Few voters likely expected President Donald Trump in the first weeks of his administration to slash billions of dollars from the nation’s premier federal cancer research agency.
But funding cuts to the National Institutes of Health were presaged in Project 2025’s “Mandate for Leadership,” a conservative plan for governing that Trump said he knew nothing about during his campaign. Now, his administration has embraced it.
The 922-page playbook compiled by the Heritage Foundation, a conservative research group in Washington, says “the NIH monopoly on directing research should be broken” and calls for capping payments to universities and their hospitals to “help reduce federal taxpayer subsidization of leftist agendas.”
Universities, now slated to face sweeping cuts in agency grants that cover these overhead costs, say the policy will destroy ongoing and future biomedical science. A federal judge temporarily halted the cuts to medical research on Feb. 10 after they drew legal challenges from medical institutions and 22 states.
Project 2025 as Prologue
The rapid-fire adoption of many of Project 2025’s objectives indicates that Trump acolytes — many of its contributors were veterans of his first term, and some have joined his second administration — have for years quietly laid the groundwork to disrupt the national health system. That runs counter to Trump’s insistence on the campaign trail, after Democrats made Project 2025 a potent attack line, that he was ignorant of the document.
“I have no idea what Project 2025 is,” Trump said Oct. 31 at a rally in Albuquerque, New Mexico, one of many times he disclaimed any knowledge of the plan. “I’ve never read it, and I never will.”
But because his administration is hewing to the Heritage Foundation-compiled playbook so closely, opposition groups and some state Democratic leaders say they’re able to act swiftly to counter Trump’s moves in court.
They’re now preparing for Trump to act on Project 2025 recommendations for some of the nation’s largest and most important health programs, including Medicaid and Medicare, and for federal health agencies.
“There has been a lot of planning on the litigation side to challenge the executive orders and other early actions from a lot of different organizations,” said Noah Bookbinder, president of Citizens for Responsibility and Ethics in Washington, a watchdog group. “Project 2025 allowed for some preparation.”
The plan, for example, calls for state flexibility to impose premiums for some beneficiaries, work requirements, and lifetime caps or time limits on Medicaid coverage for some enrollees in the program for low-income and disabled Americans, which could lead to a surge in the number of uninsured after the Biden administration vastly expanded the program’s coverage.
“These proposals don’t directly alter eligibility for Medicaid or the benefits provided, but the ultimate effect would be fewer people with health coverage,” said Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes KFF Health News. “When you erect barriers to people enrolling in Medicaid, like premiums or documenting work status, you end up rationing coverage by complexity and ability to pay.”
Congressional Republicans are contemplating a budget plan that could result in hundreds of billions of dollars being trimmed from Medicaid over 10 years.
Project 2025 called for expanding access to health plans that don’t comply with the Affordable Care Act’s strongest consumer protections. That may lead to more choice and lower monthly premiums for buyers, but unwitting consumers may face potentially massive out-of-pocket costs for care the plans won’t cover.
And Project 2025 called for halting Medicaid funding to Planned Parenthood affiliates. The organization, an important health care provider for women across the country, gets roughly $700 million annually from Medicaid and other government programs, based on its 2022-23 report. Abortion made up about 4% of services the organization provided to patients, the report says.
The administration’s steps to scrub words such as “equity” from federal documents, erase transgender identifiers, and curtail international medical aid — all part of the Project 2025 wish list — have already had sweeping ramifications, hobbling access to health care and eviscerating international programs that aim to prevent disease and improve maternal health outcomes.
Under a memorandum issued in January, for example, Trump reinstated and expanded a ban on federal funds to global organizations that provide legal information on abortions.
Studies have found that the ban, known as the “global gag rule” or “Mexico City Policy,” has stripped millions of dollars away from foreign aid groups that didn’t abide by it. It’s also had a chilling effect: In Zambia, one group removed information in brochures on contraception, and in Turkey, some providers stopped talking with patients about menstrual regulation as a form of family planning.
Project 2025 called on the next president to reinstate the gag rule, saying it “should be drafted broadly to apply to all foreign assistance.”
Trump also signed an executive order rolling back transgender rights by banning federal funds for transition-related care for people under age 19. An order he signed also directed the federal government to recognize only two sexes, male and female, and use the term “sex” instead of “gender.”
The Project 2025 document calls for deleting the term “gender identity” from federal rules, regulations, and grants and for unwinding policies and procedures that its authors say are used to advance a “radical redefinition of sex.” In addition, it states that Department of Health and Human Services programs should “protect children’s minds and bodies.”
“Radical actors inside and outside government are promoting harmful identity politics that replaces biological sex with subjective notions of ‘gender identity,’” the Project 2025 road map reads.
Data Disappears
As a result of Trump’s order on gender identity, health researchers say, the Centers for Disease Control and Prevention took down online information about transgender health and removed data on LGBTQ+ health. A federal judge on Feb. 11 ordered that much of the information be restored; the administration complied but added notices to some webpages labeling them “extremely inaccurate” and claiming they don’t “reflect biological reality.”
The CDC also delayed the release of information and findings on bird flu in the agency’s Morbidity and Mortality Weekly Report. Federal workers have said they were told to retract papers that contain words such as “nonbinary” or “transgender.” And some hospitals suspended gender-affirming care such as hormone therapy and puberty blockers for youths.
Advocacy groups say the orders discriminate and pose barriers to medically necessary care, and transgender children and their families have filed a number of court challenges.
Lawyers, advocates, and researchers say implementation of many of Project 2025’s health policy goals poses a threat.
“The playbook presents an antiscience, antidata, and antimedicine agenda,” according to a piece last year by Boston University researchers in JAMA.
The Project 2025 blueprint sets out goals to curb access to medication abortion, restructure public health agencies, and weaken protections against sex-based discrimination. It would have seniors enroll by default in Medicare Advantage plans run by commercial insurers, in essence privatizing the health program for older Americans. And it calls for eliminating coverage requirements for Affordable Care Act plans that people buy without federal subsidies, which, insurance experts say, risks leaving people underinsured.
“It’s the agenda of the Trump administration,” said Robert Weissman, a co-president of Public Citizen, a progressive consumer rights advocacy group. “It’s to minimize access to care under the guise of strict work requirements in Medicaid, privatizing Medicare, and rolling back consumer protections and subsidies in the Affordable Care Act.”
The White House didn’t respond to a message seeking comment. Conservatives have said implementation of the project’s proposals would curb waste and fraud in federal health programs and free health systems from the clutches of a radical “woke” agenda.
“Americans are tired of their government being used against them,” Paul Dans, a lawyer and former director of Project 2025, said last year in a statement. “The administrative state is, at best, completely out of touch with the American people and, at worst, is weaponized against them.”
Dans did not return messages seeking comment for this article.
The Heritage Foundation has sought to separate itself and Project 2025 from Trump’s executive orders and other initiatives on health.
“This isn’t about our recommendations in Project 2025 – something we’ve been doing for more than 40 years. This is about President Trump delivering on his promises to make America safer, stronger, and better than ever before, and he and his team deserve the credit,” Ellen Keenan, a spokesperson for Heritage, said in a statement.
Versions of the document have been produced roughly every four years since the 1980s and have influenced other GOP presidents. Former President Ronald Reagan adopted about two-thirds of the recommendations from an earlier Heritage guide, the group says.
In some instances, the Trump administration hasn’t just followed Project 2025’s proposals but has gone beyond them.
The document called on the next president to scale back and “deradicalize” the U.S. Agency for International Development, an independent federal agency that provides foreign aid and assistance, including for many international health programs. The administration hasn’t just scaled back USAID. Trump adviser Elon Musk bragged on his social media platform, X, that his “Department of Government Efficiency” fed the agency “into the wood chipper,” physically closing its offices and putting nearly all its staff on administrative leave while ending funding for its programs and disseminating misinformation about them.
But the administration risks waning public support if it adopts the project’s goals to upend U.S. health care and health policy. Almost 60% of voters said they felt negatively about Project 2025 in a September poll by NBC News.
“Project 2025 was never a thought exercise; it was always a blueprint,” said Ally Boguhn, a spokesperson for Reproductive Freedom for All, an abortion rights group. “We’re only a few weeks into his presidency, and it’s setting the groundwork for even more.”
We’d like to speak with current and former personnel from the Department of Health and Human Services or its component agencies who believe the public should understand the impact of what’s happening within the federal health bureaucracy. Please message KFF Health News on Signal at (415) 519-8778 or get in touch here. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Jackson says
Project 2025 Chapter 3 Titled General Welfare. To wit:
“HHS is home to Medicare and Medicaid, the principal drivers of our $31 trillion
national debt. When Congress passed and President Lyndon B. Johnson signed
into law these programs, they were set on autopilot with no plan for how to pay
for them. The rst year thatMedicare spendingwas visible on the bookswas 1967.
From that point on through 2020—according to the American Main Street Initiative’s
analysis of ocial federal tallies—Medicare and Medicaid combined cost $17.8
trillion, while our combined federal decits over that same span were $17.9 trillion.
In essence, our decit problem is a Medicare and Medicaid problem.”
In essence Project 2025 blames most of our U.S. deficit on Medicare and Medicaid!”
Do we really want millions of Americans going without health insurance? The answer for the current GOP administration is “YES!” They definitely will attempt it while Trump distracts.
jimmy says
Time for a January 6th at Mar-a-Lago
Pogo says
@Winning health care headed for checkered flag
…recycled pickup truck boxes mounted on straight axels, pulled by yoked and harnessed teams of convicts dressed in striped rags; the fat man in the MAGA hat sitting in the lounge chair at the front of the box with the reigns and whip in pudgy fists cheerfully calls — bring out your dead.
john says
It’s a hostile takeover and it’s destroying our democracy and our freedom.
Thomas Hutson says
Another fine article regarding Project 2025 that the King denies any knowledge of. If anyone believes that, they believe in the tooth fairy. Americans should READ Project 2025. King Trump sold you out in plain sight, This King and his minions are laughing all the way from the voting booth and you really think he cares for you or America. Other than Hitler, name any leader so full of himself and power hungry.
Janet Sullivan says
Health insurance should be stopped immediately for anyone involved in the execution, support, and approval of these inhumane activities, including elected officials who support the derangement. This should include all family members on the policies.
Matthew says
AWESOME! This is change we need, for sure.
The medical industries are a mess & Biden/Obama made it that way. “Keep your Dr, sure” He knew that was a deception when he spoke it.
We should stop spending money on international medical aid until we get our budget under control.
Edith Campins says
What Pres. Obama did was make it illegal for insurance companies to deny people with pre existing conditions., thus making it possible for millions of Americans who had been unable to get insurance to do so. As for getting our budget under control…let’s start by not spending millions oof tax dollars for trump’s trip to the Super Bowl, the Daytona 500 and sll those golfing trips to Mar-a-Lago. And while we are at it let’s stop giving millions to president musk and his companies.
Laurel says
People, please understand that “Medicare Advantage” is NOT Medicare. Medicare Advantage is the private industry getting your Medicare money and making a profit off of it. Think about that! Shortcuts must be made on your health in order for them to make a profit. Medicare Advantage is bean counters overriding your doctor’s determinations, and the bean counters denying care. There is only (real) Medicare A and B. Medicare requires you to purchase D, or be fined, though D is private insurance. All the L, M, N, O and P’s are private insurance. The government has allowed the name “Medicare” be added the private insurance company’s programs, which is incredibly misleading. This is what Republican politicians want for you.
What Matthew commented here is incorrect about Presidents Obama and Biden. Americans, when polled, 37% found Obamacare unfavorable, but 80% found the Affordable Care Act favorable. It’s the exact, same thing.
I have Medicare, and have had the same doctor for more than a dozen years. I go to Mayo Clinic, #1 hospital in the U.S. and they do not take Medicare Advantage. Mayo’s patients have medical teams, made up of primary doctors and specialists, overseeing their health care, not bean counters. Private insurance only lets you use the doctors on their lists, not necessarily the best doctors, either.
Your choice; your health. Don’t let politicians make that choice for you. Fire them.
YankeeExPat says
The irony is that the same senior and veteran voters that soo vehemently supported Trump are the same that will be taking it in the ass when the Trumpster and the Muskrat initiate the cuts to the V.A. and Medicaid
As former President Obama stated “elections have consequences”
Skibum says
You are so right, Laurel. And the Medicare “Advantage” TV commercials that want mainly older people with lots of medical issues to believe their companies are part of Medicare when they are definitely not should be forced to be more transparent and honest about their private insurance coverage. My sister-in-law has an elderly mother in an assisted living home who had wonderful healthcare because she was a veteran, but was conned into signing up for Medicare Advantage with the song and dance routine about saving lots of money and all of the supposed “extra benefits” these private insurers offer to induce older people to give up their Medicare plans. My sister-in-law only found out by accident after her mother started getting coverage denial letters in the mail. These private insurers give such a rosy picture of all that they offer, then after an elderly individual switches to one of these plans they unfortunately often find out the plans are cheaper because these private insurers routinely DENY COVERAGE, they make patients go through hoop after hoop to have tests and procedures approved BEFORE they can even get them done, and it is not only a huge hassle, but then even worse, these companies make it so difficult on doctors with all of the paperwork and approval process that more and more doctors are refusing to accept patients with Medicare “Advantage”. And this is the horrible mess that the Republicans are trying to push on the American people, giving OUR healthcare right back to the unscrupulous insurance companies that were denying healthcare and overcharging for services prior to the Affordable Care Act going into affect. I believe the GOP has finally given up on their repeated failures to overturn Obamacare, so now their tactic is just to pass federal laws to get rid of government Medicare and force everyone into Medicare “Advantage” because they want to return all of us to private healthcare so their billionaire friends who own and operate the healthcare industry’s corporations can make more money at our expense. And my sister-in-law has been fighting with one such company for months now, trying to get her elderly mother’s private health insurance cancelled and return her mother to Medicare because she is incompetent to make decisions for herself and never should have been allowed to make the switch in the first place because her daughter has power of attorney over all of her affairs. And still, the private health insurance company is fighting to keep the policy active, even knowing there is a POA in effect for her mother who is in assisted living. This is what they do, and they do it for $$$ with no regard for the health benefits of their clients. It should be outlawed because it is a crime how they are taking advantage of older, mostly uninformed individuals.
Atwp says
Millions voted for Trump. Millions are getting hurt by Trump.
JW says
This an American problem: form over substance!
Why? Lack of education which is going downhill as we speak.
This includes politicians and the government. A serious brain problem: unable to THINK critically.
Keep playing football with our two teams in Congress: isn’t it fun to watch?
Kennan says
The crazy thing is, how can you have the minerals to disrupt and take from a healthcare system that frankly is already the worst in the world. A massive for-profit shell game that puts Americans against the system that says,” I hope you have enough money to live?” This is even before Donald J. Von Doucheburg and his Afrikaan boy, Prince initiated, a governmental assault, and Ponzi scheme known as “DOGE”.
2025 “Mandate for leadership?”
Let’s go after the last vestige of anything humanistic and normal. Things like.: federal cancer research, the national Institute of health, Medicaid, Medicare, and Planned Parenthood among many others.
The”Bloods” say they are trimming the fat off a”Liberal agenda”. No….. They are axing programs that keep.”Americans “ afloat(barely I might add) in a country that call itself the richest in the world, while it’s citizens have to work two or sometimes three jobs just to pay the bills before their medical bills can really wipe them out!
The “Crips” a.k.a. Democrats are being sucked into the game. The game of us versus them while every day Americans suffer and die.
As “Orwellian” as this all seems, if we can survive this when the smoke clears, we need to ditch the two party system. A system that does not promote or encourage the average voters curiosity about what a candidate is about. Instead, we’re stuck, watching the bloods initiate evil ideas, and the Crips initiate the status quoism of no ideas.
The food fight that never gets solved while these guys have the audacity to ask us to pick a side.
FIGHT BACK!