Trump Recaptures White House, Spelling Uncertainty for Federal Health Policy

In the early hours of November 6, 2024, the presidential race was called for Donald J. Trump,¹ who will return to the White House with a mandate to enact his campaign promises to shake up federal agencies, including those overseeing health policy, public health, food, medicine, and social supports. His 2017-2021 term was marked by unsuccessful efforts to repeal the Affordable Care Act (ACA) but did bring more incremental changes to chip away at the law’s provisions. In his 2024 campaign, he did not dwell heavily on concrete policy proposals, instead saying he had “concepts” of a health plan.²

Trump’s 2024 campaign was backed by Robert F. Kennedy Jr, whose ambitions to delegitimize public health efforts from vaccination to fluoride may be realized if Trump keeps his promise to appoint Kennedy to an influential role in his second administration.³ The Trump victory also likely spells restricted access to abortion; although Trump has said he won’t sign a national abortion ban, he has expressed openness to curtailing the availability of medication abortion.⁴

Abortion Access Under a Trump Administration

At a Fox town hall event airing October 16, 2024, he said some of the state laws on abortion are “too tough,” and “those are going to be redone because already there’s a movement in those states.” And while his messaging has been unclear on medication abortion, Project 2025, a policy agenda developed by Trump administration alumni, calls for barring distribution of abortion pills by mail under the Comstock Act.

Abortion was on the ballot in 10 states: Arizona, Colorado, Florida, Maryland, Missouri, Montana, Nebraska, Nevada, New York, and South Dakota.⁵ The election concluded with 7 of the states passing measures for abortion access, whereas ballot measures fell short in Florida, Nebraska, and South Dakota.

While 57% of voters (with 95% of votes counted) favored the abortion amendment on the Florida ballot that would have limited government interference with the procedure, the measure needed to meet a 60% threshold to pass.⁶ Therefore, the 6-week abortion ban in Florida that came into effect in May stands.

Nebraska's ballot included a pair of contradictory abortion measures: the right to abortion until fetal viability and an amendment that prohibits abortions after the first trimester.⁷ Both yielded tight results, with the latter passing at 55.3% in favor of those limitations, while 51.3% (with 99% of votes counted) voted against the right to abortion until fetal viability.

South Dakota's Amendment G aimed to create a constitutional right to abortion in the first trimester, allowing for regulations in the second trimester based on the woman's health and restrictions in the third trimester except to preserve the life or health of a pregnant woman; 59.7% (91% of votes counted) voted against the amendment, and 40.3% voted in favor.⁸

Policy Contrasts

Trump’s Democratic challenger in the election, Vice President Kamala Harris, had campaigned on a platform of restoring reproductive health care access nationwide,⁹ strengthening the ACA,¹⁰ expanding caps on out-of-pocket costs for prescription medications, and extending Medicare home health care benefits.¹¹

In the sole debate between the 2 candidates, Trump criticized the ACA as “lousy” while claiming that he saved it, and he promised more details to come on a replacement plan.¹⁰ Harris touted the Biden administration’s initiatives to negotiate drug prices on behalf of Americans and cap the cost of insulin at $35 per month via passage of the Inflation Reduction Act.

Trump has not said whether he will continue these negotiations, though he had advocated during his first term for importing drugs from outside the US.¹² He also pledged to address drug shortages with a combination of tariffs, import restrictions, and domestic incentives to promote onshore drug manufacturing.¹³

References

1. Live election updates: Donald Trump wins US presidency. AP News. Updated November 6, 2024. Accessed November 6, 2024. https://apnews.com/live/trump-harris-election-updates-11-5-2024

2. Levitt L. The "concept of a plan" President Trump proposed to replace the ACA. KFF. September 11, 2024. Accessed November 6, 2024. https://www.kff.org/quick-take/the-concept-of-a-plan-president-trump-proposed-to-replace-the-aca/

3. Lawrence L. What letting RFK Jr. 'go wild' might mean for Trump's FDA. STAT. November 6, 2024. Accessed November 6, 2024. https://www.statnews.com/2024/11/06/trump-victory-upend-fda-rfk-jr-influence-vaccines-prescriptions/

4. Caffrey M. 5 hot health care topics in the presidential election. AJMC^®. October 18, 2024. Accessed November 6, 2024. https://www.ajmc.com/view/5-hot-health-care-topics-in-the-presidential-election

5. Mulvihill G, Fernando C. Abortion rights advocates win in 7 states and clear way to overturn Missouri ban but lose in 3. AP News. November 6, 2024. Accessed November 6, 2024. https://apnews.com/article/abortion-ballot-measures-harris-trump-florida-missouri-49c9073cbb6056b66a8a7d0d099795d1

6. Reuters. Florida, two other states defy trend and vote down abortion rights. November 6, 2024. Accessed November 6, 2024. https://www.reuters.com/world/us/florida-ballot-measure-guarantee-abortion-rights-falls-short-2024-11-06/

7. Nebraska ballot measures 2024. NBC News. November 6, 2024. Accessed November 6, 2024. https://www.nbcnews.com/politics/2024-elections/nebraska-ballot-measures#initiative-right-to-abortion

8. South Dakota amendment G. AP News. November 6, 2024. Accessed November 6, 2024. https://apnews.com/projects/election-results-2024/south-dakota/?r=83039

9. Grossi G. Abortion in the presidential debate: Trump defends state bans, Harris vows national protections. AJMC. September 16, 2024. Accessed November 6, 2024. https://www.ajmc.com/view/abortion-in-the-presidential-debate-trump-defends-state-bans-harris-vows-national-protections

10. Grossi G. Harris defends ACA while Trump calls for "much better" health plan during debate. AJMC. September 11, 2024. Accessed November 6, 2024. https://www.ajmc.com/view/harris-defends-aca-while-trump-calls-for-much-better-healthc-plan-during-debate

11. Bonavitacola J. Expansion of Medicare home care coverage on the table with Harris announcement. AJMC. October 10, 2024. Accessed November 6, 2024. https://www.ajmc.com/view/expansion-of-medicare-home-care-coverage-on-the-table-with-harris-announcement

12. Crowley K. Agenda47 on healthcare: how Donald Trump says he'd address drug prices, addiction crisis. USA Today. August 5, 2024. Accessed November 6, 2024. https://www.usatoday.com/story/news/politics/elections/2024/08/05/trump-agenda47-drug-shortage-prices-addiction/74587818007/