Shortly after taking office, the Trump administration issued executive actions related to immigration, health care, diversity, equity, and inclusion (DEI), global health, and other areas.
Immigration
President Donald Trump on Jan. 20 issued the Protecting the American People Against Invasion executive order, designed to expand immigration enforcement. The Department of Homeland Security announced on Jan. 21 a rescission of a Biden administration memorandum that had previously restricted immigration enforcement actions in or near “protected areas,” (PDF) including medical and mental health facilities, such as hospitals, doctor’s offices, clinics, vaccination sites, and other locations.
Health Care
Trump pulled back two executive orders issued by former President Joe Biden intended to strengthen access to health care coverage (Executive Orders 14009 and 14070). The former established a special enrollment period for uninsured Americans seeking coverage through the federal Marketplace exchanges and directed federal agencies to review existing policies, regulations, and other agency actions to “make high-quality healthcare accessible and affordable for every American.” The latter directed the Treasury Department and the IRS to address the so-called family glitch, expanding the availability of premium tax credits to families who are unable to afford their employer-sponsored insurance [refer to Washington Highlights, April 8, 2022].
The president also rescinded another Biden-era executive order directing the Centers for Medicare & Medicaid Innovation Center (CMMI) to develop new payment and delivery models designed to lower drug costs and promote access to innovative, high-cost drug therapies for Medicare and Medicaid enrollees (Executive Order 14087).
Additionally, the Acting Secretary of the Department of Health and Human Services, Dorothy Fink, MD, directed agency leaders to temporarily pause external communications and public meetings, including National Institutes of Health study sections. This policy is expected to remain in effect until Feb. 1.
Diversity, Equity, and Inclusion (DEI)
Trump issued on Jan. 21 an executive order directing the attorney general and secretary of education to issue joint guidance within 120 days to state and local educational agencies and higher education institutions receiving federal funds regarding measures and practices required to comply with the Students for Fair Admissions, Inc. v. President and Fellows of Harvard College Supreme Court decision. This executive order also directed the Office of Management and Budget (OMB) director to compile a report outlining recommendations for enforcing federal civil rights laws and encouraging the private sector to end illegal discrimination and preferences. As part of this report, federal agencies are to identify potential civil compliance investigations of entities including large nonprofit associations, state and local medical associations, and institutions of higher education with endowments over $1 billion.
In addition, the president unveiled a slate of executive actions designed to curtail DEI in the federal government or supported with federal funding, including the rescission of several DEI-related Biden administration executive orders and a new executive order directing the OMB director to identify and terminate all DEI or DEIA mandates, policies, programs, and activities within the federal government.
Trump also issued an executive order directing federal agencies to interpret the definition of “sex” as an individual’s biological classification as “male” or “female,” defining “female” as “a person belonging, at conception, to the sex that produces the large reproductive cell” and defining “male” as “a person, belonging, at conception, to the sex that produces the small reproductive cell.” The executive order rejects the concept of “gender identity” as a “meaningful basis for identification.”
Global Health
Trump issued an executive order providing notice that the United States intends to withdraw from the World Health Organization (WHO). In his previous term, Trump issued a notice for the country to withdraw from the WHO, but this notice was revoked by the Biden administration in 2021. This order sets a 12-month notice for the United States to leave the WHO and discontinue its financial contributions. The executive order also directs the director of the White House Office of Pandemic Preparedness and Response Policy to “review, rescind, and replace” the 2024 U.S. Global Health Security Strategy “as soon as practicable.” The AAMC joined a January 23 letter with 143 organizations in the public health community urging President Donald Trump to maintain U.S. membership in the World Health Organization in response to this executive order.
Additional Actions
Additionally, on Jan. 20, Trump issued a freeze on the hiring of federal civilian employees to be applied throughout the executive branch, while noting that nothing in the memorandum shall adversely impact veterans’ benefits, among other areas, and that the director of the Office of Personnel and Management may grant exemptions where necessary. Following the freeze and uncertainty as to the status of physicians practicing at Department of Veterans Affairs (VA) sites, Acting VA Secretary Todd Hunter issued a memorandum and exemptions list that included physicians and additional health professions.