A number of voters likely did not foresee that President Donald Trump, early in his administration, would choose to cut billions of dollars from the United States’ leading federal cancer research organization. However, these funding reductions to the National Institutes of Health (NIH) were foreshadowed in Project 2025’s “Mandate for Leadership,” a conservative governance framework that Trump claimed ignorance of during his campaign. His administration has since adopted many of its proposals.
The extensive 922-page document created by the Heritage Foundation, a conservative think tank based in Washington, asserts that the NIH’s control over research funding needs to be disrupted and advocates for limits on financial support to universities and hospitals, portraying this measure as a way to lessen taxpayer funding for what they term “leftist agendas.” As a result, universities face significant cuts in funding that typically supports their overhead costs, prompting concerns that these policies could jeopardize both ongoing and future biomedical research. A federal judge intervened on February 10 to temporarily block these funding reductions after medical organizations and 22 states filed lawsuits against them.
The swift implementation of numerous objectives from Project 2025 reveals that supporters of Trump, many of whom have been involved since his first term and are now part of his second administration, have been laying the groundwork to challenge the national health system for years. This contradicts Trump’s claims on the campaign trail where he frequently stated he was unaware of Project 2025. “I have no idea what Project 2025 is,” Trump stated at a rally in Albuquerque, New Mexico, asserting that he had never read it and had no intention of doing so.
Despite these claims, administration actions closely aligned with the Heritage Foundation’s recommendations have allowed opposition groups and certain state Democrats to prepare legal responses quickly in anticipation of Trump’s maneuvers regarding significant health programs like Medicaid and Medicare, as well as federal health agencies. “There has been extensive preparation for legal action to challenge executive orders and initial actions from various organizations,” noted Noah Bookbinder, president of Citizens for Responsibility and Ethics in Washington, a watchdog organization. “Project 2025 has facilitated readiness for this.”
For instance, the plan proposes allowing states to impose premiums on some Medicaid beneficiaries, introduce work requirements, and set lifetime limits on Medicaid coverage, potentially increasing the number of uninsured individuals following the Biden administration’s expansions of the program. “Although these proposals do not directly change Medicaid eligibility or benefits, they can ultimately result in a reduced number of individuals with health insurance,” explained Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit. “By creating barriers to Medicaid enrollment, such as premiums or requiring proof of employment, you end up creating inequalities in access to coverage based on complexity and financial capability.”
Proposals under consideration by congressional Republicans could lead to substantial reductions in Medicaid funding over the next decade. Project 2025 also advocates for increasing access to health insurance plans that do not adhere to some of the Affordable Care Act’s most stringent consumer protections. While this may provide consumers with more options and lower premiums, they could face significant out-of-pocket expenses for services that are not covered.
Moreover, Project 2025 calls for terminating Medicaid funding for Planned Parenthood affiliates, a crucial healthcare provider for many women across the U.S., which receives approximately $700 million from Medicaid and similar government programs annually. According to a report published by the organization for the 2022-2023 period, only about 4% of the services provided were related to abortion.
The actions of Trump’s administration to remove terms like “equity” from federal documents, eliminate references to transgender identities, and diminish international medical aid—aligned with the wishes outlined in Project 2025—have resulted in significant repercussions, restricting healthcare access and dismantling programs aimed at disease prevention and enhancing maternal health.
For example, an order issued in January reestablished and broadened a prohibition on federal funding for international organizations that provide information on legal abortions. Research indicates that this so-called “global gag rule” has siphoned off millions of dollars from foreign aid organizations that would not comply. Its impact includes situations in which groups in Zambia stopped including contraception information in brochures and providers in Turkey ceased discussing menstrual regulation as a family planning strategy.
Additionally, Project 2025 advocates for the reinstatement of this gag rule to apply broadly to all forms of foreign assistance. Trump also enacted an executive order that curtails transgender rights by prohibiting federal funds from supporting transition-related healthcare for individuals under 19 years of age, and directed federal agencies to recognize only two genders, mandating the use of “sex” instead of “gender.”
The Project 2025 framework calls for the elimination of “gender identity” terminology from federal policies and for reversing initiatives that its authors argue seek to advance a “radical redefinition of sex.” It further insists that Department of Health and Human Services programs should be structured to “protect children’s minds and bodies,” alleging that certain radical movements are harming biological definitions of sex.
Consequently, due to Trump’s directives regarding gender identity, health researchers have noted that the Centers for Disease Control and Prevention (CDC) removed online resources related to transgender health and data on LGBTQ+ health issues. Following a federal court order to restore substantial portions of this information, the administration complied but designated some of the recovered data with disclaimers labeling it as “extremely inaccurate” and declaring it does not reflect “biological reality.” Additionally, the CDC delayed the publication of vital findings related to avian flu in its Morbidity and Mortality Weekly Report. Employees of federal agencies reported being instructed to retract papers employing terms such as “nonbinary” or “transgender,” and numerous hospitals halted gender-affirming treatments, including hormone therapies for youth.
Advocacy organizations contend that these actions discriminate severely and create obstacles to necessary medical care, prompting transgender youth and their families to pursue legal challenges. Many lawyers, advocates, and researchers warn that advancing the health policy objectives of Project 2025 threatens the foundation of medical science and ethical standards. As a group of Boston University researchers described it in a piece for JAMA, the playbook embodies an “antiscience, antidata, and antimedicine agenda.”
Project 2025 outlines intentions to restrict access to medication abortion, reorganize public health institutions, and diminish safeguards against sex-based discrimination. One proposal even suggests that seniors automatically enroll in Medicare Advantage plans operated by private insurers, essentially privatizing the Medicare program. The plan also proposes to eliminate essential coverage mandates for Affordable Care Act plans bought without federal subsidies, which industry experts argue could leave many inadequately insured.
“This embodies the agenda of the Trump administration,” asserted Robert Weissman, co-president of Public Citizen, a consumer rights advocacy group. “The goal is to restrict healthcare access under the pretense of imposing strict work requirements in Medicaid, privatizing Medicare, and rolling back consumer protections and subsidies provided through the Affordable Care Act.”
The White House has not issued any comments in response to inquiries regarding the situation. Advocates on the right have claimed that the implementation of these proposals is intended to eliminate waste and fraud from federal health initiatives and to liberate health systems from what they consider to be a radical “woke” agenda. “Americans are fed up with the government being used against them,” Paul Dans, a lawyer and former director of Project 2025, stated in a past comment. “The administrative state is, at best, completely out of touch with the American public and, at worst, actively working against their interests.” Dans has not provided comments for this article. The Heritage Foundation has distanced itself and Project 2025 from Trump’s executive actions and health strategies, stating, “This is not about our recommendations in Project 2025; it has been part of our work for over four decades. This reflects President Trump delivering on his commitment to enhance safety, strength, and wellbeing in America, and he and his team deserve recognition for their achievements.
