Few voters likely expected President Donald Trump in the first weeks of his administration to slash billions of dollars from the nation\u2019s premier federal cancer research agency.<\/p>\n
But funding cuts to the National Institutes of Health were presaged in Project 2025\u2019s \u201cMandate for Leadership<\/a>,\u201d a conservative plan for governing that Trump said he knew nothing about during his campaign. Now, his administration has embraced it.<\/p>\n The 922-page playbook compiled by the Heritage Foundation, a conservative research group in Washington, says \u201cthe NIH monopoly on directing research should be broken\u201d and calls for capping payments to universities and their hospitals to \u201chelp reduce federal taxpayer subsidization of leftist agendas.\u201d<\/p>\n Universities, now slated to face sweeping cuts in agency grants that cover these overhead costs, say the policy will destroy ongoing and future biomedical science. A federal judge temporarily halted the cuts to medical research on Feb. 10<\/a> after they drew legal challenges from medical institutions and 22 states.<\/p>\n Project 2025 as Prologue<\/strong><\/p>\n The rapid-fire adoption of many of Project 2025\u2019s objectives indicates that Trump acolytes \u2014 many of its contributors were veterans of his first term, and some have joined his second administration \u2014 have for years quietly laid the groundwork to disrupt the national health system. That runs counter to Trump\u2019s insistence on the campaign trail, after Democrats made Project 2025 a potent attack line, that he was ignorant of the document.<\/p>\n \u201cI have no idea what Project 2025 is,\u201d Trump said Oct. 31 at a rally in Albuquerque, New Mexico, one of many times he disclaimed any knowledge of the plan. \u201cI\u2019ve never read it, and I never will.\u201d<\/p>\n But because his administration is hewing to the Heritage Foundation-compiled playbook so closely, opposition groups and some state Democratic leaders say they\u2019re able to act swiftly to counter Trump\u2019s moves in court.<\/p>\n They\u2019re now preparing for Trump to act on Project 2025 recommendations for some of the nation\u2019s largest and most important health programs, including Medicaid and Medicare, and for federal health agencies.<\/p>\n \u201cThere has been a lot of planning on the litigation side to challenge the executive orders and other early actions from a lot of different organizations,\u201d said Noah Bookbinder, president of Citizens for Responsibility and Ethics in Washington, a watchdog group. \u201cProject 2025 allowed for some preparation.\u201d<\/p>\n The plan, for example, calls for state flexibility to impose premiums for some beneficiaries, work requirements, and lifetime caps or time limits<\/a> on Medicaid coverage for some enrollees in the program for low-income and disabled Americans, which could lead to a surge in the number of uninsured after the Biden administration vastly expanded the program\u2019s coverage.<\/p>\n \u201cThese proposals don\u2019t directly alter eligibility for Medicaid or the benefits provided, but the ultimate effect would be fewer people with health coverage,\u201d said Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes KFF Health News. \u201cWhen you erect barriers to people enrolling in Medicaid, like premiums or documenting work status, you end up rationing coverage by complexity and ability to pay.\u201d<\/p>\n Congressional Republicans are contemplating a budget plan that could result in hundreds of billions of dollars<\/a> being trimmed from Medicaid over 10 years.<\/p>\n Project 2025 called for expanding access to health plans that don\u2019t comply<\/a> with the Affordable Care Act\u2019s strongest consumer protections. That may lead to more choice and lower monthly premiums for buyers, but unwitting consumers may face potentially massive out-of-pocket costs for care the plans won\u2019t cover.<\/p>\n And Project 2025 called for halting Medicaid funding to Planned Parenthood affiliates. The organization, an important health care provider for women across the country, gets roughly $700 million annually from Medicaid and other government programs, based on its 2022-23 report<\/a>. Abortion made up about 4% of services the organization provided to patients, the report says.<\/p>\n The administration\u2019s steps to scrub words such as \u201cequity\u201d from federal documents, erase transgender identifiers, and curtail international medical aid<\/a> \u2014 all part of the Project 2025 wish list \u2014 have already had sweeping ramifications, hobbling access to health care and eviscerating international programs that aim to prevent disease and improve maternal health outcomes.<\/p>\n Under a memorandum issued in January<\/a>, for example, Trump reinstated and expanded a ban on federal funds to global organizations that provide legal information on abortions.<\/p>\n Studies have found that the ban, known as the \u201cglobal gag rule\u201d or \u201cMexico City Policy,\u201d has stripped millions of dollars away from foreign aid groups that didn\u2019t abide by it. It\u2019s also had a chilling effect<\/a>: In Zambia, one group removed information in brochures on contraception, and in Turkey, some providers stopped talking with patients about menstrual regulation as a form of family planning.<\/p>\n Project 2025 called on the next president to reinstate the gag rule, saying it \u201cshould be drafted broadly to apply to all foreign assistance.\u201d<\/p>\n Trump also signed an executive order rolling back transgender rights by banning federal funds<\/a> for transition-related care for people under age 19. An order he signed<\/a> also directed the federal government to recognize only two sexes, male and female, and use the term \u201csex\u201d instead of \u201cgender.\u201d<\/p>\n The Project 2025 document calls for deleting the term \u201cgender identity\u201d from federal rules, regulations, and grants and for unwinding policies and procedures that its authors say are used to advance a \u201cradical redefinition of sex.\u201d In addition, it states that Department of Health and Human Services programs should \u201cprotect children\u2019s minds and bodies.\u201d<\/p>\n \u201cRadical actors inside and outside government are promoting harmful identity politics that replaces biological sex with subjective notions of \u2018gender identity,\u2019\u201d the Project 2025 road map reads.<\/p>\n Data Disappears<\/strong><\/p>\n As a result of Trump\u2019s order on gender identity, health researchers say, the Centers for Disease Control and Prevention took down online information<\/a> about transgender health and removed data on LGBTQ+ health. A federal judge on Feb. 11 ordered that much of the information be restored; the administration complied but added notices to some webpages<\/a> labeling them \u201cextremely inaccurate\u201d and claiming they don\u2019t \u201creflect biological reality.\u201d<\/p>\n The CDC also delayed the release of information and findings on bird flu in the agency\u2019s Morbidity and Mortality Weekly Report. Federal workers have said they were told to retract papers<\/a> that contain words such as \u201cnonbinary\u201d or \u201ctransgender.\u201d And some hospitals suspended gender-affirming care such as hormone therapy and puberty blockers for youths.<\/p>\n Advocacy groups say the orders discriminate and pose barriers to medically necessary care, and transgender children and their families have filed a number of court challenges.<\/p>\n Lawyers, advocates, and researchers say implementation of many of Project 2025\u2019s health policy goals poses a threat.<\/p>\n \u201cThe playbook presents an antiscience, antidata, and antimedicine agenda,\u201d according to a piece last year<\/a> by Boston University researchers in JAMA.<\/p>\n The Project 2025 blueprint sets out goals to curb access to medication abortion, restructure public health agencies, and weaken protections against sex-based discrimination. It would have seniors enroll by default in Medicare Advantage plans run by commercial insurers, in essence privatizing the health program for older Americans. And it calls for eliminating coverage requirements for Affordable Care Act plans that people buy without federal subsidies, which, insurance experts say, risks leaving people underinsured.<\/p>\n \u201cIt\u2019s the agenda of the Trump administration,\u201d said Robert Weissman, a co-president of Public Citizen, a progressive consumer rights advocacy group. \u201cIt\u2019s to minimize access to care under the guise of strict work requirements in Medicaid, privatizing Medicare, and rolling back consumer protections and subsidies in the Affordable Care Act.\u201d<\/p>\n The White House didn\u2019t respond to a message seeking comment. Conservatives have said implementation of the project\u2019s proposals would curb waste and fraud in federal health programs and free health systems from the clutches of a radical \u201cwoke\u201d agenda.<\/p>\n \u201cAmericans are tired of their government being used against them,\u201d Paul Dans, a lawyer and former director of Project 2025, said last year<\/a> in a statement. \u201cThe administrative state is, at best, completely out of touch with the American people and, at worst, is weaponized against them.\u201d<\/p>\n Dans did not return messages seeking comment for this article.<\/p>\n The Heritage Foundation has sought to separate itself and Project 2025 from Trump\u2019s executive orders and other initiatives on health.<\/p>\n \u201cThis isn\u2019t about our recommendations in Project 2025 \u2013 something we\u2019ve been doing for more than 40 years. This is about President Trump delivering on his promises to make America safer, stronger, and better than ever before, and he and his team deserve the credit,\u201d Ellen Keenan, a spokesperson for Heritage, said in a statement.<\/p>\n Versions of the document<\/a> have been produced roughly every four years since the 1980s and have influenced other GOP presidents. Former President Ronald Reagan adopted about two-thirds of the recommendations from an earlier Heritage guide, the group says.<\/p>\n In some instances, the Trump administration hasn\u2019t just followed Project 2025\u2019s proposals but has gone beyond them.<\/p>\n The document called on the next president to scale back and \u201cderadicalize\u201d the U.S. Agency for International Development, an independent federal agency that provides foreign aid and assistance, including for many international health programs. The administration hasn\u2019t just scaled back USAID. Trump adviser Elon Musk bragged on his social media platform, X, that his \u201cDepartment of Government Efficiency\u201d fed the agency \u201cinto the wood chipper<\/a>,\u201d physically closing its offices and putting nearly all its staff on administrative leave while ending funding for its programs and disseminating misinformation about them.<\/p>\n But the administration risks waning public support if it adopts the project\u2019s goals to upend U.S. health care and health policy. Almost 60% of voters said they felt negatively about Project 2025 in a September poll by NBC News<\/a>.<\/p>\n \u201cProject 2025 was never a thought exercise; it was always a blueprint,\u201d said Ally Boguhn, a spokesperson for Reproductive Freedom for All, an abortion rights group. \u201cWe\u2019re only a few weeks into his presidency, and it\u2019s setting the groundwork for even more.\u201d<\/p>\n We\u2019d like to speak with current and former personnel from the Department of Health and Human Services or its component agencies who believe the public should understand the impact of what\u2019s happening within the federal health bureaucracy. Please message KFF Health News on Signal at (415) 519-8778 or get in touch here<\/a><\/strong>.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n