With fewer than 70 days to the election, Americans are starting to learn about the distinct visions that Vice President Kamala Harris and former President Donald Trump have for our country’s future. Nowhere is the divide between the two candidates wider than in health care. Though health care has frequently played a pivotal role in presidential contests, this November’s election may be among the most consequential for our patients.
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While Harris and Governor Tim Walz will work to build on the successes of the Biden-Harris administration over the past four years—continuing efforts to lower prescription drug costs and address medical debt, for instance—Trump and his running mate J.D. Vance have said relatively little about their health policy agenda. But Project 2025 offers a glimpse of what it could look like.
Sponsored by the right-wing think tank, the Heritage Foundation, the Project 2025 policy agenda was written by more than 400 conservative experts and published in a book titled Mandate for Leadership: The Conservative Promise. While Trump has publicly disavowed the initiative, he has endorsed (and even tried to implement) many of its core proposals, several of which were penned by his former staffers.
Here are a few examples of how the Project 2025 agenda would leave my patients—and those of clinicians across the country—worse off.
Making medications more expensive
I’ve taken care of countless patients who rely on insulin to control their diabetes. When these patients don’t take their insulin, they’re at risk of not just worsened diabetes (which increases the risk of heart attacks and strokes) but also life-threatening medical emergencies from dangerously high blood-sugar levels. In the decades preceding the Biden-Harris administration, the out-of-pocket cost of insulin steadily grew, forcing many patients to cut back elsewhere to afford their insulin and others to forgo it altogether.
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The Inflation Reduction Act (IRA)—signed into law by President Biden two years ago—capped insulin costs at $35 per month for people on Medicare. The data show that this cap increased the number of insulin prescriptions that were filled, ensuring more patients with diabetes got what they needed to stay healthy. The IRA will also cap annual out-of-pocket spending on prescription drugs (not just insulin) for seniors starting next year. And despite aggressive lobbying and legal challenges from drugmakers, the law empowered Medicare to negotiate prices with Big Pharma for the first time in history, achieving significant discounts and saving billions. These are just a few of the many reasons more than 500 health professionals recently signed an open letter to protect the IRA.
Yet at a time when a third of Americans report not filling a prescription due to cost, Project 2025 calls for these life-saving provisions to be rolled back. IRA repeal, supported by Trump and Vance, would make drugs like insulin more expensive and force patients to shoulder more of the costs of the medications we prescribe them, forcing impossible choices between health and livelihood.
Decreasing access to Medicaid
Project 2025 doesn’t just try to scale back recent successes in making care more affordable for people on Medicare. It also seeks to weaken Medicaid, which more than 70 million low-income Americans rely on for health care. The authors propose instituting lifetime caps on benefits and adding work requirements as a condition for coverage, creating administrative hurdles that make life harder for people who have the least. Together, these provisions could cause millions of people—including those who are currently working—to lose coverage. These policies punish patients for being poor, and in one of the harshest ways: by denying them health care.
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Restricting reproductive health care
And at a time when reproductive rights are under attack in so many states, Project 2025 would not only further restrict abortion at the national level but also eliminate no-cost coverage for some contraception, erecting more barriers to evidence-based care for patients of reproductive age.
Endangering childrens’ health
Finally, Project 2025 takes particular aim at the well-being of children. The authors seek to prevent public health agencies from requiring vaccination in school children, which could cause more outbreaks of preventable diseases like measles. They also propose invalidating state laws intended to stem gun violence, a leading cause of death for children in the U.S. Project 2025 would even eliminate Head Start, a critical program for early childhood development, especially in low-income and rural communities.
If elected, Trump might not adopt all of these proposals. But if he institutes even some of these plans, it would set back decades of progress in medicine and public health.
As doctors, we know that progress on these issues did not come easily. The Affordable Care Act was hotly contested and survived multiple partisan efforts to dismantle it—including by Trump during his first term. For more than ten years, Medicaid expansion has been a fierce and ongoing state-by-state battle. The pharmaceutical industry fought tooth-and-nail against drug-price negotiation. At every step of the way, countless doctors have stood up for their patients, advocating for greater access to affordable medical care. The prospect of these hard-fought victories being reversed—and the suffering it would cause our patients—is worth another fight.
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