As President Donald Trump’s health care agenda for a second term takes shape, it’s becoming clear that many Joe Biden-era policies won’t make the cut.

On Monday, Trump signed a sweeping order aimed in part at reversing several Biden administration executive orders on health care, including efforts to lower the cost of prescription drugs for people on Medicare and Medicaid, enhancing the Affordable Care Act and increasing protections for Medicaid enrollees. The so-called initial rescissions order, according to the Trump White House, is aimed at Biden policies that it says are “deeply unpopular” and “radical.”

The moves by Trump, experts say, are likely to be inconsequential to many Americans in terms of what they pay in out-of-pocket health care costs.

One Biden effort overturned by Trump, for example, had directed Medicare to look at ways to lower drug costs, including whether to impose a $2 monthly out-of-pocket cap on certain generic drugs.

That initiative, however, was only in the development stage, said Stacie Dusetzina, a health policy professor at Vanderbilt University in Nashville, Tennessee, and it was unclear whether it would be implemented at all.

Biden’s bigger health care initiatives, such as a $35 monthly cap on insulin, a $2,000 annual out-of-pocket cap on prescription drugs and Medicare’s negotiating drug pricing provision weren’t affected by Trump’s executive actions Monday. 

“When administrations change over, many of them want to undo some of the actions of other presidents, even when those are more symbolic,” Dusetzina said.  

Still, she said, Trump’s move signals that the incoming administration may be unwilling to move forward on any policies laid out by its predecessor.

“It could mean that the Trump administration is not interested in pursuing any of the work that has since developed out of these executive orders,” she said.

A change in priorities

Some of the actions Monday were expected, experts say, including weakening the Affordable Care Act, also known as Obamacare, a primary goal during Trump’s first term. 

Trump overturned a policy that had extended Obamacare’s open enrollment period an additional 12 weeks in 36 states, giving uninsured adults more time to sign up.

He also rescinded an order aimed at strengthening Medicaid, which included providing more outreach funding to states. 

Some of the policies eliminated, however, had previously aligned with Trump’s goals — possibly indicating a change in his priorities, said Larry Levitt, executive vice president of health policy at KFF, a nonprofit group that researches health policy issues.

In jettisoning Biden’s order to look into new ways to lower out-of-pocket spending on prescription drugs, Levitt said, it could signal that Trump is less serious about addressing the cost of health care in the U.S.

“Trump is kind of wiping the slate clean,” he said. “If you contrast Day 1 of this Trump administration with the last one, it is a different approach to health care.”

Levitt said it remains unclear whether the Trump administration supports Medicare’s negotiating drug prices, a key provision in Biden’s Inflation Reduction Act. Last week, Medicare announced the next round of prescription drugs up for negotiations, including Ozempic and Wegovy.

“Trump could signal that he wants to continue drug price negotiation, or, alternatively, try to repeal it,” Levitt said. “The Trump administration has quite a bit of leeway to choose to negotiate more aggressively or less aggressively.”

Arthur Caplan, the head of the division of medical ethics at the NYU Grossman School of Medicine in New York City, said that for now, it appears that Trump is proceeding on health care costs “with great caution,” leaving Biden’s bigger initiatives alone.

Although Trump has advocated for a minimalist approach to government, Caplan said Trump is aware that the U.S. pays much higher prices for care than other countries and that the government may need to intervene.  

Caplan said he hopes Trump leaves the Medicare negotiation provision in place. 

“Right now, he seems to be nibbling on the edges,” Caplan said. “But I hope he doesn’t go further.”