“We want to make sure everybody is covered,” he told NBC’s Kristen Welker. “But the best way to do that is to actually promote some more choice in our health care system and not have a one-size-fits-all approach that puts a lot of people into the same insurance pools.”
This could mean cheaper options for young healthy people, experts say. But it could also mean more expensive plans for older people and those with chronic illnesses.
The administration also may not renew the tax credit that helps low-income patients afford premiums, which may force some people to drop coverage, Keenan said.
The Affordable Care Act “is so embedded in our system now that it would be very hard to rip it out completely and replace it,” she said. But the Trump administration can “nibble at it.”
In the days leading up to the election, the Trump team put out a series of ads attacking Harris for her support of the transgender community.
“Kamala supports taxpayer-funded sex changes for prisoners,” one of the ads stated. “Kamala is for they/them. President Trump is for you.’”
The official 2024 Republican Party Platform promised to stop “taxpayer-funded schools from promoting gender transition,” under a section entitled “Republicans will end left-wing gender insanity.”
In a September speech, Trump promised he would issue an executive order instructing federal agencies to cease “promotion of gender transition.” He said he would institute a ban on gender-affirming care for minors and keep federal funding from health institutions that violated it. He also said he would restore the “Trump ban on transgender in the military.”
On the topic of abortion access, there are laws in place that prevent federal dollars from funding abortions, according to Kennan, so extending that rule to gender-affirming care wouldn’t be a heavy lift.
However, Kennan worries about the mental health impact for people diagnosed with gender dysphoria, which is distress caused by a mismatch between a person’s gender identity and their sex assigned at birth. Treatment plans for gender dysphoria typically include changes in gender expression and role, hormone therapy, surgery and behavioral therapy, according to the Mayo Clinic.
Kennan said she’s also concerned about what will happen to patients without access to safe gender-affirming care who may try unproven, alternative methods.
People might seek hormonal therapy from unreputable sources and “end up harming themselves because the substances aren’t what they’re supposed to be,” she said.
Robert F. Kennedy Jr., a 2024 presidential candidate who still appeared on some ballots even though he dropped out of the race in August, told supporters that Trump “promised” to put him in charge of public health agencies.
Howard Lutnick, Trump’s transition team co-chair, said in an interview with CNN that Kennedy won’t have a job at the Department of Health and Human Services.
“That’s not what he wants to do. … He just wants data,” he told CNN’s Kaitlan Collins last week.
But Trump suggested in his victory speech that Kennedy may have a broader role than overseeing data collection.
“He’s going to help make America healthy again. … He wants to do some things and we’re going to let him go to it,” Trump said at 2:30 a.m. Wednesday from his home state of Florida. “Go have a good time, Bobby.”
Kennedy earned a reputation for being critical of vaccines and raising questionable claims about the origins of the COVID-19 virus. However, Kennedy said in an interview with NBC News Wednesday he wouldn’t “take away anybody’s vaccines.”
Instead, Trump has instructed him to “clean up corruption” within federal health agencies – returning them “to the gold-standard science” – and to “make America healthy again” by ending chronic diseases.
Republican lawmakers have discussed the potential for restructuring federal health agencies like the Centers for Disease Control and Prevention and the National Institutes of Health, according to media reports. Experts hope any restructuring will not affect research.
“The devil is always going to be in the details,” said Chan, from Columbia Business School. “My hope is that in the restructuring, there’s still going to be core funding.”
Adrianna Rodriguez can be reached at [email protected].