Decoding Trump's Project 2025, Part 5
This time we talk about healthcare - especially for women, but also for everyone - and how Donald Trump and JD Vance would cause more suffering, and higher prices for health insurance and medications.
It’s time for another installment of Decoding Project 2025, and now we reach a part of the document that you’ve undoubtedly already heard about, on healthcare and especially on reproductive healthcare.
Yet there are even more destructive policies in here than you may realize, plus some particular statements that really show how badly the right wing has betrayed any free-market bona fides it ever had and has become ever more fixated on rallying the xenophobic, reactionary MAGA base.
Anti-vaxxers 1, free marketers 0
For example, while elsewhere in the document they trot out the usual conservative odes to the private sector — and while the Heritage Foundation has historically been a vocal proponent of public-private partnerships between the government and the private sector — when it comes to healthcare in 2024, they suddenly decry such partnerships. They now attack relationships between pharma companies and NIH, CDC, and FDA as “conflicts of interest,” and they want to regulate pharma advertising (when conservatives were the ones who led the charge to deregulate that advertising in the first place, back in the 1980s and 1990s). If you read this and didn’t know any better, you’d be more than excused for thinking it was a white paper from someone like Bernie Sanders.
What’s going on here? While the default mode for these right-wing policy documents is usually to promote privatization, here they care far more about the political benefits of stoking support among anti-vaxxers and conspiracy theorists.
In other words, they’re now more interested in getting votes from Joe Rogan fans than they are about securing support from Big Pharma. Indeed, Project 2025 also proposes ending the vaccine mandate at hospitals and paying reparations to anti-vaxxers who lost their jobs in healthcare because they refused to follow standard healthcare protocol. All of this pandering to the base is sickening — figuratively and literally.
Yet in the same section, as we’ll see, they suddenly swing back to being pro-industry again, proposing that Medicare’s ability to negotiate lower drug prices be revoked and eliminated once again. Their hypocrisy and lack of principles are remarkable although by no means surprising.
The Gilead database
Now we reach perhaps the most notorious section of the entire 885-page document — wherein the Trumpers propose a federal database to track every pregnancy and abortion in America.
There is, of course, the weird creep factor of all this. Especially when one imagines either Donald Trump or JD Vance having access to this data.
But let’s look at the serious legal implications of this — and what it really says about the Trump Republicans’ plans for American women.
The database would be populated by forcing states, at threat of having their federal funding ripped away, to report data on every pregnancy — when it started, how many days/weeks along it is, and the circumstances of any termination of the pregnancy (miscarriage, abortion, etc.), as well as the residence of the woman and the location of the providers who treated her, plus any data on complications that may have arisen from the use of abortion medications.
By definition, this would also mean the data would include the last menstruation before pregnancy, because that is how the length of a pregnancy is measured: Day 1 is the first day after the last menstruation.
(Yes, you read that correctly. It is not measured from conception or implantation or ovulation. This is why when a state bans abortion after 6 weeks, this actually means only having a matter of days when one may realize one is pregnant. At the point of a “missed period” or being “late,” someone who’s pregnant is already four weeks pregnant or more. A six-week ban is really a two-week ban. Or less.)
We can call this the Gilead Database.
Such a Gilead Database would allow the federal government to know exactly who’s getting abortions — including abortion procedures as part of post-miscarriage care — and where that care is occurring. This would allow prosecution of the women and providers, and it also paves the way for a nationwide abortion ban that will be federally imposed in all 50 states and federally enforced, including making it a federal crime to cross state lines to receive an abortion procedure, or to receive abortion medications that traveled across state lines. (Plus, imagine what will happen when they cross-reference the Gilead Database with travel databases that show exactly when and where people have boarded planes, or crossed the border into Canada or Mexico?)
And to be clear: Donald Trump stated his public support for a nationwide abortion ban in April of this year, after which House Republican leaders overwhelmingly voted in support of Trump’s position. Trump has tried to slink away from that position during the general election campaign, but again, when he had a clear chance to disavow that position during the debate with Kamala Harris, Trump refused to do so, instead awkwardly trying to change the subject to student loans.
Project 2025 makes it clear though: Trump and his allies plan to make abortion prosecution a nationwide, federal project.
Make America Sicker (and Broker) Again
What hasn’t received quite as much attention is what Project 2025 proposes for the economics of healthcare overall — and how much more money that would cost all of us.
Not only do they propose tricking seniors into choosing a private insurance option over Medicare (by no longer having Medicare as the default option for seniors’ insurance), but they want a whole range of changes that would jack up healthcare costs:
They want to end one of the most critical reforms of recent years, by eliminating Medicare’s ability to negotiate lower drug prices. Not only did that reduce seniors’ medication costs, but it also gave Medicare the leverage to negotiate lower drug prices for everyone. This was how the Biden/Harris administration, in partnership with Bernie Sanders in the Senate, achieved the breakthroughs of capping insulin costs at $35/month — and the same for inhalers — among a whole array of massive price reductions for life-saving drugs that millions of people depend on. All of that will be reversed if Trump can implement Project 2025.
They also want to kill the No Surprises Act, which aimed to mitigate some of the worst misconduct in medical billing — re-opening the door for providers to bill patients however they want, hiding the ball and misleading them with impunity.
They also want to resume their attempt to kill the Affordable Care Act (ACA), aka Obamacare. Specifically, they want to give insurers ways to circumvent the ACA prohibition on discriminating against pre-existing conditions — yanking us backward to the bad old days when it was often effectively impossible to get private health insurance for an individual with a condition like diabetes or cancer. This was not a one-off comment: JD Vance blurted out a lot of policy language about “risk pools” in an interview recently when he was pressed on what the Trump/Vance healthcare plan would entail. “Risk pools” is code for allowing insurers to discriminate based on health conditions again.
All of these Trump changes would undoubtedly cause healthcare costs to start skyrocketing out of control again. They were growing exponentially until 2010, when the ACA began to be implemented. Since then, they have leveled off, with the one-year exception of 2020 during the very worst of the Covid-19 pandemic. We should be looking for ways to decrease the cost of healthcare — not increase.
Let’s talk more about the Medicare negotiation power. Project 2025 tries to criticize such power as being inimical to free-market principles. Yet it’s the exact opposite: the true bedrock principle of a free market is open competition. If Medicare has the market power to negotiate lower drug prices, then it should have the freedom to do so. Restricting Medicare’s ability to negotiate is exactly the kind of anti-competitive imposition that conservatives claim to dislike.
So why are the right-wingers so hellbent on restricting Medicare? First, because it’s a beloved entity that happens to be government-run — perish the thought! Imagine the would-be oligarch(s) who should be owning that juicy plum and exploiting it, rather than the government running it for the benefit of all Americans! Think of the billionaires who will never exist! The superyachts they would have bought!
Whenever we hear the right wing daydreaming about the privatization of an otherwise successful and well-regarded government institution, just remember that it’s their desire to Kremlinize the government. They don’t want to reform Medicare. They don’t even want to end Medicare. They want to own and control and exploit Medicare — for themselves.
Second, and related to the first, the far-right folks care far more about pandering to allied interests than they do about having consistent principles. Competition is good — unless it hurts a company or industry that can donate to your campaign or your think tank. In which case, competition is bad! It’s a clear case of “four legs good, two legs better.”
(I then started writing a fun aside about Animal Farm and populism masking hypocrisy and kleptocracy, but this piece is long enough as it is!)
Next up we’ll be continuing with a sweep of Project 2025’s nefarious plans for other federal departments, including HUD, Interior, Justice, and more.
Gilead, indeed. As a teen who had a traumatic abortion in Pennsylvania the late '60s, I remember vividly how the fear of prosecution compounded the awfulness and vulnerability of the situation. My positive pregnancy test was a matter of record in that era, which predated home tests. What kind of dystopian society believes that information about women's reproductive cycles rightly belongs to the government? A FICTIONAL society.
I think a look at the history and to why Medicare was formed in the first place would be important at this time also. The health of the citizens will be affected.