Trump’s Embrace of Project 2025 Shapes U.S. Health Policy
In the early days of his administration, few voters anticipated that President Donald Trump would cut billions from the nation’s leading federal cancer research agency. However, these budget reductions at the National Institutes of Health (NIH) align closely with proposals outlined in Project 2025: Mandate for Leadership—a conservative policy roadmap that Trump distanced himself from during his campaign but has now largely adopted.
The 922-page plan, drafted by the Heritage Foundation, calls for breaking the NIH’s “monopoly” on research direction, capping funds for universities and hospitals to limit federal subsidies for what it calls “leftist agendas.” Universities warn that these measures threaten ongoing biomedical research, and a federal judge temporarily blocked the cuts on Feb. 10 after legal challenges from 22 states and medical institutions.
Project 2025 as a Blueprint
Trump previously dismissed Project 2025 as something he had never read, but his administration’s policies closely follow its framework. Many of the plan’s contributors, including veterans from his first term, now hold key positions in his administration, enabling a swift implementation of the agenda.
Legal and advocacy groups, recognizing the plan’s influence, have been preparing countermeasures in court. Critics warn that upcoming changes to Medicaid, Medicare, and federal health agencies will significantly alter access to care. The plan suggests imposing work requirements, lifetime caps, and premiums for Medicaid recipients—policies that could lead to coverage losses for millions.
“Technically, these changes don’t remove Medicaid eligibility,” said Larry Levitt, executive vice president of health policy at KFF. “But the result would be fewer people with coverage because of new barriers like work documentation and premiums.”
Congressional Republicans are also considering budget proposals that would slash Medicaid funding by hundreds of billions over the next decade.
Expanding Alternative Health Plans
Among other priorities, Project 2025 advocates for expanding access to non-ACA-compliant health plans. Supporters argue these plans increase consumer choice and lower premiums, but critics warn they could expose unsuspecting buyers to high out-of-pocket costs for uncovered services.
The plan also calls for cutting Medicaid funds to Planned Parenthood, which receives approximately $700 million annually from government programs. This move aligns with broader efforts to reshape women’s health care access, despite the fact that abortion services account for only 4% of Planned Parenthood’s offerings, according to its latest report.
Erasing Equity and Gender Protections
Sweeping policy changes have already removed terms like “equity” from federal documents, erased transgender identifiers, and curtailed international medical aid. In January, Trump reinstated and expanded the “global gag rule,” blocking federal funds for international groups that provide abortion-related information. Past studies show this policy has led to reduced access to contraception and reproductive care in countries like Zambia and Turkey.
Domestically, the administration has restricted federal funding for gender-affirming care and mandated that official documents recognize only two sexes, male and female. Federal agencies have removed LGBTQ+ health data, and the CDC delayed reports on public health issues, including bird flu, after being told to avoid terms like “transgender” and “nonbinary.”
Disrupting Public Health Agencies
Trump’s executive orders are going beyond Project 2025’s recommendations. The plan suggested restructuring USAID to “deradicalize” its operations, but his administration has instead dismantled the agency entirely. Advisor Elon Musk boasted on X that his “Department of Government Efficiency” had effectively shut down USAID, placing staff on leave and halting its programs.
While Trump and his allies claim these moves curb government waste, opponents argue they represent an attack on science, public health, and access to care. Polling reflects growing public concern—nearly 60% of voters expressed a negative view of Project 2025 in a September NBC News survey.
“This was never just a theoretical plan,” said Ally Boguhn, a spokesperson for Reproductive Freedom for All. “It’s a blueprint, and we’re seeing it unfold in real time.”
KFF Health News is seeking insights from current and former Department of Health and Human Services employees about these changes. Contact us securely via Signal at (415) 519-8778.
