Project 2025: Potential Health Risks for Americans
With less than 70 days until the election, voters are starting to see the distinct visions that Vice President Kamala Harris and former President Donald Trump have for the nation’s future. The contrast between the two candidates is particularly stark in the area of health care. While health care has always been a significant issue in presidential campaigns, this November’s election may have an especially profound impact on patients.
While Harris and Governor Tim Walz aim to build upon the accomplishments of the Biden-Harris administration over the past four years – continuing efforts to and , for instance – Trump and his running mate J.D. Vance have offered relatively little detail about their health policy plans. However, Project 2025 provides a glimpse into what a Trump administration might look like.
Developed by the conservative think tank, the Heritage Foundation, the Project 2025 policy agenda was crafted by over 400 conservative experts and published in a titled Mandate for Leadership: The Conservative Promise. While Trump has publicly the initiative, he has embraced (and even attempted to implement) of its core proposals, several of which were written by his former staff members.
Here are some examples of how the Project 2025 agenda would negatively affect my patients and those of clinicians across the country.
Making medications more expensive
I have treated countless patients who rely on insulin to manage their diabetes. When these patients do not take their insulin, they face risks beyond simply worsened diabetes (which increases the risk of heart attacks and strokes); they also risk life-threatening medical emergencies caused by dangerously high blood-sugar levels. In the decades leading up to the Biden-Harris administration, the of insulin , forcing many patients to elsewhere to afford their insulin and others to it altogether.
The (IRA) – signed into law by President Biden two years ago – capped insulin costs at $35 per month for Medicare recipients. The data show that this cap the number of insulin prescriptions that were filled, ensuring that more patients with diabetes received the treatment they needed to stay healthy. The IRA will also cap annual out-of-pocket spending on prescription drugs (not just insulin) for seniors beginning next year. And despite intense lobbying and from drug manufacturers, the law empowered Medicare to negotiate prices with Big Pharma for the first time in history, achieving significant and saving . These are just a few of the many reasons why over 500 health professionals an to protect the IRA.
Yet, at a time when a of Americans report not filling a prescription due to , Project 2025 calls for these life-saving provisions to be repealed. IRA repeal, by Trump and Vance, would make drugs like insulin more expensive and force patients to bear a greater share of the costs of their medications, leading to difficult choices between health and finances.
Decreasing access to Medicaid
Project 2025 not only seeks to roll back recent advancements in making care more affordable for Medicare recipients; it also aims to weaken Medicaid, which over 70 million low-income Americans depend on for health care. The authors propose implementing lifetime caps on benefits and adding work requirements as a condition for coverage, creating administrative obstacles that make life more challenging for those who are already struggling. Taken together, these provisions could result in millions of individuals – including those who are currently – losing their coverage. These policies penalize individuals for being poor, and they do so in one of the harshest ways: by denying them access to health care.
Restricting reproductive health care
At a time when reproductive rights are under attack in many states, Project 2025 would not only further at the but also eliminate no-cost coverage for some contraception, creating additional obstacles to evidence-based care for patients of reproductive age.
Endangering childrens’ health
Finally, Project 2025 specifically targets the well-being of children. The authors aim to prevent public health agencies from requiring vaccinations for school children, which could lead to more outbreaks of preventable diseases like . They also propose invalidating state laws intended to curb gun violence, a cause of death for children in the U.S. Project 2025 would even eliminate Head Start, a for early childhood development, especially in low-income and rural communities.
If elected, Trump may not adopt all of these proposals. However, even the implementation of a portion of these plans would represent a significant setback for decades of progress in medicine and public health.
As doctors, we recognize that progress on these issues was not easily achieved. The Affordable Care Act faced intense opposition and survived multiple partisan efforts to dismantle it – including by Trump during his first term. For more than a decade, Medicaid expansion has been a fierce and ongoing state-by-state battle. The pharmaceutical industry fought vehemently against drug price negotiation. At every turn, countless doctors have advocated for their patients, promoting greater access to affordable medical care. The prospect of these hard-won victories being reversed – and the suffering it would inflict on our patients – is a cause worth fighting for.