One of the key initiatives embraced early in the Trump administration proposed significant changes to the nation’s leading federal cancer research agency, the National Institutes of Health (NIH). This shift was underpinned by a conservative strategy authored by the influential Heritage Foundation known as ‘Project 2025’s ‘Mandate for Leadership’. President Trump, however, steadfastly maintained he was unaware of this plan during his campaign, suggesting the adoption of this approach was largely driven by policy advocates within his administration.
The extensive 922-page strategy suggested by the Heritage Foundation introduced the idea of ending the monopoly of NIH in directing research, aiming to diversify the agency’s responsibility and bring in new perspectives. Furthermore, the strategy suggested capping payments to universities and their affiliated hospitals, addressing the perceived issue of excessive federal taxpayer subsidization of agendas that lean heavily towards the left.
There was strong opposition to this shift by universities that were anticipating a substantial reduction in agency grants covering their operating costs. They argued that such drastic changes would have a deleterious effect on ongoing and future biomedical science research. However, supporters of this initiative shared the belief that an overhaul was required to keep costs in check and foster a more balanced allocation of resources.
Legal challenges against these suggested changes led to a temporary suspension of the cuts to medical research, courtesy of an order by a federal judge on Feb. 10. It can be argued, however, that the adoption of many elements of Project 2025 exhibits a mobilized effort by Trump loyalists who served in his first term and continued into the second, aiming to make substantial changes within the national health system.
It’s interesting to contrast this assertive adoption of Project 2025’s goals with Trump’s consistent denial of any knowledge of the plan during his campaign. This denial was especially pronounced when he was criticized by Democrats who capitalized on the supposedly unpopular aspects of Project 2025. Trump disclaimed any familiarity with the plan at every opportunity, even as recently as Oct. 31, during a rally in Albuquerque, New Mexico.
Despite his disavowal, Trump’s administration remained committed to the transformative actions outlined by the Heritage Foundation. Opposition groups and some state Democratic leaders claimed this dedication enabled them to anticipate and counter Trump’s moves in court effectively and swiftly. Furthermore, they geared up for what they interpreted as Trump’s impending implementation of Project 2025 recommendations for other major health programs, and federal health agencies like Medicaid and Medicare.
In the backdrop of these changes was the keen vigilance of numerous organizations that were ready to challenge the effects of these policy shifts. Noah Bookbinder, president of watchdog group Citizens for Responsibility and Ethics in Washington (CREW), noted that the visibility of Project 2025 allowed for some level of preparation and foresight in challenging any executive orders or other actions stemming from this plan.
Part of Project 2025 included a call for state flexibility to impose premiums for some beneficiaries, and also the potential for lifetime caps or time limits on Medicaid coverage. These ideas were framed as a means to bring about improvements by heightening the responsibility of enrollees in the program, targeting low-income and disabled Americans.
Larry Levitt, executive vice president for health policy at KFF (a health information nonprofit), suggested that while these proposals did not directly alter Medicaid eligibility or benefits, their implementation would likely result in a reduction in the number of people with health coverage. This raised the question of whether the increased complexity and financial obligation would effectively lead to rationed coverage.
Separately, the Republican congressional delegation was contemplating a budget plan that could potentially trim billions of dollars from Medicaid over the next 10 years. In a broader sense, Project 2025 also called for offering more access to health plans that exclude the Affordable Care Act’s most robust consumer protections. While this could lead to more options and lower premiums for some, it could also result in consumers bearing significant out-of-pocket costs for some care not covered by these plans.
One element of Project 2025 which garnered attention was its recommendation to cease Medicaid funding to Planned Parenthood affiliates. Planned Parenthood, an essential healthcare provider for women throughout the country, could potentially be affected as it receives roughly $700 million from Medicaid and other government programs annually according to its 2022-23 report. It’s worth noting that abortion services comprise about 4% of the organization’s services as stated in the same report.
Project 2025’s recommendations also touched on issues such as the use of language in federal documents and international medical aid. The Trump administration implemented decisions aligning with these guidelines, such as removing words like ‘equity’ from federal documents and curtailing international medical assistance. Critics argued that these changes had far-reaching implications and restricted access to healthcare.
An example of this was Trump’s executive order reinstating and expanding a ban on federal funds for global organizations that provide legal information on abortions. Studies indicated that this ban, sometimes referred to as the ‘global gag rule’ or ‘Mexico City Policy,” had considerable financial implications, significantly reducing funding available to foreign aid groups that did not comply.
The scope of Project 2025’s influence extended to the classification of gender identity as well. Trump signed an executive order rolling back certain rights for transgender persons by prohibiting the use of federal funds for transition-related care for individuals under 19 years of age. Furthermore, it also mandated the federal government to recognize only two sexes, male and female, moving the terminology from ‘gender’ to ‘sex’.
Despite criticisms, Project 2025 aimed to protect children and put an end to what the Heritage Foundation perceived to be a radical redefinition of sex. It advocated the removal of the term ‘gender identity’ from federal rules, regulations, and grants while promoting the view that biology should be the determinant of sex rather than subjective notions of gender.