5 Key Health Care Changes During Trump’s First Year Back in Office

In 2025, the Trump administration launched a sweeping overhaul of the American health care landscape, marked by the enactment of the landmark One Big Beautiful Bill and a series of transformative executive actions. From the codification of stringent federal Medicaid work requirements to a radical restructuring of the national vaccine schedule under HHS Secretary Robert F. Kennedy Jr, these shifts represent a fundamental departure from the previous administration’s focus on entitlement and expanded coverage.

With the debut of TrumpRx.gov and other moves, the administration is steering the nation toward a market-driven, “America First” health model that prioritizes individual responsibility and direct-to-consumer competition over traditional regulatory frameworks.

Here are 5 key health care changes that happened during the first year of President Donald Trump’s second term in office.

1. Codification of Medicaid Work Requirements

Through the One Big Beautiful Bill signed on July 4, 2025, the Trump administration established a federal requirement that “able-bodied” adults in the Medicaid expansion group must complete 80 hours per month of work, community service, or education to maintain coverage. This marked a fundamental shift in Medicaid from a pure entitlement program to a work-incentive program. The Congressional Budget Office estimates this will reduce federal spending by $326 billion over a decade, though it is projected to increase the number of uninsured Americans.^1,2

The implementation of Medicaid work requirements marks a clear departure from President Joseph Biden, who spent his term rescinding the state-level work requirement waivers Trump had granted previously during his first term.^3,4 Biden’s administration had argued that these requirements created "red tape" that caused people to lose coverage. In 2019, the New England Journal of Medicine published research that found thousands of adults in Arkansas, the first state to implement work requirements during Trump’s first term, had lost insurance due to the Medicaid work requirements with no change in employment.⁵

“The idea of work requirements is to get people into new jobs and private insurance,” Benjamin Sommers, MD, PhD, the study’s lead author and a professor of health policy and economics at Harvard T.H. Chan School of Public Health, had said in a statement at the time the study was published.⁶ “But in our study that didn’t happen. We didn’t find any employment changes and instead we see Medicaid coverage rates dropping and more people without health insurance—usually because the process itself was confusing or beneficiaries didn’t even know about the new requirements.”

2. Challenges to Vaccine Recommendations

Kennedy led the way to make significant changes to immunizations in the US, which could have immediate, nationwide health outcomes. Since before he was confirmed, Kennedy’s stance on vaccines has been scrutinized.⁷

In June 2025, the health care world was taken by surprise when Kennedy announced he had retired all 17 existing members of the Advisory Committee on Immunization Practices (ACIP).⁸ Days later, he announced a new set of ACIP members who he claimed would restore public trust in vaccines. However, the committee now included individuals who had expressed antivaccine views, which raised alarm among some experts.⁹

The new committee later voted to split up the measles, mumps, rubella, and varicella (MMRV) vaccine, recommending the chickenpox shot be given as a standalone injection,¹⁰ and voted to end the universal hepatitis B birth dose for infants.¹¹

All of this culminated at the beginning of 2026, when the administration announced it was slashing the recommended childhood vaccine schedule from 17 to 11 vaccines, removing recommendations for the flu, rotavirus, and respiratory syncytial virus vaccines for most children.¹²

3. Rollback of LGBTQ+ Health Protections

A day 1 executive order mandated that all federal agencies, including HHS, recognize sex as an "immutable biological classification" (male or female).¹³ This effectively rescinded Biden-era protections for gender identity in health care.

Another executive order from January 2025 directed agencies and programs to start significantly limiting access to gender-affirming care for children under the age of 19 years. In December, a proposed rule was introduced that would prohibit the use of federal Medicaid and Children’s Health Insurance Program funds from covering pharmaceutical or surgical gender-affirming services for young people. Kennedy followed this rule up with a declaration that certain gender-affirming care procedures are not safe or effective as a way to treat gender dysphoria and related disorders in minors.

4. Launch of TrumpRx.gov and Market-Based Drug Pricing

In October 2025, the administration announced TrumpRx.gov, a government-operated portal where manufacturers could offer certain high-cost drugs at deeply discounted prices directly to consumers, bypassing traditional insurance.¹⁴ The creation of this portal was a delivery mechanism for his Most Favored Nation (MFN) pricing principle.

MFN was initially introduced during Trump’s first term but was not pursued by the Biden administration.¹⁵ In May 2025, Trump reintroduced the concept.¹⁶

The goal of MFN and TrumpRx is to lower prices through deals between the government and pharmaceutical companies rather than just regulation. Deals announced in November would cut the cost of the popular glucagon-like peptide-1 weight loss drugs semaglutide and tirzepatide.¹⁷ There are now deals in place with 14 of 17 pharmaceutical companies that had received letters in July to lower prices.¹⁸

5. Aggressive Enforcement of Health Care Price Transparency

Building on his earlier work, Trump issued an executive order in February 2025 titled "Making America Healthy Again By Empowering Patients.”¹⁹ It shifted the focus from merely posting prices to standardizing them so they are easily comparable across all hospitals.

This executive order aims to turn patients into “shoppers,” theoretically driving down costs through competition. The order includes heavy fines for hospitals that fail to disclose actual negotiated rates rather than estimates.

This order is a consistent bridge from Trump’s first term. Trump considers price transparency his signature health care achievement from 2019 and is now using his second term to finish its implementation. His first administration released the rule in 2019 but didn’t finalize it until October 2020, shortly before he lost reelection.^20,21

References

1. Hinton E, Diana A, Rudowitz. A closer look at the work requirement provisions in the 2025 federal budget reconciliation law. KFF. July 30, 2025. Accessed January 8, 2026. https://www.kff.org/medicaid/a-closer-look-at-the-work-requirement-provisions-in-the-2025-federal-budget-reconciliation-law/

2. Bonavitacola J. Medicaid work requirements set to leave millions without insurance. AJMC^®. November 4, 2025. Accessed January 8, 2026. https://www.ajmc.com/view/medicaid-work-requirements-set-to-leave-millions-without-insurance

3. Alker J. Biden administration withdraws Medicaid work requirements guidance and more. Georgetown University McCourt School of Public Policy Center for Children and Families. February 17, 2021. Accessed January 8, 2026. https://ccf.georgetown.edu/2021/02/17/biden-administration-withdraws-medicaid-work-requirements-guidance-and-more/

4. Rosenberg J. 5 updates on Medicaid work requirements. AJMC. June 8, 2018. Accessed January 8, 2026. https://www.ajmc.com/view/5-updates-on-medicaid-work-requirements

5. DiGrande S. Study finds no change in employment after implementation of Medicaid work requirements. AJMC. June 20, 2019. Accessed January 8, 2026. https://www.ajmc.com/view/study-finds-no-change-in-employment-after-implementation-of-medicaid-work-requirements

6. Coverage losses, substantial confusion in Arkansas following implementation of Medicaid work requirements. News release. Harvard T.H. Chan School of Public Health. June 19, 2019. Accessed January 8, 2026. https://hsph.harvard.edu/news/coverage-losses-substantial-confusion-in-arkansas-following-implementation-of-medicaid-work-requirements/

7. Steinzor P. 5 key takeaways from RFK Jr’s confirmation hearings. AJMC. January 31, 2025. Accessed January 8, 2026. https://www.ajmc.com/view/5-key-takeaways-from-rfk-jr-s-confirmation-hearings

8. Grossi G. RFK Jr sweeps clean CDC vaccine advisory panel, aiming to bolster public confidence. AJMC. June 9, 2025. Accessed January 8, 2026. https://www.ajmc.com/view/rfk-jr-sweeps-clean-cdc-vaccine-advisory-panel-aiming-to-bolster-public-confidence

9. Steinzor P. CDC vaccine panel meets for first time after RFK Jr expelled former members. AJMC. June 25, 2025. Accessed January 8, 2026. https://www.ajmc.com/view/cdc-vaccine-panel-meets-for-first-time-after-rfk-jr-expelled-former-members

10. Halpern L. ACIP meeting: combined MMRV vaccine, hepatitis B vaccine restricted for some age groups. Pharmacy Times^®. September 19, 2025. Accessed January 8, 2026. https://www.pharmacytimes.com/view/acip-meeting-combined-mmrv-vaccine-hepatitis-b-vaccine-restricted-for-some-age-groups

11. Halpern L. ACIP votes to end universal hepatitis B vaccination recommendation for infants. Pharmacy Times. December 5, 2025. Accessed January 8, 2026. https://www.pharmacytimes.com/view/acip-votes-to-end-universal-hepatitis-b-vaccination-recommendation-for-infants

12. Grossi G. CDC reduces US childhood immunization schedule from 17 to 11 diseases. AJMC. January 5, 2026. Accessed January 8, 2026. https://www.ajmc.com/view/cdc-reduces-us-childhood-immunization-schedule-from-17-to-11-diseases

13. Dawson L, Kates J. Overview of President Trump’s executive actions impacting LGBTQ+ health. KFF. January 5, 2026. Accessed January 8, 2026. https://www.kff.org/other-health/overview-of-president-trumps-executive-actions-impacting-lgbtq-health/

14. Joszt L. White House, Pfizer reach agreement on drug discounts; Trump announces TrumpRx. AJMC. September 30, 2025. Accessed January 8, 2026. https://www.ajmc.com/view/white-house-pfizer-reach-agreement-on-drug-discounts-trump-announces-trumprx

15. Trump administration announces prescription drug payment model to put American patients first. News release. CMS. November 20, 2020. Accessed January 8, 2026. https://www.cms.gov/newsroom/press-releases/trump-administration-announces-prescription-drug-payment-model-put-american-patients-first

16. Bonavitacola J. Trump executive order could reduce pharmaceutical costs by 59%. AJMC. March 12, 2025. Accessed January 8, 2026. https://www.ajmc.com/view/trump-executive-order-could-reduce-pharmaceutical-costs-by-59-

17. McNulty R. Trump announces deals with Lilly, Novo to cut weight loss drug prices. AJMC. November 6, 2025. Accessed January 8, 2026. https://www.ajmc.com/view/trump-announces-deals-with-eli-lilly-novo-nordisk-for-lower-weight-loss-drug-prices

18. Valletti D. Trump announces pricing deals with 9 drugmakers, expanding Most-Favored-Nation drug pricing strategy. December 19, 2025. Accessed January 8, 2026. https://www.pharmacytimes.com/view/trump-announces-pricing-deals-with-9-drugmakers-expanding-most-favored-nation-drug-pricing-strategy

19. Making America healthy again by empowering patients with clear, accurate, and actionable healthcare pricing information. White House. February 25, 2025. Accessed January 8, 2026. https://www.whitehouse.gov/presidential-actions/2025/02/making-america-healthy-again-by-empowering-patients-with-clear-accurate-and-actionable-healthcare-pricing-information/

20. Joszt L. HHS releases rules to promote price transparency and empower patient decision making. AJMC. November 16, 2019. Accessed January 8, 2026. https://www.ajmc.com/view/hhs-releases-rules-to-promote-price-transparency-and-empower-patient-decision-making

21. Inserro A, Joszt L. HHS wraps up rule requiring price transparency by payers. AJMC. October 29, 2020. Accessed January 8, 2026. https://www.ajmc.com/view/hhs-wraps-up-rule-requiring-price-transparency-by-payers