A Right to Health: Day One Policy Actions for 2029
By Susan Czajkowski | Project 2029 Board of Advisors
Susan Miller | Project 2029 Board of Advisors
Rebecca Moryl | Project 2029 Deputy Policy Chief
Luke Sassa | Project 2029 Deputy Policy Chief
Editor’s Note: This brief proposes health and well-being policies that are immediately implementable on ‘Day One’ of a 2029 Presidential administration. These proposals are designed to take immediate steps toward advancing a fundamental right to health for all Americans in support of Project 2029’s upcoming proposal for a Congressionally codified universal healthcare system. We have identified several actionable healthcare priorities for ‘Day One’ policy within five priority areas: (1) federally recognize a right to whole-person health (2) reinvigorate a focus on public health, (3) ensure healthcare is research and evidence based, (4) provide equity in healthcare access & address health disparities, (5) reduce prescription drug prices, and (6) foster nutrition and physical activity as critical inputs to health.
Table of Contents
Federally recognize a right to whole-person health
Reinvigorate a focus on public health
Ensure healthcare is research and evidence-based
Provide equity in healthcare access & address health disparities
Reduce prescription drug prices
Foster nutrition & physical activity as critical inputs to health
A Right to Health is Fundamental
It is of fundamental interest to the United States to prevent illness, alleviate the consequences of disease, and promote physical and mental well-being across all income levels and communities. A healthier population strengthens families, communities, and the national economy, while reducing long-term public and private costs associated with preventable illness
Improving health outcomes is not only a moral imperative but also a practical strategy for strengthening the economy, reducing long-term public spending, and enhancing the quality of life across the country. Preventing disease, expanding access to primary care, and addressing the conditions that drive poor health lowers costs over time and supports a more productive workforce. Investments in prevention and primary care reduce reliance on emergency services, lower long-term treatment costs, and improve system efficiency overall.
A ‘right to health’ has been enshrined by the nations of the world in the U.N. and the World Health Organization (W.H.O.), and must be similarly enshrined in the United States in pursuit of a healthier, stronger nation. Federal and state policies, such as the Affordable Care Act, have recognized the human right to adequate healthcare. 1 Still, implementation has been incomplete and has not resulted in upholding an individual’s right to that “highest attainable standard of physical and mental health.” Health as a right requires a holistic approach incorporating medical care, along with attention to the broader social and environmental factors that determine health and well-being. 2
This human right to health is our foundation for addressing current healthcare and well-being problems. The human right to health does NOT mean the government has to directly provide healthcare services for every American. 3 It does mean that the government has a responsibility to implement policies and regulate systems to ensure healthcare access is available to all, to enable the achievement of optimal health for all Americans.
Addressing the environmental, occupational, and social drivers of disease is necessary for ensuring optimal health for all. This includes a recognition of the government's role in social determinants of health, including access to healthy food; safe built environments, including housing, transport, and neighborhoods; and safe natural environments, including air and water. 4 It also includes optimizing access to preventive and therapeutic healthcare.
This initial health policy brief focuses on ‘Day One’ policies that can be implemented by a new administration to realize the right of every American to achieve their maximal health potential. These ‘Day One’ policies exist firmly within our vision of establishing and supporting a right to health in the U.S., and a stronger and healthier nation overall. 5 6
Federally Recognize a Right to Health
Problem: A right to health must include mental and physical health
A whole-of-society approach is needed to transform our healthcare system from a system oriented toward high-cost, reactive treatment to one that emphasizes prevention, early intervention, and long-term well-being. This transformation requires integrating preventive, behavioral, and biomedical interventions and emphasizes prevention of disease. It supports interventions that promote healthy lifestyles and positive mental and behavioral health in our healthcare and broader societal structures.
This approach ensures our federal, state, and local policies and systems of care provide an environment that supports mental and physical health in all aspects of life and for all people. Integrating mental, behavioral, and physical health improves outcomes while reducing fragmentation, duplication of services, and avoidable long-term costs.
Policy Solution: Establish a focus on whole-person health
The President shall issue an executive order directing the Secretary of HHS, in consultation with the Secretaries of Veterans Affairs, Defense, Education, Housing and Urban Development, and the heads of other relevant agencies, to adopt a unified federal definition of “healthcare” that encompasses physical, mental, behavioral, preventive, and social determinants of health. Pursuant to the President’s constitutional duty under Article II, Section 3 to ensure the faithful execution of the laws, and consistent with the nondiscrimination protections in Section 1557 of the Affordable Care Act (42 U.S.C. § 18116), the order shall instruct all federal agencies administering health-related programs to interpret “healthcare” to include all clinically appropriate and evidence-based services that seek to maintain or restore physical or mental health.
This interpretation shall apply to programs authorized under the Public Health Service Act, which grants the Secretary of HHS broad authority to promote and coordinate public health and disease prevention activities, thereby supporting an inclusive definition of “healthcare” that encompasses behavioral and preventive services as integral to maintaining population well-being.
It shall also apply to programs administered under the Social Security Act, including Medicare and Medicaid. Under its existing authorities, including 42 U.S.C. § 1315a, 42 § 1395hh, and 42 § 1396a(a), Centers for Medicare and Medicaid Services (CMS) is empowered to design, test, and revise Medicare and Medicaid payment and delivery models, issue regulations defining covered services and medical necessity, and oversee state plan compliance, providing the legal foundation to implement integrated, whole-person care models. Building on these authorities, the executive order shall direct CMS, in coordination with the Health Resources and Services Administration (HRSA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), to:
Issue joint guidance clarifying that reimbursement, coverage, and quality metrics must treat behavioral and preventive services as medically necessary components of healthcare; and
Revise CMS payment and quality frameworks to expand value-based care models that emphasize prevention, primary care, and integration of behavioral and physical healthcare. Doing so will incentivize prevention, encourage and enable access to interventions that optimize healthy behaviors and behavioral health, improve care coordination, and reduce long-term expenditures and administrative burden across payers and providers.
The Mental Health Parity and Addiction Equity Act (29 U.S.C. § 1185a) further provides a policy foundation for eliminating any artificial distinction between physical and mental health coverage by requiring parity in treatment limitations and financial requirements. This means that insurers and health programs must cover mental health and substance use disorder services at the same level as medical and surgical services, without imposing stricter limits, higher co-pays, or more restrictive treatment rules for behavioral health. By reinforcing this principle, the executive order can build on existing law to ensure that federal agencies treat behavioral, preventive, and social services as core components of healthcare under a unified, whole-person definition.
In implementing this unified interpretation, agencies shall follow the procedural requirements of the Administrative Procedure Act (5 U.S.C. § 553) to propose and finalize conforming regulations that harmonize definitions of “healthcare,” “health service,” and “medical necessity” across applicable programs and funding mechanisms.
Policy Solution: Issue an executive order recognizing health as a protected human right within existing Civil Rights law
A new presidential administration shall issue an executive order establishing health as a protected human right under existing civil rights law, recognizing that access to evidence-based preventive and therapeutic care is essential to preventing avoidable illness, disease, and long-term system costs. Ensuring consistent access to evidence-based care supports prevention, earlier intervention, and reduced reliance on high-cost emergency services.
Grounded in the President’s constitutional Article II Section 3 authority to “take Care that the Laws be faithfully executed,” the executive order shall direct the Secretary of Health and Human Services (HHS), pursuant to Section 1557 of the Affordable Care Act (42 U.S.C. § 18116), to issue guidance to reinterpret existing civil rights protections in health programs and activities.
This guidance shall clarify that denial of access to medically necessary or essential health services, whether through economic, geographic, or administrative barriers, can constitute a form of prohibited discrimination under federal law when such denials have a disparate impact on individuals protected by Title VI of the Civil Rights Act of 1964 (race, color, or national origin), Title IX of the Education Amendments of 1972 (sex), the Age Discrimination Act of 1975 (age), or Section 504 of the Rehabilitation Act of 1973 (disability). The HHS guidance shall include an analysis of and recommendations for the implementation of this framework.
Under this interpretation, the HHS Office for Civil Rights (OCR) must leverage its established powers to investigate, enforce, and remedy discriminatory denials of care or coverage. These powers include conducting compliance reviews, requiring corrective action plans, and, where necessary, initiating proceedings to suspend or withdraw federal funds. Individuals denied care or coverage under these circumstances would retain the right to file complaints with OCR or pursue civil actions alleging discrimination in access to healthcare. The HHS guidance shall include analysis of and recommendations for further implementation.
Upon review and analysis of the HHS guidance, the Secretary shall then initiate rulemaking under 5 U.S.C. § 553 to codify this interpretation and ensure that all HHS programs, funding recipients, and enforcement mechanisms align with the clarified definition of discrimination. Pending further congressional action, the executive order shall also instruct all relevant agencies to interpret and enforce existing civil rights authorities to the maximum permissible extent to protect this right.
Policy Solution: Establish a White House Interagency Council on Health and Well-being to create and align integrated systems to promote healthy behaviors & environments
A shift toward establishing a right to health will require coordinated policy development and implementation across all relevant executive branch Departments. Coordinated action across agencies improves efficiency, reduces duplication, and aligns federal investments to address the factors that contribute to whole-person health and disease prevention rather than exclusively to acute and chronic disease treatment and management. The President shall issue an executive order establishing a White House Interagency Task Force to develop integrated policies across all relevant Departments to support and improve health.
This body shall serve as the federal government’s central coordinating mechanism for identifying and implementing evidence-based reforms that improve healthcare access, food and drug safety, and nutrition standards, reduce preventable disease, and strengthen overall system performance..
The Task Force shall include senior representatives from the:
Department of Health and Human Services (HHS), as the lead agency;
Food and Drug Administration (FDA), as the regulatory authority over food and drugs (21 U.S.C. §§ 301 et seq.);
Centers for Disease Control and Prevention (CDC), tasked with national disease monitoring and prevention (42 U.S.C. § 247d);
National Institutes of Health (NIH), conducting medical and public health research;
Department of Agriculture (USDA), providing food assistance, school nutrition, and procurement standards (42 U.S.C. § 1753; 7 U.S.C. § 1431e);
Department of Justice (DOJ), enforcing fraud and food mislabeling violations (21 U.S.C. § 331; 15 U.S.C. § 45);
Federal Trade Commission (FTC), safeguarding consumer protection against deceptive food and drug marketing (15 U.S.C. § 45).
Department of Veterans Affairs (VA), supporting veteran healthcare integration and nutrition standards;
Department of Labor, enforcing workplace safety and promoting employment for individuals with health conditions;
Environmental Protection Agency (EPA), ensuring safe environments, including clean drinking water and clean air;
Centers for Medicare & Medicaid Services (CMS), overseeing the implementation of coverage, affordability, and prescription drug cost control (42 U.S.C. § 1395hh);
The Agency for Healthcare Research and Quality (AHRQ), as the lead agency for healthcare synthesis and evaluation standards;
Department of Education, guiding best educational practices in leading a healthy lifestyle, accessing healthcare, and strengthening school-based movement standards;
The Department of Transportation (DOT) and the Department of Housing and Urban Development (HUD), integrating walkability and physical activity into federal transportation planning, housing policy, land use, and community development programs by incentivizing walkable and bikeable community design, expanding access to parks and recreation, and promoting equitable access to safe spaces for physical activity (23 U.S.C. §§ 133; 42 U.S.C. § 5301)
The Task Force shall also coordinate with non-governmental stakeholders, including public health NGOs, academic experts, patient advocacy groups, and medical associations. This should include maintaining a formal channel of collaboration with the World Health Organization (WHO) and other global health bodies to align with international standards and evidence-based best practices.
The Task Force shall coordinate across agencies and with partner organizations to execute the following core goals:
Non-Discriminatory Access to Healthcare: guide agency interpretations and civil rights enforcement to ensure non-discriminatory access to care, including mental health (i.e, substance and use disorders) and reproductive health (42 U.S.C. § 2000d; and Medicaid waivers under 42 U.S.C. § 1315).
Health Disparities Research and Intervention: prioritize addressing health inequities affecting groups where health disparities exist, including people of color, LGBTQ+ communities, women, children, rural residents, low-income populations, and Black maternal mortality rates. 7
Prescription Drug Cost Control: coordinate Medicare drug price negotiations and reductions under the Inflation Reduction Act (IRA, Pub. L. No. 117-169)
Mental Health Integration: direct agencies to treat mental health as healthcare under federal programs (42 U.S.C. § 290aa et seq.).
Global Health Leadership: restore U.S. participation in the WHO by rescinding prior withdrawal orders.
Food Safety and Nutrition Reform: enforce bans on toxic additives and contaminants (21 U.S.C. §§ 342, 348, 371).
To reduce waste and overlapping efforts across agencies, the Task Force should:
Commission the Government Accountability Office (GAO) and agency Inspectors General to identify inefficiencies and recommend structural reforms that support and streamline promotion of health and well-being across the executive branch.
Direct the Office of Management and Budget (OMB), under 31 U.S.C. § 1115, to align budgets and performance goals across HHS, USDA, Department of Defense (Tricare), and Veterans Administration (VA) programs.
Consolidate overlapping nutrition programs (SNAP, WIC, VA hospitals, school meals) under unified procurement standards to maximize federal purchasing power.
Key Healthcare Priorities for ‘Day One’ Action
In addition to establishing a right to health, we have identified a number of actionable priorities that can be implemented on ‘Day One’ to improve outcomes, equity, and system sustainability. These fall within five priority areas:
Provide equity in healthcare access & address health disparities
Foster nutrition and physical activity as critical inputs to health.
Priority: Reinvigorate a focus on public health
Public health investments are among the most cost-effective tools for improving population health and reducing long-term healthcare spending. In addition to treating people who are sick through health care, the government must reinvigorate its focus on public health to better prevent occurrences of illness and injury. Public health focuses on disease prevention and health promotion. 8. Improving public health requires policies that address social determinants of health to ensure the well-being of populations in neighborhoods, cities, states, and regions.
The U.S. public health system provided a robust response to the COVID-19 crisis, but faced significant obstacles caused by insufficient funding, resources, and infrastructure, as well as institutional silos. 9 In order to be prepared for the increasing risk of future public health emergencies, we must invest in public health. 10 Studies have shown that every additional dollar spent on preventive care, such as environmental health, health education, and chronic disease prevention, can reduce long-term healthcare costs and improve population health outcomes. 11 The following ‘Day One’ policies support this critical priority:
Problem: Accessing accurate, evidence-based health information is a challenge
Public health activities promote health and prevent disease. The dissemination of health information is a critical role that public health plays in promoting health. Accurate, trusted information supports early prevention, informed decision-making, and adherence to evidence-based care. In our current information ecosystem of polarization, misinformation, and the erosion of shared, trusted sources for health information, identifying and accessing evidence-based information is a challenge. 12 Faced with a deluge of information, reliable sources for the dissemination of accurate information are critical.
A reinvigoration of public health must include efforts to identify existing and leverage trusted sources across communities to disseminate health information.
Policy Solution: Establish a White House Task Force on communicating evidence-based health information
A new administration shall issue an executive order establishing a Task Force to identify strategies to communicate evidence-based health information. This body shall reestablish active, reliable, and trusted sources for health information for providers and the public to improve public understanding, reduce preventable harm, and strengthen confidence in evidence-based health guidance. The Task Force shall identify and implement best practices in the dissemination of health information for disease prevention and health promotion, including the identification of and partnership with trusted community and faith leaders. 13 14
The Task Force shall also identify and implement strategies to curb the spread of false health and well-being information that undermines public health and patient safety. Enforcement efforts are intended to protect public health and consumer safety while preserving constitutional protections for free expression. To achieve these goals, the Task Force shall include representatives from:
HHS, as the lead agency, and representatives from its Departments, including:
The CDC, for national monitoring of misinformation-related harms;
The FDA, for oversight of misleading health product claims;
NIH, the National Science Foundation (NSF), and the Office of Science and Technology Policy (OSTP), to coordinate behavioral and communications research on misinformation dynamics and public response under 42 U.S.C. § 241 and 42 U.S.C. § 289, with resulting data informing regulatory design, future legislative proposals, and targeted strategies;
The Department of Education, to enhance public capacity to evaluate and integrate health information by integrating health and science education into K–12 and adult learning systems. Acting under 20 U.S.C. §§ 1221e-3 and 20 U.S.C. 3412(a)(2)(A), the Secretary and Deputy Secretary of Education shall:
Develop and disseminate evidence-based educational materials, lesson plans, and digital content that promote scientific reasoning, media literacy, and public health understanding;
Coordinate with state and local education agencies to incorporate these materials into curricula and continuing education programs;
Partner with the CDC, NIH, and NSF to ensure content accuracy and alignment with evolving scientific consensus; and
Expand teacher training and community education programs that equip educators to foster informed, critical engagement with health information across diverse populations;
The Task Force shall also partner with public communication networks to coordinate evidence-based campaigns, ensuring the public receives clear and consistent healthcare and wellness information.
To ensure that federal resources do not indirectly subsidize the dissemination of health misinformation, the President must direct the Office of Management and Budget (OMB) and the General Services Administration (GSA) to integrate misinformation mitigation standards into all federal procurement, advertising, and public education contracts. This condition shall be applied pursuant to the President’s authority under 41 U.S.C. §§ 3301–3307 and OMB’s procurement oversight, consistent with the federal government’s responsibility to ensure that all expenditures serve the public interest.
Policy Solution: Restore the role of public health data
Budget cuts and layoffs, program elimination, and defunding in recent years have significantly weakened the public health data infrastructure, limiting the government’s ability to respond efficiently to health threats. 15 16 Recent research also raises concerns about changes to federal health datasets that lack transparency and may undermine public trust. 17
Public health data provide the foundation for improving population health outcomes, enabling earlier intervention, better targeting of prevention strategies, and more efficient use of public resources. Reliable, timely data tracking allows policymakers and health systems to identify emerging risks early and reduce avoidable illness and downstream medical costs. Such data may be used to identify increases and causes of chronic disease, clusters of chronic and infectious disease, immunization rates, and exposure to environmental health risks.
These data serve as the basis for developing and evaluating health promotion and disease prevention strategies across the American population.
Policy Solution: Restore and improve the resilience of public health data systems
A new administration shall immediately direct federal departments responsible for collecting, retaining, and publishing health-related data sets to review their health-related data systems, including census data. Departments shall assess existing damage and develop proposals (including required funding) to not only reconstruct damaged public health data systems, but also improve their interoperability, privacy protections, validity, accessibility, and exchange within and across levels of government, while also coordinating with academia and researchers. This must be done in concert with safeguards to protect the individual identities of the sources of health data, ensuring public health data are used to improve outcomes and system performance rather than for enforcement or surveillance.
Policy Solution: Restore the role of public health data in pandemic response
Public health data play a critical role in informing policy decisions and improving pandemic and disease outbreak response. 18 A new administration shall restore relevant elements of Executive Order 13994, known as "Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats. 19 This order, signed on January 21, 2021, focused on enhancing the collection, sharing, and use of public health data across federal agencies to better inform policy decisions and improve pandemic response. Specifically, it directed the heads of relevant agencies to designate senior officials responsible for leading efforts to modernize public health data systems, ensuring interoperability, privacy protections, and real-time data exchange.
The order also required that agencies work collaboratively with the Office of Management and Budget (OMB) to identify data gaps, improve data collection infrastructure, and increase transparency in public health communication. Ultimately, this order aimed to create a more unified, data-driven federal approach to managing not only COVID-19 but also future pandemics or biological threats, thus strengthening federal readiness for future public health emergencies while reducing reliance on ad hoc crisis response.
Priority: Ensure healthcare is research and evidence-based
Extensive research demonstrates that evidence-based medicine improves patient outcomes while delivering greater cost-effectiveness and return on public investment. 20
Problem: Immunization recommendations are not research and evidence-based
Recent changes to the structure and composition of the Advisory Committee on Immunization Practices (ACIP) have created uncertainty among clinicians and parents and weakened confidence in vaccine guidance. 21 ACIP is the federal advisory committee tasked with developing recommendations for the use of vaccines in the U.S. population. Stable, evidence-driven immunization guidance is essential to maintaining vaccine uptake while preventing outbreaks and avoidable healthcare costs. 22 A subsequent 2026 action by the reconstituted ACIP to cut the number of recommended childhood vaccines was sharply criticized by leading pediatric medical organizations. 23 These changes also negatively impact vaccine access and affordability. 24
Policy Solution: Reconstitute ACIP to be research and evidence-based, to foster trust, and to expand vaccine access and affordability
A new administration shall direct HHS to remove unqualified members and reconstitute ACIP in accordance with its charter. 25 HHS shall also review and reinstate necessary staff positions that were eliminated, but are required for the effective functioning of ACIP. 24 This reconstituted ACIP shall be tasked with immediately reviewing and revising the recommended vaccine schedule.
Problem: Cuts in science research are a significant setback to health outcomes now and in the future
For decades, the U.S. government's investments in health research led to historic eradications of infectious disease, reductions in illness and death from chronic disease, and cutting-edge advances in health interventions to improve length and quality of life. This prioritization of research has simultaneously driven technological advances, fostered new industries, supported economic growth, and supported national security. 26 These investments have also produced gains in life expectancy that have an estimated economic impact of about $38 trillion per year, demonstrating the substantial economic returns created by investing in health research.
Recent administration cuts to medical research funding and reductions in staffing and funding for research agencies, such as the National Institutes of Health and Food and Drug Administration, will delay treatments and cures for major diseases, weaken regulatory oversight, and increase long-term healthcare costs. 27 These cuts also negatively impact the quality of drugs, food, and other consumer products that households rely on. 28
Policy Solution: Establish a task force to restore and ensure resilience for agencies focused on health research and policy
The President shall convene a Task Force composed of medical research representatives and practicing organizations to plan and implement a restoration and reinvigoration of agencies critical in supporting evidence-based research. 29 Rebuilding research capacity is essential to sustaining innovation, protecting public health, and ensuring effective use of federal healthcare spending. This stakeholder group shall identify, plan, and supervise the restoration of key agencies, including but not limited to: the National Institutes of Health, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the U.S. Vaccine Committee, and agencies tasked with understanding and addressing health disparities, including:
FDA's Office of Minority Health and Health Equity
HHS Office of Minority Health
CMS Office of Minority Health
NIMHD National Institute on Minority Health and Health Disparities
In addition to restoring the capacity, staffing, and resources of these agencies, this stakeholder task force shall develop mechanisms to ensure their resilience. This will include, but not be limited to:
Guardrails to ensure appointment processes for leadership roles include review and approval by nonpartisan professional organizations to protect scientific independence and long-term institutional stability;
Requirements for sustainable funding.
Policy Solution: Rescind or suspend Executive Orders, memoranda, and/or regulatory actions that undermine a research-based healthcare system
Ensuring a research- and evidence-based healthcare system requires reversing prior actions that weakened scientific integrity, data transparency, and institutional capacity.
A new administration shall direct the Office of Science and Technology Policy (OSTP), the HHS, and OMB to work with the Task Force to restore, reinvigorate, and ensure resilience for health research and policy by identifying and immediately rescinding or suspending any executive orders, memoranda, or regulatory actions from the previous administration that:
Undermined scientific integrity or evidence-based policymaking;
Restricted public health data collection, transparency, or reporting; or
Removed and opposed diversity, equity, and inclusion standards in federally funded health or research programs.
The OSTP shall publish a public inventory of such actions within 30 days and recommend replacement directives to ensure federal science and healthcare policy is grounded in independent, peer-reviewed evidence.
Furthermore, the administration shall build resilience into a research and science-based system for future healthcare infrastructure by working to ensure that these initial executive order actions are subsequently supported by legislation. Doing so will provide durability beyond initial executive action and reduce future disruptions.
Policy Solution: Support funding mechanisms, policies & structures that promote development of innovative solutions to longstanding, complex, and/or resistant health problems
Behavioral and social factors, such as tobacco use, poor nutrition, and physical inactivity, have been found to contribute substantially to premature deaths in the U.S., as well as to specific diseases such as cancer. Thus, developing new approaches to improving these behavioral and social risk factors, including addressing their social and environmental drivers, is a critical priority for reducing chronic disease and disability and extending life. In addition, more effective approaches are needed to ensure that existing evidence-based interventions to reduce behavioral risk factors that have been developed are routinely implemented and accessible to all Americans.
Agencies such as the National Institutes of Health, as well as ARPA-H, have key roles to play in generating novel and more effective approaches to address behavioral risk factors and thus reduce chronic disease burden. The President shall direct the Office of Science and Technology Policy (OSTP) to amend ARPA-H’s mandate and appropriations framework to include bold research into behavioral, psychological, and social determinants of health. Within 180 days, OSTP shall propose legislation to authorize appropriations (including personnel requirements) for permanent cross-agency behavioral “labs” within NIH Institutes to incubate novel prevention and treatment models that bridge behavioral and biomedical science.
Policy Solution: Secure health services research as critical infrastructure for effective healthcare governance
Scientific integrity and transparency of evidence are critical policies that must be upheld for HHS health research and evidence-based agencies. This includes clear standards for disclosure of research methods, protected funding for scientific grant review committees, and guardrails against suppression, delay, or political editing of research findings. A new administration shall recognize health services research as core national infrastructure for effective healthcare governance. On ‘Day One,’ the HHS shall direct the Agency for Healthcare Research and Quality (AHRQ) to lead a Federal Health Services Research & Learning Agenda for American Healthcare, in partnership with CMS, CDC, NIH, and the VHA, to generate, synthesize, and translate evidence-based needs and recommendations to improve US healthcare research, healthcare system performance, patient safety, equity, and affordability.
Policy Solution: Create funding mechanisms, policies & structures that can support solutions-oriented long-term research targeting pressing health issues/problems
The President shall direct NIH, NSF, and the Advanced Research Projects Agency for Health (ARPA-H) to prioritize multi-year funding programs targeting systemic health challenges, including addiction, health behavior intervention development and testing, behavioral health, and chronic disease prevention. OSTP shall coordinate the development of new grant mechanisms that fund outcome-based research across behavioral and biomedical domains, with clear outcome metrics and cross-agency accountability.
Policy Solution: Target lines of research funding to address health problems for the most vulnerable communities
High-quality data are essential for identifying disparities in access, outcomes, and drivers of health across populations. Enhancing data collection will allow for better evaluation of subpopulations and coordination across agencies. 30 The President shall direct NIH, the Substance Abuse and Mental Health Services Administration (SAMHSA), Health Resources and Services Administration, Indian Health Services (IHS), and the CDC to establish dedicated funding lines addressing health inequities affecting groups where health disparities exist, including people of color, the LGBTQ+ community, women, children, rural residents, and low-income populations.
A 2025 technical brief by the HHS Agency for Healthcare Research and Quality recommended updates to the framework and scope of the National Healthcare Quality and Disparities Report, implementation of which shall be a top priority. These include reorienting the equity lens to consider access to care and drivers of health, expanding the types of care and care settings considered, and shifting the framework toward population health (outcomes) as opposed to focusing only on healthcare quality. Agencies shall set measurable goals and report annually on progress in closing health outcome gaps by population and geography.
Policy Solution: Rebuild the employee pipeline to make research a viable & stable career choice
A new administration can restore medical research as a viable career choice for young people through targeted and well-resourced funds for career development from graduate through post-doctoral and early-stage investigator levels. This includes providing a variety of support mechanisms for mid- and senior scientists in addition to regular (R01) research grant mechanisms. Workforce stability is essential to maintaining research continuity, institutional knowledge, and long-term return on federal research investments.
The President shall direct OSTP, NIH, and NSF to launch a Research Careers for the Future Initiative with new fellowships and grants spanning graduate through mid-career stages. Graduate and early-stage investigators shall receive secure, multi-year funding commitments to allow stable career development, while mid-career and senior researchers shall gain access to bridge grants that sustain their work during funding gaps. OSTP and the Office of Management and Budget (OMB) shall report annually on workforce stability and diversity metrics in federally funded research.
Policy Solution: Secure research funding for multilevel, whole-of-community approaches to addressing health problems
‘Whole-of-community’ approaches to health promotion and disease prevention are recommended by the National Institutes of Health and others. 31 These approaches are associated with improved outcomes by addressing risk factors upstream and reducing reliance on costly clinical interventions. The President shall direct HHS, in coordination with the Departments of Housing and Urban Development (HUD) and Agriculture (USDA), to reinstate where necessary and secure funding for community health programming in states and municipalities. 32 Grants shall support partnerships among local governments, nonprofits, community representatives, and universities to support interventions that reduce behavioral and psychosocial risk factors and improve population health outcomes.
Policy Solution: Rejoin the WHO
Withdrawing from the World Health Organization by Presidential directive in 2025 has adverse consequences for the United States and the world. In particular, this withdrawal is likely to negatively impact pandemic preparedness, cross-border collaboration on health initiatives and urgent crises, health inequality across the globe, and American influence on global health policies and priorities. 33
A new administration shall rescind Executive Order 14155, known as "Withdrawing the United States from the World Health Organization," and direct CDC staff and others to reestablish working relationships with staff of the WHO. This order expressed the intent to withdraw the United States from the World Health Organization (WHO), while also directing the Secretary of State and the Director of the Office of Management and Budget to "pause the future transfer of any United States Government funds, support, or resources to the WHO." Rescinding this executive order and then issuing new corrective executive action will enable a future administration to restore American participation in the WHO, while advancing U.S. national security, economic stability, and global health leadership.
Priority: Provide equity in healthcare access & address health disparities
Despite overall advances in medical care, the United States continues to experience uneven access to healthcare and preventable differences in health outcomes across communities. Documented health disparities persist across the U.S., driven by racial, ethnic, and geographic factors, as recorded in the National Healthcare Quality and Disparities Report published by the Department of Health and Human Services since 2018, reflecting differences in access to care, coverage, environmental conditions, and availability of services.
Disparities are evident in measurable health outcomes: For example, average years of life expectancy in 2021 ranged from 83.5 for Asian people, 77.7 for Hispanic people, 76.4 for non-Hispanic White people, 70.8 for non-Hispanic Black people, and 65.2 for American Indian or Alaska Native people. 34
Disparities are also reflected in access to care: With more than 63% of U.S. counties facing shortages of primary care doctors, more than 70% of those counties are designated as rural or small towns.
Disparities are further reflected in health insurance coverage: Access to care differs geographically across states, with the percentage of the population covered by health insurance ranging from 77.6% to 96.7%. It also differs along racial and ethnic lines, with Hispanic and American Indian or Alaska Native populations the least likely to have health insurance coverage.
Disparities also exist in access to types of care: access to mental health services and treatment is particularly lacking for young people, especially those who are low-income or Hispanic.
Problem: Rural disparities in health access and outcomes
Approximately 15% of the U.S. population lives in rural areas. Rural health outcomes have significant implications for national healthcare costs, workforce participation, and community stability. While urban-rural health access disparities exist globally, they are more pronounced in the U.S. than in many other high-income countries. 35
Research shows that people living in rural areas of the U.S. have higher rates of chronic disease, suicide, lower maternal health, and less access to care than those in urban areas. 35 They experience worse healthcare outcomes for physical, mental, and sexual health, as well as for substance misuse. People living in rural areas also experience lower quality of treatment and more prevalent chronic physical and mental health conditions when compared to more urban areas. 36 Barriers to healthcare access include availability, cost, ability to pay, insurance status, and acceptability, contributing to delayed care and higher downstream treatment costs. 37
As a result of these disparities, rural residents experience a life expectancy approximately two years shorter than their urban counterparts, with mortality rates increasing among the rural population between 1999 and 2019. 36 38 These worse outcomes are expected to be exacerbated as rural hospitals close in the wake of budget cuts and reduced coverage for Medicaid and health exchange subsidies, further increasing pressure on emergency care and regional health systems. 39
Policy Solution: Invest in rural healthcare
Numerous strategies have proven effective for improving access to primary care in rural areas, including incentive programs to attract healthcare professionals to rural areas, community and school-based health programs, mobile clinics and outreach services, telemedicine, and partnering with community organizations such as non-profits, schools, and faith-based organizations. 40 Evidence suggests that improved access to rural healthcare is associated with better population outcomes and longer life expectancies, making this investment both humane and economically sound. 41
To initiate a priority investment in rural healthcare, the president shall direct federal agencies to leverage existing authorities and funding streams that do not require new appropriations. Under 42 U.S.C. § 254c (the Public Health Service Act, Section 330), the Health Resources and Services Administration (HRSA) may expand and reallocate resources to federally qualified health centers (FQHCs) serving rural and underserved communities. The president shall issue an executive order instructing HRSA to prioritize grants, technical assistance, and staffing support for rural clinics, including support for rural residency training programs in primary care, mobile units, and telehealth initiatives using currently appropriated funds.
Similarly, under 42 U.S.C. § 254d, the National Health Service Corps (NHSC) can deploy existing scholarship and loan repayment programs to incentivize physicians, nurse practitioners, and physician assistants to serve in rural areas immediately, effectively increasing the rural clinician-to-patient ratio without awaiting new legislation.
Additionally, agencies can begin administrative and regulatory actions that lay the groundwork for long-term expansion. For example, HRSA and the CMS may issue guidance to expedite telehealth reimbursement, relax licensure reciprocity barriers across state lines under 42 U.S.C. § 1395x (Medicare provisions), and streamline grant applications for community-based and school-based rural programs. By taking these steps, the administration can achieve a rapid ‘Day One’ impact while Congress works on broader appropriations, infrastructure investments, and legislative expansions.
Problem: Women’s reproductive freedoms are not protected
Access to comprehensive reproductive healthcare, including contraception, is closely associated with improved maternal health outcomes, economic stability, and health equity. 42 Recent policy changes have diminished the availability of reproductive healthcare services across many states. After the overturning of Roe v. Wade, women’s healthcare access has diminished not only for abortion care, but also for broader access to family planning services and contraceptive care. 43 The access that does exist is inequitable along geographic, economic, and demographic lines, as well as along divisions of access to and quality of health insurance. 42
While a broader strategy to address reproductive healthcare access and continuity of care is necessary, there are numerous ‘Day One’ policy actions to be implemented.
Policy Solution: Rescind the "Enforcing the Hyde Amendment" Executive Order
Executive Order 14182, known as "Enforcing the Hyde Amendment," shall immediately be rescinded by the next administration. This order, signed on January 24, 2025, revokes prior executive actions that supported access to abortion, contraception, and reproductive healthcare services following the overturning of Roe v. Wade. Executive Orders 14076 and 14079 provided critical federal support for abortion access, contraception, and reproductive healthcare services, particularly for marginalized communities most affected by state-level bans and restrictions.
By eliminating these protections, the new order not only strips away essential guidance for agencies but also significantly weakens the federal government’s ability to support consistent access. The revocation of these orders has increased variability in access to care and legal uncertainty for patients and providers, leaving millions of Americans more vulnerable to forced pregnancies and reduced access to safe, legal medical procedures. A new administration shall reinstate Executive Orders 14076 and 14079.
Policy Solution: Restore the "Protecting Access to Reproductive Healthcare Services" Executive Order
Executive Order 14076, known as "Protecting Access to Reproductive Healthcare Services,” must immediately be restored by the next administration. This order, originally signed on July 13, 2022, was a comprehensive federal response to the rollback of abortion rights following the Supreme Court’s overturning of Roe v. Wade. It directed federal agencies to take immediate steps to safeguard access to reproductive health services, including abortion and contraception, especially for people in states with abortion bans or severe restrictions.
The order required the Secretary of Health and Human Services to develop plans to expand access to medication abortion, emergency contraception, and other family planning services, and to improve public education about reproductive healthcare options and rights. It also launched efforts to bolster legal protections for patients experiencing pregnancy-related emergencies and miscarriages.
To address security and privacy concerns, the order encouraged federal actions to protect clinics, patients, and providers from harassment and violence, and to defend sensitive health data from surveillance or misuse. Additionally, the order created an interagency task force to coordinate and advance reproductive healthcare policy across the federal government, while encouraging pro bono legal assistance for patients and providers.
Policy Solution: Restore the "Securing Access to Reproductive and Other Healthcare Services" Executive Order
Executive Order 14079, known as "Securing Access to Reproductive and Other Healthcare Services," must also be restored by the next administration. This order, originally signed on August 3, 2022, aimed to bolster protections for reproductive healthcare in response to the Supreme Court’s decision to overturn Roe v. Wade. Building upon Executive Order 14076, this directive instructed HHS to take additional steps to safeguard access to abortion and related care, especially in states where restrictive laws have created legal uncertainty and risk for patients and providers.
Specifically, it called on HHS to explore ways to help patients access reproductive care across state lines using Medicaid, reinforce compliance with federal non-discrimination laws among healthcare providers, and provide technical support and guidance to ensure patients are not denied care based on pregnancy status or related conditions. The order also directed HHS to assess and improve federal data collection on how access to reproductive healthcare affects maternal and public health outcomes. Restoring these directives will improve care continuity and support consistent standards across states.
Problem: Transgender people face health inequities in outcomes and in access to care
The American Medical Association and the American Public Health Association, among other leading medical and public health organizations, recognize evidence-based standards of gender-affirming healthcare. 44 45 Research indicates that gender-affirming care is a protective factor for the mental health and well-being of the 2.3 million transgender people living in America. 44 Despite clear consensus from leading professional organizations that gender-affirming care is safe, effective, and evidence-based, many transgender Americans face systemic barriers to accessing medically necessary care, as insurance coverage and availability remain inconsistent across states. 46
Transgender people experience elevated rates of mental health conditions, substance use disorders, violence exposure, and certain infectious diseases. They also face challenges accessing health insurance, with approximately half reporting being denied insurance coverage for gender-affirming care. Further, about half report an inability to find in-network providers to provide care. Even when care is available, 30% of transgender people report postponing necessary medical care, and 40% avoiding preventative screenings for fear of experiencing discrimination or mistreatment. 47 Delayed and foregone care increases preventable health complications and long-term system costs.
Policy Solution: Rescind Executive Order Eliminating Federal support for gender-affirming care
Before initiating new executive action to expand access to lifesaving gender affirming care, the President must first rescind Executive Order 14187, known as "Protecting Children from Chemical and Surgical Mutilation". This order, signed on January 28, 2025, eliminated federal support for gender-affirming care for transgender youth by imposing sweeping restrictions on medical practices, insurance coverage, and state-level autonomy. Timely access to gender-affirming care is critical for the health and well-being of transgender youth as they develop mature physical characteristics. Yet this order defines gender-affirming treatments, including puberty blockers, hormone therapy, and surgeries, as "chemical and surgical mutilation," a term designed to delegitimize medically recognized gender-affirming care.
It directs federal agencies to revoke funding from medical institutions that provide gender-affirming care, mandates the reversal of inclusive healthcare policies, and explicitly instructs departments like HHS, DoD, and the DOJ to initiate actions that defund, criminalize, and stigmatize this care. Rescinding this order is necessary to restore evidence-based federal healthcare policy and enable subsequent executive action.
Policy Solution: Issue Executive Order on lifesaving gender-affirming healthcare access
To ensure consistent, evidence-based access to medically necessary care, the President shall issue an executive order on Lifesaving Gender-Affirming Healthcare Access, directing federal agencies to act immediately as follows:
Clarify Gender-Affirming Care as Medically Necessary Healthcare.
The Secretary of HHS shall direct the Centers for Medicare & Medicaid Services (CMS) to issue formal guidance and adopt regulations clarifying that evidence-based gender-affirming treatments, including puberty blockers, hormone therapy, and surgical procedures, meet the “reasonable and necessary” standard for coverage under Medicare, Medicaid, and other federally funded health programs under the following authorities:
42 U.S.C. § 18116 - prohibiting discrimination on the basis of sex under the Affordable Care Act
42 U.S.C. § 1395hh - granting the Secretary of HHS rulemaking authority for Medicare
42 U.S.C. § 1395y(l)(1) - defining limits on Medicare payment and the “reasonable and necessary” standard for covered services
Clear federal guidance reduces coverage variability, improves continuity of care, and lowers administrative and legal uncertainty. Consequently, CMS shall also clarify that exclusion or denial of coverage for gender-affirming care may constitute discrimination on the basis of sex under Section 1557 of the Affordable Care Act, ensuring consistent interpretation of coverage across federal programs. Section 1557 requires that “Individuals cannot be denied healthcare or health coverage based on their sex,” and that “Sex-specific health programs or activities are permissible only if… the sex-specific health program or activity is substantially related to the achievement of an important health-related or scientific objective.”
Ensure Transgender Youth Can Access Critical Gender-Affirming Care During Puberty.
The HHS Office for Civil Rights shall issue a proposed rule clarifying that the denial of coverage for gender-affirming care to transgender youth, when pursued with the consent of their parents or guardians and in accordance with professional medical standards, constitutes prohibited sex discrimination under Section 1557 of the Affordable Care Act. This rule shall ensure that federally funded health programs, including state Medicaid programs, recognize evidence-based gender-affirming treatments as medically necessary and may not exclude or restrict such care in violation of Section 1557, particularly during puberty, when timely access to gender-affirming care is critical for the health and well-being of transgender youth as they develop mature physical characteristics.
Reinforce Planned Parenthood and Federally Qualified Health Centers (FQHCs) as Access Points for Gender-Affirming Care.
The President shall direct HHS to expand Title X family planning grants and Health Resources and Services Administration (HRSA) funding streams to explicitly include gender-affirming hormone therapy, counseling, and related services. Title X supports low-cost reproductive and sexual health services at clinics such as Planned Parenthood, while HRSA funds Federally Qualified Health Centers that deliver primary care in underserved and rural communities. Expanding these programs’ eligibility criteria ensures that transgender individuals, whether in urban or rural settings, can access medically necessary gender-affirming care without prohibitive cost, stigma, or geographic barriers.
Support Research and Data Modernization.
The NIH and CDC shall restore and expand data collection on sexual orientation and gender identity (SOGI) in federal surveys, ensuring that policy decisions are guided by accurate, up-to-date evidence on access gaps and health outcomes.
Launch a “Gender Health and Wellbeing” Public Education Campaign.
Acting through the Surgeon General and the White House Office of Public Engagement, the administration shall disseminate evidence-based information on the safety, efficacy, and clinical standards of gender-affirming care. This campaign shall mirror the tone and reach of successful HIV destigmatization and mental health awareness initiatives.
Priority: Reduce Prescription Drug Prices
Affordable access to prescription drugs is essential to maintaining health outcomes, supporting medication adherence, and preventing avoidable medical costs. Prescription drugs are a primary tool to both prevent and manage health conditions, particularly chronic diseases, such as diabetes, high cholesterol, and high blood pressure. Experts recognize non-adherence to medication regimens as a significant problem that impacts approximately half of the population receiving prescriptions, resulting in preventable health complications, avoidable hospitalizations, and higher overall healthcare spending. 48 49 Research indicates that non-adherence to medication is often due to prescription costs, particularly among the elderly, low-income, and other vulnerable populations, thus undermining the effectiveness of medical treatment and increasing downstream costs across the healthcare system. 50
Problem: Excessive Burden of prescription drug prices
The per capita cost-burden of prescription drug spending in the United States is higher than in any other industrialized country. 51 A 2024 Rand study found prescription drug prices in other OECD countries averaged approximately 33% of U.S. prices. 52 Approximately 40% of Americans with incomes below $40,000 per year and 25% of all Americans face difficulty affording medications prescribed by their doctor. 53 Based on a 2021 study, more than half of Americans will have at some point not taken prescribed medication because of cost. On average, younger Americans who suffer from depression and have poor health status are less likely to take prescribed medications due to cost. 54 More than 20% of seniors (aged 65+) reported cost-related nonadherence to doctor-prescribed medications, often not filling prescriptions.
Some seniors reported using ‘extreme forms of cost-coping’ to afford their prescriptions, with approximately 9% forgoing ‘basic needs, ’and approximately 5% going into debt. 55 Responding to a survey in 2023, 82% of Americans reported that the cost of prescription drugs is ‘unreasonable.’ On top of rising household prescription drug costs, physician and hospital spending on prescription medication provided to patients in the office, clinic, or hospital is also rising and projected to increase by more than 40% by 2031. 53 Monopoly rights granted by patents and FDA approval contribute to higher prices, particularly when competition is delayed. While generic drugs are available after patent exclusivity runs out, increasingly, firms employ business and legal strategies to retain monopoly power and delay patient access. 51
Policy Solution: Restore the "Lowering Prescription Drug Costs for Americans" Executive Order
A new administration shall restore Executive Order 14087, known as “Lowering Prescription Drug Costs for Americans. ” This order, originally signed on October 14, 2022, aimed to build upon the Inflation Reduction Act (IRA) and further address the high cost of prescription medications in the United States. The order directed HHS, through the Center for Medicare and Medicaid Innovation (CMMI), to explore and test new healthcare payment and delivery models aimed at reducing drug costs and improving access to innovative therapies for Medicare and Medicaid beneficiaries. Among the initiatives considered were a $2 monthly copayment cap on certain generic drugs, support for state-led drug importation and bulk purchasing programs, and measures to enhance transparency and competition in the pharmaceutical market. These actions are designed to improve medication affordability, support prescription adherence, and reduce long-term public spending associated with preventable complications.
Policy Solution: Direct HHS to prioritize high-cost drug negotiations and use international prices as benchmarks
Strategic drug price negotiation is essential to lowering drug costs for patients and fiscal sustainability for Medicare. A new administration must prioritize leveraging the Medicare Drug Price Negotiation Program, established under the Inflation Reduction Act of 2022, to aggressively reduce the cost of high-expenditure prescription drugs. Beginning in 2029, Medicare will be authorized to implement newly negotiated prices of up to 20 drugs annually across both Part B and Part D. 56 To maximize the program’s impact, negotiations should prioritize drugs with the highest budgetary burden and patient cost exposure. The President must direct the Department of Health and Human Services to issue guidance instructing the Centers for Medicare & Medicaid Services to incorporate international reference pricing benchmarks as a negotiating tool. Aligning U.S. prices with those in peer nations will ensure fairer pricing and drive systemic cost reductions, ultimately helping seniors adhere to their prescriptions, reducing preventable hospitalizations, and strengthening Medicare’s long-term solvency.
Policy Solution: Aggressively reduce drug costs for seniors
The 2022 reconciliation bill, known as the Inflation Reduction Act (IRA), allowed Medicare to negotiate down prescription drug prices for the first time. 57 Using a phased approach that enables Medicare to negotiate an increasing amount of prescription drug prices over time, this long-awaited reform will ultimately save seniors enrolled in Medicare billions in healthcare costs. Once a drug is selected for negotiation, drug manufacturers are required under law to participate in negotiations with Medicare, as refusal to negotiate results in stiff financial penalties, including civil monetary penalties and excise taxes on U.S. sales of that drug. 58
In 2023, the Centers for Medicare & Medicaid Services (CMS) announced that 10 Part D drug discounts would go into effect beginning in 2026. 59 CMS estimates that if these negotiated drug prices had applied in 2023, Medicare would have saved $6 billion in costs; Medicare Part D patients are set to save an estimated $1.5 billion out of their own pockets starting in 2026. Overall, the savings will benefit both the consumers of these drugs and the taxpayers who fund Medicare.
In January 2025, the Department of Health and Human Services (HHS) announced that an additional 15 drugs were selected for the next phase of Medicare Part D drug price negotiations. From November 2023 to October 2024, roughly 5.3 million Medicare Part D enrollees took these drugs for conditions including cancer, type 2 diabetes, and asthma. 60
This second cycle of negotiated Part D drug prices will go into effect in 2027, while the third cycle of drug negotiations will expand to allow Medicare to negotiate down another 15 drugs for 2028, including both Part B and Part D drugs. Subsequent cycles, beginning in 2029, will enable Medicare to negotiate the price of 20 Part B and Part D drugs annually. These 20-drug negotiation cycles will continue indefinitely, so long as the IRA remains law, as there is no current expiration date. 60
This existing law creates a golden opportunity for a future administration to take bold action in 2029 to maximize prescription drug savings for seniors by aggressively negotiating down the cost of high-expenditure prescription drugs, while also closing loopholes used to evade negotiations. 61 A future administration must issue an executive order containing the following actions to ensure the Medicare Drug Price Negotiation Program achieves maximum impact:
Direct HHS to issue guidance to CMS to prioritize drugs with the highest Medicare burden and patient out-of-pocket costs. This must include a requirement to extend substantial savings to the greatest number of consumers possible, while also prioritizing drugs that impact low-income seniors.
Direct HHS to issue guidance requiring CMS to incorporate international price referencing benchmarks as a negotiating tool. Aligning U.S. prices with those in peer nations will ensure fairer pricing and drive systemic cost reductions.
Direct CMS, using its HHS authority under 42 U.S.C. § 1395hh, to issue regulations preventing avoidance of Medicare Part B and Part D negotiations through minor or non-clinically meaningful modifications to drugs (such as reformulations, new delivery mechanisms, or slight chemical changes) that do not substantially improve therapeutic value.
Nominate and appoint a new HHS Inspector General, using authority under 5 U.S.C. App. §§ 3, whose enforcement priorities align with the administration’s policy objectives for effective oversight of Medicare drug pricing.
Once appointed, issue a presidential memorandum encouraging the HHS Office of Inspector General to consider, consistent with its independent authority under 42 U.S.C. § 1320a-7k(b), whether additional audits or reviews are warranted to ensure that negotiated Medicare drug prices are accurately applied at the point of sale, that statutory savings are passed through to beneficiaries, and that improper billing, overcharging, or circumvention of negotiated prices is identified and addressed. Where noncompliance is identified, the Office of Inspector General retains discretion to recommend corrective actions, issue civil monetary penalties, or pursue other enforcement measures authorized under federal law with respect to entities participating in Medicare Part B or Part D.
Direct HHS and CMS to create a public, frequently-updated “Medicare Drug Price Reduction” tracker showing which drugs have been discounted, drugs eligible for future selection in the Drug Price Negotiation Program, how many people use them, and potential projected out-of-pocket and taxpayer savings.
Policy Solution: Leverage federal authority & state innovation within Medicaid to overcome rising prescription drug costs & ensure equitable access
The existing Medicare Drug Price Negotiation Program from the 2022 Inflation Reduction Act does not include prescription drugs covered under Medicaid, thus limiting the benefits of the Medicare Drug Price Negotiation Program to Medicare beneficiaries only. Extending cost-containment strategies to Medicaid is critical to ensuring equitable access to essential medications while managing state and federal healthcare expenditures.
The HHS Secretary, acting through the Centers for Medicare & Medicaid Services (CMS), shall initiate a series of pilot programs and policy guidance designed to leverage both federal authority and state innovation to address rising prescription drug costs and ensure equitable access for Medicaid beneficiaries, to the extent permitted under existing law.
Under 42 U.S.C. § 1315, the HHS Secretary may approve demonstration projects that waive certain statutory requirements to test new approaches to program delivery. HHS shall exercise this authority to allow states to pilot negotiated drug pricing and bulk purchasing arrangements as experimental or demonstration projects, provided these pilots maintain or expand coverage and benefits for Medicaid beneficiaries and comply with all applicable federal Medicaid requirements. These projects will enable states to explore cost-saving strategies while maintaining or expanding access to essential medications for their Medicaid recipients.
To further facilitate innovation, HHS shall issue guidance clarifying that demonstration waivers may, where legally permissible, include state-led efforts to negotiate prices directly with manufacturers and/or engage in collaborative purchasing arrangements across multiple states. By pooling purchasing power, states can amplify their leverage to secure lower prices. In parallel, HHS shall convene state Medicaid directors, patient advocacy groups, and pharmaceutical stakeholders to develop a national framework of best practices for Medicaid drug affordability. This framework shall provide guidance on negotiation strategies, equity-focused implementation, and lessons learned from previous demonstration projects.
Finally, a new administration must urge Congress to pass legislation granting Medicaid programs negotiation authority similar to the framework established for Medicare under the 2022 Inflation Reduction Act. Such legislation would provide a legal foundation for states to scale successful cost-saving initiatives beyond the pilot stage.
Priority: Foster nutrition and physical activity as critical inputs to health
Diet quality and physical activity are foundational drivers of population health outcomes and long-term healthcare costs.
Problem: Inadequate food standards, labelling, and information
Poor quality diet and nutrient intake directly correlate with poor health outcomes, including obesity, diabetes, heart disease, and cancer. 62 Improving diet reduces strain on the health care system by preventing disease rather than treating its consequences. Being physically active reduces the risk of chronic disease, including diabetes, high blood pressure, heart disease, asthma, and arthritis. 63 It also supports positive societal outcomes, including increased workforce productivity and improved academic success. 64
High consumption of ultra-processed foods and certain additives is associated with increased risk of obesity, type 2 diabetes, heart disease, certain cancers, and even cognitive decline. 65 66 Estimates indicate that over the coming decade, these obesity and related diseases will cost the U.S. $8.2-$9.1 trillion in excess medical expenditures. 67 Improving food standards and labeling is especially critical for low-income families, communities of color, and rural populations, as these groups are most affected by diet-related illnesses. 68
Policy Solution: Improve access to healthy food
Informational food labels have been shown to support more healthful purchasing and to encourage producers to reformulate to improve nutrition, supporting healthier purchasing decisions and reducing diet-related disease over time. 69 Nutritional standards, such as those for school lunches, can reduce dietary disparities across children of diverse backgrounds. 70 Programs such as the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) and WIC (Women, Infants, and Children) improve health outcomes and lower health care costs. 71 72
A new administration shall use federal resources to distribute healthier food to Americans by directing the Secretary of Agriculture to:
Revise school meal nutrition standards under 42 U.S.C. § 1753(b)(3) and the Healthy, Hunger-Free Kids Act of 2010 to align with HHS additive and contaminant tolerance regulations.
Update federal procurement standards for special nutrition projects under 7 U.S.C. § 1431e to align with HHS additive and contaminant tolerance regulations.
Direct the Department of Agriculture (USDA) Food and Nutrition Service to issue binding guidance within 90 days directing federal nutrition programs (school meals, SNAP, The Special Supplemental Nutrition Program for Women, Infants, and Children, commissaries, prisons, VA hospitals, etc.) to prioritize whole foods and minimally processed ingredients that align with additive and contaminant tolerance regulations promulgated by HHS.
Support the presidential nomination and appointment of a new USDA Inspector General, using authority under 5 U.S.C. App. §§ 3, to ensure their enforcement priorities align with the administration’s policy objectives on implementing healthier food standards.
Once appointed, issue a presidential memorandum encouraging the USDA Office of Inspector General to consider, consistent with its independent authority under 7 U.S.C. § 2270, whether additional audits or reviews are warranted to assess compliance with updated USDA procurement standards. Where noncompliance is identified, the Office of Inspector General retains discretion to recommend corrective actions, pursue contractual remedies, or take other enforcement measures authorized under federal law with respect to contractors supplying food under USDA programs.
Policy Solution: Review population exposure to food and color additives to minimize risk to the population and improve public information and transparency
To quickly remove harmful additives and contaminants from the food supply while simultaneously improving transparency, the next administration must direct the Secretary of HHS, acting through the Commissioner of Food and Drugs, to:
Commence a review of all approved food and color additives to:
Determine where widespread exposure constitutes a public health threat, based on epidemiological studies, FDA reports, and international bans that demonstrate evidence of chronic exposure causing neurological, carcinogenic, and reproductive harms to the U.S. population.
Confirm compliance with the “Delaney Clause” (21 U.S.C. § 348(c)(3)(A)), which prohibits the FDA from approving any food or color additive shown to cause cancer in humans or animals.
In particular, this review shall address the following additives, which are currently not authorized for use in the European Union:
Brominated Vegetable Oil (BVO), linked to neurological issues, thyroid dysfunction, and memory loss;
Potassium Bromate, linked to kidney and thyroid tumors;
Titanium Dioxide (E171), linked to DNA damage and carcinogenic effects;
Azodicarbonamide, linked to respiratory issues, allergies, and cancer-causing chemicals;
Propylparaben, linked to negative impacts on fertility and reproductive health;
Olestra (Olean), linked to digestive issues like diarrhea and cramps that inhibit the absorption of key nutrients;
Sudan Dyes (Sudan I, II, III, IV), classified as carcinogenic and linked to liver and bladder tumors;
Auramine O (AO), classified as carcinogenic and linked to skin and eye irritation, and negative impacts on the liver and kidneys;
Rhodamine B, linked to DNA damage, liver and nervous system toxicity; and
Artificial Food Colorings, linked to hyperactivity in children and carcinogenic effects.
HHS shall publish the findings of the review. Where evidence indicates an immediate public health risk, existing statutory authorities allow for timely regulatory action to reduce exposure. These include:
Issuing emergency food additive regulations under the “emergency conditions“ exception in 21 U.S.C. § 371(e)(3), to achieve immediate regulatory effect. The emergency declaration under 42 U.S.C. § 247d should provide the necessary finding that ordinary notice-and-comment procedures are impracticable and contrary to the public interest, thereby justifying the use of immediate emergency regulations. § 348(a) & (c) must also be cited to further ground this action in HHS’s authority to regulate food additives.
Issuing emergency orders under 21 U.S.C. § 371(e)(3) to revoke any additive found to induce cancer in humans or animals, citing the emergency declaration and the ‘Delaney Clause.”
HHS shall follow up with formal Administrative Procedure Act (APA) rulemaking using the authority granted under 21 U.S.C. § 371(a) to ensure the long-term existence and enforceability of each of these initial emergency regulatory actions.
Executive action must also be taken to direct the FDA to develop regulatory plans to require front-of-pack warning labels modeled on Chile’s “High in Sugar/Salt/Fat” system, consistent with its statutory authority to prohibit false or misleading food labeling (21 U.S.C. §343). The FDA shall also refer deceptive labeling and/or additive evasion to the Department of Justice (DOJ) and/or Federal Trade Commission (FTC) for the pursuit of immediate enforcement actions under 15 U.S.C. § 45 and 21 U.S.C. § 331.
Problem: Americans are not meeting recommended physical activity guidelines
Physical activity is a core driver of health across the lifespan. It reduces the risk of cardiovascular disease, type 2 diabetes, obesity, certain cancers, depression, and premature mortality. 62 73 Yet physical inactivity remains widespread in the United States. Recent research indicates that 75% of adults do not meet physical activity guidelines for aerobic or muscle-strengthening activities. 74 Factors limiting activity include the physical and social environments in which people live. Research in exercise science and public health consistently concludes that restructuring built environments and policy frameworks, rather than relying solely on education or individual behavior change, is essential to increasing population-level physical activity. 75 76
On Day One, a new Administration will deploy the full force of the federal government to treat physical activity as a core component of health policy, on par with nutrition and clinical care:
Policy Solution: Embed Physical Activity into Federal Health Programs
The Secretary of Health and Human Services (HHS) shall direct CMS to:
Explore expanding reimbursement pathways for exercise counseling and physical activity prescription in primary care
Promote integrating physical activity screenings as a standard part of medical visits in federally funded clinics and hospitals, just like checking blood pressure, weight, or heart rate.
The Secretary of HHS shall also leverage existing preventive services authorities under Section 2713 of the Public Health Service Act (42 U.S.C. § 300gg-13) to encourage insurers to cover evidence-based counseling that helps patients become more physically active, and shall issue guidance clarifying that lifestyle and exercise interventions may qualify as reimbursable preventive services when recommended by the U.S. Preventive Services Task Force.
HHS shall further support state innovation through Section 1115 Medicaid demonstration waivers (42 U.S.C. § 1315) that test community-based physical activity interventions, including exercise referral programs and partnerships with local recreation providers.
In parallel, the Administration shall direct federal employee health benefit programs to incentivize participation in evidence-based physical activity programs.
Policy Solution: Direct Federal Transportation and Housing Policy Toward Active Living
The Secretary of Transportation shall issue guidance prioritizing active transportation modalities, including walking, bicycling, and public transit, in formula grants and discretionary programs. Federal transportation funding must explicitly incentivize:
Complete Streets design standards
Protected bicycle infrastructure
Safe pedestrian corridors
Bikeshare infrastructure
Implementation shall build on existing federal transportation authorities, including the Transportation Alternatives Set-Aside (23 U.S.C. § 133(h)) and Safe Routes to School activities authorized under 23 U.S.C. § 208, which provide funding for pedestrian and bicycle infrastructure. The Administration shall prioritize these programs within discretionary grant criteria, including RAISE grants (49 U.S.C. § 6702), to advance active transportation and injury prevention objectives.
The Secretary of Housing and Urban Development shall incorporate walkability, bikeability, and access to recreational space into Community Development Block Grants (42 U.S.C. § 5301), which authorizes investments that improve livability, neighborhood conditions, and public facilities, including recreational infrastructure that supports physical activity. Through agency guidance and competitive housing programs. HUD shall prioritize projects that integrate safe, connected pedestrian infrastructure and proximity to schools, parks, and transit.
These actions recognize that land use and transportation policy are health policy.
Policy Solution: Strengthen Youth Physical Activity and School-Based Movement
The Department of Education shall issue guidance clarifying that federal education funds may be used to strengthen physical education, recess, and after-school movement programs. The Administration shall also amend formula grant and discretionary program criteria to reward states that prioritize active Safe Routes to School, thus encouraging students to walk or bike to school on a daily basis. States shall also be incentivized through funding criteria to adopt minimum physical education standards aligned with public health guidance.
The Department of Education shall also coordinate with USDA to ensure alignment with the Local School Wellness Policy requirements established under the Healthy, Hunger-Free Kids Act (42 U.S.C. § 1758b), which mandates school-level policies addressing physical activity and wellness. Federal guidance shall clarify best practices for meeting these requirements through minimum physical education time, active recess, and before- and after-school programming.
Early-life movement patterns can be a catalyst for adult health trajectories by helping children stay active. Federal education policy must therefore treat physical activity as integral to academic and developmental outcomes.
Policy Solution: Expand Access to Public Lands and Recreational Spaces
The Department of the Interior and the U.S. Forest Service shall be directed to develop strategies to expand access to national parks, public lands, and urban green spaces, particularly for communities historically underserved by recreational infrastructure. Federal agencies will assess barriers to park access, including transportation, cost, and awareness, and implement strategies to broaden participation in outdoor physical activity.
These efforts shall be carried out pursuant to existing authorities under the Federal Land Policy and Management Act (43 U.S.C. § 1701) and the Land and Water Conservation Fund Act (54 U.S.C. Ch. 2003), which support public recreation access, outdoor infrastructure, and equitable distribution of recreational resources. Agencies shall prioritize LWCF funding to expand access in underserved communities.
Policy Solution: Launch a National Public Awareness Campaign on Physical Activity
The Administration shall direct the Department of Health and Human Services, in coordination with the Centers for Disease Control and Prevention, to develop and launch a sustained national public information campaign promoting regular physical activity as a foundational component of health. The campaign will deliver clear, evidence-based messaging across television, digital platforms, schools, and community organizations.
The campaign shall align with the National Physical Activity Plan and build on CDC authorities under 42 U.S.C. § 247b to conduct public health information, education, and prevention initiatives, ensuring consistent federal messaging on movement guidelines and health promotion.
The effort must emphasize achievable movement goals, highlight the mental and physical health benefits of daily activity, and ensure materials are culturally and linguistically appropriate. Public communication will complement structural reforms by reinforcing that physical activity is a routine and necessary input to long-term health for all who are able.
Endnotes:
Medicare ensures a universal right to healthcare for persons age 65 and older. Medicaid and the Children’s Health Insurance Program ensure healthcare for children, pregnant women, and individuals with qualifying disabilities. https://www.commonwealthfund.org/international-health-policy-center/countries/united-states
Binagwaho A, Mathewos K. The Right to Health: Looking beyond Health Facilities. Health Hum Rights. 2023 Jun;25(1):133-135. PMID: 37266319; PMCID: PMC9973503.
Definition of healthcare services: “the formal systems established to deliver medical care, ensuring the fulfillment of children’s right to health. These include preventive measures like immunizations, curative treatments for illnesses, and rehabilitative care. Delivered through public, private, or hybrid systems, healthcare should be accessible, affordable, and equitable, ensuring children receive the care needed to live healthy lives (Journal of Child Obesity, n.d.)." https://www.humanium.org/en/fundamental-rights-2/health/
CDC (2024) Social Determinants of Health (SDOH)
Note: Moving toward a right to health across the healthcare system will take time for effective and robust implementation. In order for the protection to be codified in the absence of a constitutional amendment, Congress must pass a law that “Every individual has the right to the enjoyment of the highest attainable standard of physical and mental health.” Additionally, Congress should also pass a law that codifies a system to provide universal healthcare. The details of this plan and the pathway to achieve it extend beyond the scope of this ‘Day One’ brief.
Black women currently face a risk of death over 2.5 times higher than white women when birthing children Center for Disease Control. (2024)
Atrash, K., and Richard Carpentier. (2012).; Littlejohns, L.B., Smith, N. & Townend, L. (2019)
DeSalvo, K., Hughes, B., Bassett, M., Benjamin, G., Fraser, M., Galea, S., & Gracia, J. N. (2021)
Office of the Surgeon General (2021). Tandar, Clara E et al.(2024)
Lal, A., Ashworth, H. C., Dada, S., Hoemeke, L., & Tambo, E. (2022). Pisani, E., Ghataure, A., & Merson, L. (2018)
Restoration will be forward-looking and so may ignore or redirect aspects of the Executive Order that were strictly relevant to COVID-19
Example organizations may include: Academy of Behavioral Medicine Research, Society of Behavioral Medicine, Division 38 of the American Psychological Association
Institute of Medicine (US). How Far Have We Come in Reducing Health Disparities? Progress Since 2000: Workshop Summary. Washington (DC): National Academies Press (US); 2012. 7, Legislative Actions to Reduce Health Disparities. Available from: https://www.ncbi.nlm.nih.gov/books/NBK114237/
A series of meetings held in 2024 as a joint effort of NIH & the National Collaborative on Childhood Obesity Research (NCCOR), providing useful recommendations for "whole-of-community" approaches
See here for a list of programs previously funded by the National Center for Chronic Disease Prevention and Health Promotion. These grant programs will be informed by the guidance on community engagement developed by the National Institute of Health’s COMPASS program.
Clove (2023)
Reilly (2021)
Cross, Califf, and Warraich (2021)
Frakt (2019)
AMA to states: Stop interfering in healthcare of transgender children (2021)
Mulcahy, Schwam, and Lovejoy (2024)
De Avila, Meltzer, Zhang. (2021)
Negotiation begins in 2027, with implementation of new prices in 2029
Note that while existing law limits the number of prescription drugs that can be targeted in each cycle, ‘Day One’ policies leverage this opening. Future policy briefs will provide for expansion beyond this framework.