How Much of Trump’s Health Agenda Has Biden Undone?

By Julie Rovner

4 years ago

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Since President Joe Biden took the reins of the federal executive branch, and with them the power to undo health policies of his predecessor, how much has this administration accomplished?

It depends on how — and what — you count. Biden or his health officials were quick to reverse many of the policies President Donald Trump implemented that did not require formal regulations. Those include having the U.S. rejoin the World Health Organization, rolling back the “Mexico City” policy that banned aid or international organizations that support abortion rights, and canceling a ban on the use of federal funds to study fetal tissue from elective abortions.

The administration also managed more complex unwindings. Final regulations were issued to restore the ability of Planned Parenthood and other abortion providers to participate in the federal family planning program. Also undone by regulation was the Trump administration’s effort to link prescription drug prices to their lowest available costs, equivalent to those of other industrialized countries.

But other high-profile Trump policies remain in place, at least for now. For example, the Biden administration has not yet attempted to amend Trump policies allowing prescription drug imports from Canada, although Biden officials have yet to approve any of the state plans submitted under that policy.

KFF Health News will continue to follow the Biden administration’s actions on Trump executive branch policies and update this interactive tool, which covers executive orders, agency guidance, formal regulations, and court matters.

Topics: Affordable Care Act | HHS Operations | Immigration | Insurance | Medicaid | Prescription Drugs | Price Transparency | Public Health | Women’s Reproductive Health

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Latest Action

(updated May 6, 2024)

OVERTURNED Curtailed LGBTQ+ civil rights protections offered by the ACA

WHEN: June 19, 2020

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Enjoined by the U.S. District Court for the Eastern District of New York on Oct. 29, 2020. Biden’s Jan. 20, 2021, executive order mandates that agencies “consider whether to revise, suspend, or rescind” actions that do not fully implement statutes barring discrimination. On May 10, 2021, HHS announced it would resume enforcement of discrimination prohibitions based on sexual orientation or gender identity, citing court decisions that the department said supported the change.

On May 6, 2024, the Biden administration issued final rules reinstituting the protections.

Overturned Expanded the availability of short-term health plans

WHEN: Aug. 3, 2018

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The regulation was challenged in court but upheld by the U.S. Court of Appeals for the District of Columbia on July 17, 2020.

A rule proposed on July 12, 2023, would limit how long such plans can last (up to three months); would limit how many times they can be renewed (once, for only one month); and would require clearer notice to purchasers about what the plans do and do not cover.

The final version of the rule was issued April 3, 2024.

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Affordable Care Act

OVERTURNED Ordered federal officials to minimize “the economic burden” of the Affordable Care Act on states and individuals

WHEN: Jan. 24, 2017

HOW: Executive order

STATUS/BIDEN ADMINISTRATION ACTION: Revoked by Biden’s Jan. 28, 2021, executive order.

overturned Cut funding for marketplace operations and urged states to drop out of healthcare.gov

WHEN: Jan. 19, 2021

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Regulation remains in effect. An HHS review was ordered as part of Biden’s Jan. 28, 2021, executive order. The policy was reversed as part of the final 2022 regulation for ACA marketplaces, which took effect on Nov. 26, 2021.

OVERTURNED Cut funding for navigators and ACA marketplace enrollment outreach to consumers

WHEN: Aug. 31, 2017

HOW: Press release

STATUS/BIDEN ADMINISTRATION ACTION: Biden indirectly ordered the Department of Health and Human Services to restore funding as part of his Jan. 28, 2021, ACA executive order and promised to spend $50 million for outreach during a special 2021 open enrollment period. HHS announced on April 21, 2021, that it would provide $80 million for navigators for the 2022 plan year.

UNCHANGED Eliminated payments to insurers that helped cover the costs the ACA required them to pay for very low-income customers

WHEN: Oct. 12, 2017

HOW: Announcement by HHS, backed by a Department of Justice legal opinion

STATUS/BIDEN ADMINISTRATION ACTION: Policy remains unchanged.

IN Process Shortened marketplace open enrollment from three months to six weeks

WHEN: April 18, 2017

HOW: Included in a larger HHS regulation

STATUS/BIDEN ADMINISTRATION ACTION: Effectively overturned by Biden’s Jan. 28, 2021, executive order.

IN PROCESS Allowed states to loosen requirements for the “essential health benefits” required by plans sold on the ACA marketplaces

WHEN: April 17, 2018

HOW: Included in a larger Centers for Medicare & Medicaid regulation

STATUS/BIDEN ADMINISTRATION ACTION: Regulation remains in effect, but Biden’s Jan. 28, 2021, executive order mandated a review by HHS.

overturned Loosened rules for Section 1332 waivers under the ACA, which allow states to experiment with different coverage options. This was a change to the “guardrails” that sought to ensure that all ACA plans offered the same comprehensive coverage and that state experiments not cause a reduction in enrollment.

WHEN: Oct. 24, 2018

HOW: CMS guidance

STATUS/BIDEN ADMINISTRATION ACTION: The guidance was written into regulation the day before Trump’s term ended, Jan. 19, 2021. A lawsuit was filed in U.S. District Court in Washington in January challenging both the guidance and the regulation. A review by HHS was ordered as part of Biden’s Jan. 28, 2021, executive order. The policy was reversed as part of the final 2022 regulation for ACA marketplaces, which took effect on Nov. 26, 2021.

IN PROCESS Changed the formula for indexing increases in ACA plan premiums — a move expected to lead to high consumer out-of-pocket costs

WHEN: April 25, 2019

HOW: Regulation

STATUS/ BIDEN ADMINISTRATION ACTION: Regulation remains in effect. An HHS review was ordered as part of Biden’s Jan. 28, 2021, executive order.

Overturned Allowed Georgia to pull out of healthcare.gov

WHEN: Nov. 1, 2020

HOW: Waiver

STATUS/BIDEN ADMINISTRATION ACTION: Remains in effect. Georgia’s plan is to move out of healthcare.gov for insurance policies purchased for 2023. A lawsuit seeking to reverse the decision was filed in U.S. District Court in Washington on Jan. 14, 2021. An HHS review was ordered as part of Biden’s Jan. 28, 2021, executive order. The Centers for Medicare & Medicaid Services formally withdrew approval of the plan in a letter on April 29, 2022.

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HHS Operations

OVERTURNED Allowed health providers to refuse to offer any service that violates their consciences

WHEN: May 21, 2019

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The regulation was blocked by several federal district courts. A hearing on the rule before the 9th Circuit Court of Appeals scheduled for March 17, 2021, was canceled at the request of the Biden administration. The Biden administration on Jan. 5, 2023, proposed a new rule to rescind parts of the Trump administration rule, narrowing the circumstances under which health providers can refuse to provide certain medical care. A final version of the rule was issued and took effect Jan. 9, 2024.

OVERTURNED Executive Order: Limited the government’s ability to use agency “guidance,” as opposed to formal regulation, to assess civil penalties against “regulated parties”

WHEN: Oct. 9, 2019

HOW: Executive order

STATUS/BIDEN ADMINISTRATION ACTION: Rescinded by Biden’s executive order on Jan. 20, 2021.

IN PROCESS Regulation: Limited the government’s ability to use agency “guidance,” as opposed to formal regulation, to assess civil penalties against “regulated parties”

WHEN: Jan. 14, 2021

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Biden ordered the Office of Management and Budget to “promptly take steps to rescind” the regulation in his Jan. 20, 2021, executive order. The Department of Health and Human Services published proposed regulations to reinstate the pre-Trump era policy in the Federal Register on Oct. 20, 2021.

OVERTURNED Sunsetting all regulations unless they are reviewed within five years, and then reviewed again at least once every 10 years after that

WHEN: Jan. 19, 2021
HOW: Regulation
STATUS/BIDEN ADMINISTRATION ACTION: Several health groups filed suit in U.S. District Court for the Northern District of California on March 9, 2021, asking that the regulation be overturned. On March 23, 2021, the Biden administration postponed, pending judicial review, the effective date of the regulation to March 22, 2022. After delaying the implementation several times, the Biden administration formally withdrew the rule on May 26, 2022.

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Immigration

overturned Expanded the list of federal assistance programs that if used by immigrants could make them potentially “public charges,” a designation that would hamper their ability to become lawful, permanent residents. The expansion included Medicaid.

WHEN: Aug. 14, 2019

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The regulation has been blocked by several federal district courts and upheld by circuit courts. The Supreme Court dismissed pending appeals on March 9, 2021, after the Biden administration announced it was no longer enforcing the provision. Biden ordered a review of the regulation in an executive order on Feb. 2, 2021. The Department of Health and Human Services advised states in an “informational bulletin” on July 22, 2021, that receipt of Medicaid, other than for long-term care, would not be considered in determining whether an immigrant is a “public charge.”

Overturned Blocked visas for immigrants who couldn’t show they could afford health insurance

WHEN: Oct. 4, 2019

HOW: Proclamation announced Oct. 4, 2019, and published Oct. 9, 2019

STATUS/BIDEN ADMINISTRATION ACTION: The policy was challenged in court but upheld by a panel of judges from the 9^th Circuit Court of Appeals on Dec. 21, 2020. The plaintiffs have requested a review by the full court. Biden ordered a review of the policy in an executive order on Feb. 2, 2021. On May 13, 2021, Biden formally rescinded the proclamation.

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Insurance

IN PROCESS Allowed association health plans

WHEN: June 21, 2018

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: A judge in U.S. District Court in Washington struck down parts of the regulation on March 28, 2019. The case was appealed to the Court of Appeals for the D.C. Circuit, which heard arguments on Nov. 14, 2019, but has not yet issued an opinion. On Jan. 28, 2021, the Biden administration asked the court to delay its decision by at least 60 days.

UNCHANGED Expanded health reimbursement arrangements (HRAs) for employers to fund premiums for workers getting coverage on the individual market

WHEN: June 20, 2019

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Regulation remains unchanged.

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Medicaid

IN PROCESS Allowed states to impose work requirements for some enrollees

WHEN: Jan. 11, 2018

HOW: Guidance

STATUS/BIDEN ADMINISTRATION ACTION: The waivers granted to states were challenged, and a federal district judge vacated several approvals. That was appealed and the case made its way to the Supreme Court, which set a hearing date of March 29, 2021. The court removed the case from its calendar on March 11, 2021, but the case could still be heard later. In his Jan. 28, 2021, executive order, Biden mandated that HHS “consider whether to suspend, revise, or rescind” the guidance, which has since been removed from the CMS website. As of June 29, 2021, HHS had notified New Hampshire, Arkansas, Indiana and Arizona that it is withdrawing their work requirement waivers.

UNCHANGED Weakened standards for Medicaid managed-care plans

WHEN: Nov. 13, 2020

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The regulation remains unchanged.

IN PROCESS Allows states to ask for a waiver to take their Medicaid federal contribution as a block grant

WHEN: Jan. 30, 2020

HOW: Guidance

STATUS/BIDEN ADMINISTRATION ACTION: HHS was ordered to “consider whether to suspend, revise, or rescind” the guidance in Biden’s Jan. 28, 2021, executive order.

IN PROCESS Approved TennCare’s block grant

WHEN: Jan. 8, 2021

HOW: Waiver

STATUS/BIDEN ADMINISTRATION ACTION: HHS was ordered to “consider whether to suspend, revise, or rescind” the waiver for Tennessee’s Medicaid program in Biden’s Jan. 28, 2021, executive order.

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Prescription Drugs

OVERTURNED Ordered HHS to establish “most favored nation” prices for Medicare drugs based on lowest price in other developed countries

WHEN: Nov. 27, 2020

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Lawsuits were filed and several U.S. district courts — including those for Maryland, the Northern District of California and the Southern District of New York — blocked the rule. Following the courts’ actions, CMS announced on Dec. 28, 2020, that the rule would not be implemented without further rule-making. The Biden administration on Aug. 10, 2021, published a proposed rule that would formally rescind the policy. On Dec. 29, 2021, the Centers for Medicare & Medicaid Services published a final rule rescinding the policy, effective Feb. 28, 2022.

unchanged Required drug prices in TV ads

WHEN: May 10, 2019

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Drugmakers filed a lawsuit seeking to overturn the rule. The rule was blocked by the U.S. Court of Appeals for the District of Columbia on June 16, 2020.

UNCHANGED Executive Order: Ordered discounts for consumers who get insulin and injectable epinephrine from community health centers that purchase through the 340B program

WHEN: July 24, 2020

HOW: Executive order

STATUS/BIDEN ADMINISTRATION ACTION: Order remains unchanged.

UNCHANGED Authorized prescription drug imports from Canada

WHEN: Oct. 1, 2020

HOW: Regulation and guidance from the FDA

STATUS/BIDEN ADMINISTRATION ACTION: A lawsuit challenging the rule was filed by drugmakers on Nov. 23, 2020, and is pending.

IN PROCESS Altered drug rebate rules for Medicare prescription drugs

WHEN: Nov. 30, 2020

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The U.S. District Court in Washington postponed most of the provisions a year, so they won’t take effect until Jan. 1, 2023. HHS, under the Biden administration, issued a final rule on Feb. 2, 2021, delaying the effective date of the parts of the rule that had not been stayed by the judge until March 22, 2021. The administration has until April 1 to decide whether to proceed to defend the remainder of the lawsuit.

overturned Regulation: Required discounts for consumers who get insulin and injectable epinephrine from community health centers that purchase through the 340B program

WHEN: Dec. 23, 2020

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The Biden administration delayed implementation of the regulation until at least March 22, 2021. On March 23, the Biden administration again delayed the effective date to July 20, 2021. On June 16, 2021, HHS published a proposed rule in the Federal Register that would rescind the Trump rule. The final version of the rule rescinding the policy was published on Oct. 1, 2021.

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Price Transparency

IN PROCESS Required hospitals to publish “standard charges”

WHEN: Nov. 27, 2019

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The American Hospital Association sued to overturn the regulation, but a judge in U.S. District Court in Washington dismissed the challenge on June 23, 2020. The regulation took effect Jan. 1, 2021. On July 19, 2021, the Biden administration announced a proposed regulation that would substantially raise penalties for hospitals that fail to comply with the rules.

UNCHANGED Called for hospital and insurer price transparency regulations

WHEN: June 24, 2019

HOW: Executive order

STATUS/BIDEN ADMINISTRATION ACTION: Order remains unchanged.

UNCHANGED Required health insurers to provide estimated prices to patients

WHEN: Nov. 12, 2020

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Health plans and insurers must make data files publicly available for policies that take effect starting Jan. 1, 2022, and they must provide cost-sharing information on 500 specified services the following year. Information on all items and services is required for policies that take effect starting Jan. 1, 2024.

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Public Health

OVERTURNED Disbanded the Directorate on Global Health Security and Biodefense, part of the National Security Council

WHEN: May 2018

HOW: A reorganization ordered by then-national security adviser John Bolton, the details of which were not made public.

STATUS/BIDEN ADMINISTRATION ACTION: The office was reconstituted under Biden’s Jan. 20, 2021, executive order.

OVERTURNED Withdrew the U.S. from the World Health Organization

WHEN: July 6, 2020

HOW: Nonpublic letter

STATUS/BIDEN ADMINISTRATION ACTION: Biden announced the U.S. would rejoin WHO via a national security memorandum on Jan. 21, 2021

IN PROCESS Changed the rules for distributing organs for transplant

WHEN: Dec. 2, 2020

HOW: Regulation

STATUS/BIDEN ADMINISTRATON ACTION: A challenge by major organ transplant centers in federal district court was rejected on Jan. 16, 2020. The regulation was frozen by the Biden administration on Feb. 2, 2021, as part of a 60-day review of Trump administration regulations.

OVerturned Added new restrictions on funding for National Institutes of Health research using fetal tissue from elective abortions

WHEN: July 26, 2019

HOW: Guidance

STATUS/BIDEN ADMINISTRATION ACTION: An April 16, 2021, announcement from the director of the NIH informed outside researchers that the new restrictions would be lifted and that NIH would not convene an ethics advisory board to review new research using human fetal tissue from elective abortions.

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Women’s Reproductive Health

Overturned Barred abortion providers from Title X family planning program

WHEN: March 4, 2019

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Multiple lawsuits were filed, but the full 9th U.S. Circuit Court of Appeals upheld the regulation on Feb. 24, 2020. Biden’s Jan. 28, 2021, executive order instructed HHS to act to “suspend, revise, or rescind” the regulation.

On April 14, HHS proposed new regulations that would return the program to the policies in effect pre-Trump. The proposed regulations were published in the Federal Register on April 15. Biden ordered a review of the policy in an executive order on Feb. 2, 2021. On May 17, the Supreme Court dismissed the cases, after the Biden administration said it would continue to enforce the Trump rules (except in Maryland, where they were blocked by a separate court order) until its new rules are finalized. The regulations were made final on October 7, 2021.

OVERTURNED Reinstated and expanded the so-called Mexico City policy, or “global gag rule,” which limits funding to organizations that perform or support abortion outside the United States

WHEN: Jan. 23, 2017

HOW: Memorandum

STATUS/BIDEN ADMINISTRATION ACTION: Rescinded by Biden memorandum, Jan. 28, 2021.

OVERTURNED Withdrew U.S. funding from the U.N. family planning agency

WHEN: April 3, 2017

HOW: Memorandum from the State Department

STATUS/BIDEN ADMINISTRATION ACTION: Funding was restored by Secretary of State Antony Blinken on Jan. 28, 2021, following Biden’s executive order that day.

UNCHANGED Ordered the HHS secretary to “consider changing” the ACA’s contraceptive mandate regulations

WHEN: May 9, 2017

HOW: Executive order

STATUS/BIDEN ADMINISTRATION ACTION: Written into multiple regulations Oct. 13, 2017, and Nov. 15, 2018. Remains unchanged.

UNCHANGED Interim final regulation: Allowed employers with moral objections to opt out of offering contraceptive coverage under the ACA

WHEN: Oct. 13, 2017

HOW: Interim final regulation

STATUS/BIDEN ADMINISTRATION ACTION: Litigated alongside final regulation (below). Upheld by the Supreme Court on July 8, 2020.

UNCHANGED Interim final regulation: Allowed employers with religious objections to opt out of offering contraceptive coverage under the ACA

WHEN: Oct. 13, 2017

HOW: Interim final regulation

STATUS/BIDEN ADMINISTRATION ACTION: Litigated alongside final regulation (below). Upheld by the Supreme Court on July 8, 2020.

UNCHANGED Reinterpreted “free choice of provider” guidance for Medicaid recipients, which allows people to receive services from any qualified provider

WHEN: Jan. 19, 2018

HOW: CMS guidance

STATUS/BIDEN ADMINISTRATION ACTION: Guidance remains in effect. Lawsuits challenging individual states’ efforts to exclude Planned Parenthood from Medicaid are at various stages of litigation, but no suits have been filed challenging the federal guidance.

IN PROCESS Final regulation: Allowed employers with moral objections to opt out of offering contraceptive coverage under the ACA.

WHEN: Nov. 15, 2018

HOW: Final regulation

STATUS/BIDEN ADMINISTRATION ACTION: Upheld by the Supreme Court on July 8, 2020. A rule proposed Feb. 2, 2023, would eliminate the ability of employers to exercise “moral” (as opposed to religious) objections to offer contraceptive coverage.

UNCHANGED Final regulation: Allowed employers with religious objections to opt out of offering contraceptive coverage under the ACA

WHEN: Nov 15, 2018

HOW: Final regulation

STATUS/BIDEN ADMINISTRATION ACTION: Upheld by the Supreme Court on July 8, 2020.

overturned Required separate ACA premiums for abortion coverage

WHEN: Dec. 27, 2019

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: A federal district judge in Maryland overturned the rule on July 10, 2020. The decision has been appealed. The policy was reversed as part of the final 2022 regulation for ACA marketplaces, which took effect on Nov. 26, 2021.

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KHN reporter Victoria Knight contributed to this report.

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