The great undoing: Which of Trump’s policies will Biden reverse?

KHN has put together an interactive tool of significant health policies implemented by the Trump administration using its own authority — executive orders, agency guidance or formal regulations — and is tracking Biden administration and court actions.

We will update this chart as actions are taken.

Topics: Affordable Care Act | HHS Operations | Immigration | Insurance | Medicaid | Prescription Drugs | Price Transparency | Public Health | Women's Reproductive Health

—Affordable Care Act

OVERTURNED Ordered federal officials to minimize “the economic burden" of the Affordable Care Act on states and individuals

WHEN: Jan. 24, 2017

HOW: Executive order

STATUS/BIDEN ADMINISTRATION ACTION: Revoked by Biden's Jan. 28, 2021, executive order.

OVERTURNED Cut funding for navigators and ACA marketplace enrollment outreach to consumers

WHEN: Aug. 31, 2017

HOW:Press release

STATUS/BIDEN ADMINISTRATION ACTION: Biden indirectly ordered the Department of Health and Human Services to restore funding as part of his Jan. 28, 2021, ACA executive order and promised to spend $50 million for outreach during a special 2021 open enrollment period.

UNCHANGED Eliminated payments to insurers that helped cover the costs the ACA required them to pay for very low-income customers

WHEN: Oct. 12, 2017

HOW: Announcement by HHS, backed by a Department of Justice legal opinion

STATUS/BIDEN ADMINISTRATION ACTION: Policy remains unchanged.

IN Process Shortened marketplace open enrollment from three months to six weeks

WHEN: April 18, 2017

HOW: Included in a larger HHS regulation

STATUS/BIDEN ADMINISTRATION ACTION: Effectively overturned by Biden's Jan. 28, 2021, executive order.

IN PROCESS Allowed states to loosen requirements for the “essential health benefits" required by plans sold on the ACA marketplaces

WHEN: April 17, 2018

HOW: Included in a larger Centers for Medicare & Medicaid regulation

STATUS/BIDEN ADMINISTRATION ACTION: Regulation remains in effect, but Biden's Jan. 28, 2021, executive order mandated a review by HHS.

IN PROCESS Loosened rules for Section 1332 waivers under the ACA, which allow states to experiment with different coverage options. This was a change to the “guardrails" that sought to ensure that all ACA plans offered the same comprehensive coverage and that state experiments not cause a reduction in enrollment.

WHEN: Oct. 24, 2018

HOW: CMS guidance

STATUS/BIDEN ADMINISTRATION ACTION: The guidance was written into regulation the day before Trump's term ended, Jan. 19, 2021. A lawsuit was filed in U.S. District Court in Washington in January challenging both the guidance and the regulation. A review by HHS was ordered as part of Biden's Jan. 28, 2021, executive order.

IN PROCESS Changed the formula for indexing increases in ACA plan premiums — a move expected to lead to high consumer out-of-pocket costs

WHEN: April 25, 2019

HOW:Regulation

STATUS/ BIDEN ADMINISTRATION ACTION: Regulation remains in effect. An HHS review was ordered as part of Biden's Jan. 28, 2021, executive order.

IN PROCESS Curtailed LGBTQ civil rights protections offered by the ACA

WHEN: June 19, 2020

HOW:Regulation

STATUS/BIDEN ADMINISTRATION ACTION:Enjoined by the U.S. District Court for the Eastern District of New York on Oct. 29, 2020. Biden's Jan. 20, 2021, executive order mandates that agencies “consider whether to revise, suspend, or rescind" actions that do not fully implement statutes barring discrimination.

IN PROCESS Allowed Georgia to pull out of healthcare.gov

WHEN: Nov. 1, 2020

HOW:Waiver

STATUS/BIDEN ADMINISTRATION ACTION: Remains in effect. Georgia's plan is to move out of healthcare.gov for insurance policies purchased for 2023. A lawsuit seeking to reverse the decision was filed in U.S. District Court in Washington on Jan. 14, 2021. An HHS review was ordered as part of Biden's Jan. 28, 2021, executive order.

IN PROCESS Cut funding for marketplace operations and urged states to drop out of healthcare.gov

WHEN: Jan. 19, 2021

HOW:Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Regulation remains in effect. An HHS review was ordered as part of Biden's Jan. 28, 2021, executive order.

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—HHS Operations

OVERTURNED Executive Order: Limited the government's ability to use agency “guidance," as opposed to formal regulation, to assess civil penalties against “regulated parties"

WHEN: Oct. 9, 2019

HOW:Executive order

STATUS/BIDEN ADMINISTRATION ACTION: Rescinded by Biden's executive order on Jan. 20, 2021.

IN PROCESS Regulation: Limited the government's ability to use agency “guidance," as opposed to formal regulation, to assess civil penalties against “regulated parties"

WHEN: Jan. 14, 2021

HOW:Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Biden ordered the Office of Management and Budget to “promptly take steps to rescind" the regulation in his Jan. 20, 2021, executive order.

IN PROCESS Sunsetting all regulations unless they are reviewed within five years, and then reviewed again at least once every 10 years after that

WHEN: Jan. 19, 2021HOW: RegulationSTATUS/BIDEN ADMINISTRATION ACTION: Several health groups filed suit in U.S. District Court for the Northern District of California on March 9, 2021, asking that the regulation be overturned. On March 23, 2021, the Biden administration postponed, pending judicial review, the effective date of the regulation to March 22, 2022.

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—Immigration

IN PROCESS Expanded the list of federal assistance programs that if used by immigrants could make them potentially “public charges," a designation that would hamper their ability to become lawful, permanent residents. The expansion included Medicaid.

WHEN: Aug. 14, 2019

HOW:Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The regulation has been blocked by several federal district courts and upheld by circuit courts. The Supreme Court dismissed pending appeals on March 9, 2021, after the Biden administration announced it was no longer enforcing the provision. Biden ordered a review of the regulation in an executive order on Feb. 2, 2021.

UNCHANGED Blocked visas for immigrants who couldn't show they could afford health insurance

WHEN: Oct. 4, 2019

HOW:Proclamation announced Oct. 4, 2019, and published Oct. 9, 2019

STATUS/BIDEN ADMINISTRATION ACTION: The policy was challenged in court but upheld by a panel of judges from the 9th Circuit Court of Appeals on Dec. 21, 2020. The plaintiffs have requested a review by the full court.

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—Insurance

UNCHANGED Expanded the availability of short-term health plans

WHEN: Aug. 3, 2018

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The regulation was challenged in court but upheld by the U.S. Court of Appeals for the District of Columbia on July 17, 2020.

IN PROCESS Allowed association health plans

WHEN: June 21, 2018

HOW:Regulation

STATUS/BIDEN ADMINISTRATION ACTION: A judge in U.S. District Court in Washington struck down parts of the regulation on March 28, 2019. The case was appealed to the Court of Appeals for the D.C. Circuit, which heard arguments on Nov. 14, 2019, but has not yet issued an opinion. On Jan. 28, 2021, the Biden administration asked the court to delay its decision by at least 60 days.

UNCHANGED Expanded health reimbursement arrangements (HRAs) for employers to fund premiums for workers getting coverage on the individual market

WHEN: June 20, 2019

HOW:Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Regulation remains unchanged.

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—Medicaid

IN PROCESS Allowed states to impose work requirements for some enrollees

WHEN: Jan. 11, 2018

HOW: Guidance

STATUS/BIDEN ADMINISTRATION ACTION: The waivers granted to states were challenged, and a federal district judge vacated several approvals. That was appealed and the case made its way to the Supreme Court, which set a hearing date of March 29, 2021. The court removed the case from its calendar on March 11, 2021, but the case could still be heard later. In his Jan. 28, 2021, executive order, Biden mandated that HHS “consider whether to suspend, revise, or rescind" the guidance, which has since been removed from the CMS website.

UNCHANGED Weakened standards for Medicaid managed-care plans

WHEN: Nov. 13, 2020

HOW:Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The regulation remains unchanged.

IN PROCESS Allows states to ask for a waiver to take their Medicaid federal contribution as a block grant

WHEN: Jan. 30, 2020

HOW: Guidance

STATUS/BIDEN ADMINISTRATION ACTION: HHS was ordered to “consider whether to suspend, revise, or rescind" the guidance in Biden's Jan. 28, 2021, executive order.

IN PROCESS Approved TennCare's block grant

WHEN: Jan. 8, 2021

HOW:Waiver

STATUS/BIDEN ADMINISTRATION ACTION: HHS was ordered to “consider whether to suspend, revise, or rescind" the waiver for Tennessee's Medicaid program in Biden's Jan. 28, 2021, executive order.

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—Prescription Drugs

unchanged Required drug prices in TV ads

WHEN: May 10, 2019

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Drugmakers filed a lawsuit seeking to overturn the rule. The rule was blocked by the U.S. Court of Appeals for the District of Columbia on June 16, 2020.

UNCHANGED Executive Order: Ordered discounts for consumers who get insulin and injectable epinephrine from community health centers that purchase through the 340B program

WHEN: July 24, 2020

HOW:Executive order

STATUS/BIDEN ADMINISTRATION ACTION: Order remains unchanged.

UNCHANGED Authorized prescription drug imports from Canada

WHEN: Oct. 1, 2020

HOW:Regulation and guidance from the FDA

STATUS/BIDEN ADMINISTRATION ACTION: A lawsuit challenging the rule was filed by drugmakers on Nov. 23, 2020, and is pending.

IN process Ordered HHS to establish “most favored nation" prices for Medicare drugs based on lowest price in other developed countries

WHEN: Nov. 27, 2020

HOW:Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Lawsuits were filed and several U.S. district courts — including those for Maryland, the Northern District of California and the Southern District of New York — blocked the rule. Following the courts' actions, CMS announced on Dec. 28, 2020, that the rule would not be implemented without further rule-making.

IN PROCESS Altered drug rebate rules for Medicare prescription drugs

WHEN: Nov. 30, 2020

HOW:Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The U.S. District Court in Washington postponed most of the provisions a year, so they won't take effect until Jan. 1, 2023. HHS, under the Biden administration, issued a final rule on Feb. 2, 2021, delaying the effective date of the parts of the rule that had not been stayed by the judge until March 22, 2021. The administration has until April 1 to decide whether to proceed to defend the remainder of the lawsuit.

IN PROCESS Regulation: Required discounts for consumers who get insulin and injectable epinephrine from community health centers that purchase through the 340B program

WHEN: Dec. 23, 2020

HOW:Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The Biden administration delayed implementation of the regulation until at least March 22, 2021. On March 23, the Biden administration again delayed the effective date to July 20, 2021.

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—Price Transparency

UNCHANGED Called for hospital and insurer price transparency regulations

WHEN: June 24, 2019

HOW: Executive order

STATUS/BIDEN ADMINISTRATION ACTION: Order remains unchanged.

UNCHANGED Required health insurers to provide estimated prices to patients

WHEN: Nov. 12, 2020

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Health plans and insurers must make data files publicly available for policies that take effect starting Jan. 1, 2022, and they must provide cost-sharing information on 500 specified services the following year. Information on all items and services is required for policies that take effect starting Jan. 1, 2024.

UNCHANGED Required hospitals to publish “standard charges"

WHEN: Nov. 27, 2019

HOW:Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The American Hospital Association sued to overturn the regulation, but a judge in U.S. District Court in Washington dismissed the challenge on June 23, 2020. The regulation took effect Jan. 1, 2021.

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—Public Health

OVERTURNED Disbanded the Directorate on Global Health Security and Biodefense, part of the National Security Council

WHEN: May 2018

HOW: A reorganization ordered by then-national security adviser John Bolton, the details of which were not made public.

STATUS/BIDEN ADMINISTRATION ACTION: The office was reconstituted under Biden's Jan. 20, 2021, executive order.

UNCHANGED Added new restrictions on funding for National Institutes of Health research using fetal tissue from elective abortions

WHEN: July 26, 2019

HOW:Guidance

STATUS/BIDEN ADMINISTRATION ACTION: Policy remains unchanged.

OVERTURNED Withdrew the U.S. from the World Health Organization

WHEN: July 6, 2020

HOW:Nonpublic letter

STATUS/BIDEN ADMINISTRATION ACTION: Biden announced the U.S. would rejoin WHO via a national security memorandum on Jan. 21, 2021

IN PROCESS Changed the rules for distributing organs for transplant

WHEN: Dec. 2, 2020

HOW: Regulation

STATUS/BIDEN ADMINISTRATON ACTION: A challenge by major organ transplant centers in federal district court was rejected on Jan. 16, 2020. The regulation was frozen by the Biden administration on Feb. 2, 2021, as part of a 60-day review of Trump administration regulations.

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—Women's Reproductive Health

OVERTURNED Reinstated and expanded the so-called Mexico City policy, or “global gag rule," which limits funding to organizations that perform or support abortion outside the United States

WHEN: Jan. 23, 2017

HOW: Memorandum

STATUS/BIDEN ADMINISTRATION ACTION:Rescinded by Biden memorandum, Jan. 28, 2021.

OVERTURNED Withdrew U.S. funding from the U.N. family planning agency

WHEN: April 3, 2017

HOW: Memorandum from the State Department

STATUS/BIDEN ADMINISTRATION ACTION: Funding was restored by Secretary of State Antony Blinken on Jan. 28, 2021, following Biden's executive order that day.

UNCHANGED Ordered the HHS secretary to “consider changing" the ACA's contraceptive mandate regulations

WHEN: May 9, 2017

HOW: Executive order

STATUS/BIDEN ADMINISTRATION ACTION: Written into multiple regulations Oct. 13, 2017, and Nov. 15, 2018. Remains unchanged.

UNCHANGED Interim final regulation: Allowed employers with moral objections to opt out of offering contraceptive coverage under the ACA

WHEN: Oct. 13, 2017

HOW:Interim final regulation

STATUS/BIDEN ADMINISTRATION ACTION: Litigated alongside final regulation (below). Upheld by the Supreme Court on July 8, 2020.

UNCHANGED Interim final regulation: Allowed employers with religious objections to opt out of offering contraceptive coverage under the ACA

WHEN: Oct. 13, 2017

HOW: Interim final regulation

STATUS/BIDEN ADMINISTRATION ACTION: Litigated alongside final regulation (below). Upheld by the Supreme Court on July 8, 2020.

UNCHANGED Reinterpreted “free choice of provider" guidance for Medicaid recipients, which allows people to receive services from any qualified provider

WHEN: Jan. 19, 2018

HOW: CMS guidance

STATUS/BIDEN ADMINISTRATION ACTION: Guidance remains in effect. Lawsuits challenging individual states' efforts to exclude Planned Parenthood from Medicaid are at various stages of litigation, but no suits have been filed challenging the federal guidance.

UNCHANGED Final regulation: Allowed employers with moral objections to opt out of offering contraceptive coverage under the ACA

WHEN: Nov. 15, 2018

HOW:Final regulation

STATUS/BIDEN ADMINISTRATION ACTION: Upheld by the Supreme Court on July 8, 2020.

UNCHANGED Final regulation: Allowed employers with religious objections to opt out of offering contraceptive coverage under the ACA

WHEN: Nov 15, 2018

HOW:Final regulation

STATUS/BIDEN ADMINISTRATION ACTION: Upheld by the Supreme Court on July 8, 2020.

IN PROCESS Barred abortion providers from Title X family planning program

WHEN: March 4, 2019

HOW:Regulation

STATUS/BIDEN ADMINISTRATION ACTION: Multiple lawsuits were filed, but the full 9th U.S. Circuit Court of Appeals upheld the regulation on Feb. 24, 2020. Biden's Jan. 28, 2021, executive order instructed HHS to act to “suspend, revise, or rescind" the regulation.

in process Allowed health providers to refuse to offer any service that violates their consciences

WHEN: May 21, 2019

HOW: Regulation

STATUS/BIDEN ADMINISTRATION ACTION: The regulation was blocked by several federal district courts. A hearing on the rule before the 9th Circuit Court of Appeals scheduled for March 17, 2021, was canceled at the request of the Biden administration.

UNCHANGED Barred the use of fetal tissue from elective abortions in research conducted at the National Institutes of Health and barred the use of fetal tissue from elective abortions in extramural NIH-funded research unless such research is expressly approved by an ethics advisory board

WHEN: June 5, 2019

HOW:Statement from HHS

STATUS/BIDEN ADMINISTRATION ACTION: Remains unchanged.

in process Required separate ACA premiums for abortion coverage

WHEN: Dec. 27, 2019

HOW:Regulation

STATUS/BIDEN ADMINISTRATION ACTION: A federal district judge in Maryland overturned the rule on July 10, 2020. The decision has been appealed.

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KHN reporter Victoria Knight contributed to this report.

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