And so it begins: Trump rescinds Biden XOs which strengthened the ACA, strengthened Medicaid & lowered prescription drug costs

On his first day in office, Donald Trump issued dozens of Executive Orders. Some of these are mostly symbolic; some won't have any effect without legislative action; some are blatantly unconstitutional & are already being challenged in court. Many, however, are terrifying and will have horrific consequences for thousands or potentially millions of Americans and non-Americans alike.

I already noted that one such order would withdraw the United States from the World Health Organization, which we curently provide 20% of the funding for.

Along with issuing his own new ones, Trump has also already rescinded over 60 XOs issued by President Biden. In this post I'm going to focus on three of them which pertain specifically to healthcare policy.

Again, all three of the following have now been RESCINDED BY DONALD TRUMP:

Biden Executive Order 14009 of January 28, 2021 (Strengthening Medicaid and the Affordable Care Act).

This established a COVID-era Special Enrollment Period (SEP) in response to the extraordinary circumstances the U.S. found itself in at the height of the pandemic. It also:

• Ordered the Secretaries of the Treasury, Labor, HHS & other departments related to Medicaid and/or the ACA to review all regulations, policies etc. to make sure they were designed to strengthen & protect those programs, including looking for & reversing, if possible, policies/practices which might undermine protections for those w/pre-existing conditions; might reduce coverage; undermine the ACA exchanges or the individual or group markets; present unnecessary barriers to coverage, etc.

• Revoked several of Trump's own first-term XOs which had weakened Medicaid and/or the ACA

Biden Executive Order 14070 of April 5, 2022 (Continuing To Strengthen Americans’ Access to Affordable, Quality Health Coverage).

This XO noted a number of actions which had been taken since and/or in response to XO 14009 above, including:

• facilitating ACA Medicaid expansion for nearly 500K people in MO & OK (both of which had previously passed ballot initiatives expanding the program)
• Extending postpartum Medicaid coverage out to 12 months for pregnant women in IL, NJ, VA & LA
• A COVID-specific SEP which added 2.8 million people to ACA exchange coverage
• Extended the federal exchange Open Enrollment Period by a month & breaking OEP enrollment records
• Increasing outreach funding by quadrupling the number of trained Navigators
• Reducing maximum out of pocket costs to employer & ACA enrollees by $400 on average
• Reducing Medicaid/ACA paperwork burdens
• Allowing low-income (under 150% FPL) Americans to enroll in ACA coverage year-round
• Strengthening state waiver policies for Medicaid & the ACA
• Beefing up ACA healthcare provider network requirements
• Proposing regulatory rule changes to close the "Family Gap" (more on this later), and...
• Signing the American Rescue Plan Act into law, which made ACA exchange subsidies more generous & expanded them to more people, along with other improvements

This XO further ordered various federal departments to do whatever they could to expand on policies/practices which would:

• make it easier for all consumers to enroll in and retain coverage, understand their coverage options, and select appropriate coverage;
• strengthen benefits and improve access to healthcare providers;
•  improve the comprehensiveness of coverage and protect consumers from low-quality coverage;
• expand eligibility and lower costs for coverage in the ACA Marketplaces, Medicaid, Medicare, and other programs;
• help improve linkages between the healthcare system and other stakeholders to address health-related needs; and
• help reduce the burden of medical debt on households.

Biden Executive Order 14087 of October 14, 2022 (Lowering Prescription Drug Costs for Americans).

This one is shorter so I'll just post the text verbatim:

 Section 1.  Policy.  Too many Americans face challenges paying for prescription drugs.  On average, Americans pay two to three times as much as people in other countries for prescription drugs, and one in four Americans who take prescription drugs struggle to afford their medications.  Nearly 3 in 10 American adults who take prescription drugs say that they have skipped doses, cut pills in half, or not filled prescriptions due to cost.

On August 16, 2022, I signed Public Law 117-169, commonly referred to as the Inflation Reduction Act of 2022 (IRA), which will lower the cost of prescription drugs and save millions of Americans hundreds or thousands of dollars per year.  The IRA will protect Medicare beneficiaries from catastrophic drug costs by phasing in a cap for out-of-pocket costs at the pharmacy and establishing a $35 monthly cap per prescription for insulin covered by a Medicare prescription drug plan and insulin delivered through traditional pumps.

Starting this January, Medicare beneficiaries with prescription drug coverage will pay $0 out of pocket for recommended adult vaccines (including the shingles vaccine).  The IRA will also require certain companies to pay Medicare rebates if they increase the prices of drugs used by Medicare beneficiaries faster than the rate of inflation.  In addition, the Secretary of HHS (Secretary) will be able to negotiate prices for selected high-cost prescription drugs for Medicare beneficiaries for the first time ever.  Following the passage of the IRA, HHS has taken critical steps to swiftly implement these historic provisions in order to deliver results and lower health care costs for the American people.

As my Administration works to implement the IRA, it is critical that we take additional actions to complement the IRA and further drive down prescription drug costs.  Within HHS, the Center for Medicare and Medicaid Innovation (“Innovation Center”) tests health care payment and delivery models to improve health care quality and make the delivery of health care more efficient.  In June 2022, the Innovation Center announced a new model to improve cancer care and lower health care costs for cancer patients, including prescription drug costs.  The Innovation Center provides my Administration and the American people with a useful set of tools to help lower health care costs and improve quality of care, and its work can advance the continued policy of my Administration to lower the cost of prescription drugs.

Sec. 2.  HHS Actions.  In furtherance of the policy set forth in section 1 of this order, the Secretary shall, consistent with the criteria set out in 42 U.S.C. 1315a(b)(2), consider whether to select for testing by the Innovation Center new health care payment and delivery models that would lower drug costs and promote access to innovative drug therapies for beneficiaries enrolled in the Medicare and Medicaid programs, including models that may lead to lower cost-sharing for commonly used drugs and support value-based payment that promotes high-quality care.

The Secretary shall, not later than 90 days after the date of this order, submit a report to the Assistant to the President for Domestic Policy enumerating and describing any models that the Secretary has selected.  The report shall also include the Secretary’s plan and timeline to test any such models.  Following the submission of the report, the Secretary shall take appropriate actions to test any health care payment and delivery models discussed in the report.