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What executive orders on health care did Donald Trump sign affecting Medicare and when were they signed (include year)?
Executive Summary
President Donald Trump signed at least one major executive order directly aimed at Medicare in 2019—Executive Order 13890, “Protecting and Improving Medicare for Our Nation’s Seniors,” signed October 3, 2019—and his later actions in 2025 included a set of executive orders and rescissions affecting Medicare drug-pricing rules and related agency directives. The 2019 order set a regulatory agenda to expand Medicare Advantage and promote market-based changes, while 2025 orders and rescissions targeted Medicare drug-price negotiations, delayed negotiations for many small-molecule drugs, and rescinded Biden-era directives that had instructed agencies to pursue payment and delivery reforms [1] [2] [3] [4] [5].
1. A 2019 Playbook to Reshape Medicare—What Trump Signed and When
President Trump issued Executive Order 13890 on October 3, 2019, explicitly titled “Protecting and Improving Medicare for Our Nation’s Seniors,” directing the Department of Health and Human Services (HHS) to propose regulatory and administrative actions within a year to strengthen Medicare’s fiscal sustainability, increase beneficiary choice and expand Medicare Advantage options. The order emphasized market-based approaches, site-neutral payments, and value-based care, charging HHS to design new payment models and update regulatory processes to favor innovations like supplemental benefits and telehealth in Medicare Advantage [1] [2] [6]. This 2019 action is the clearest single EO from Trump explicitly focused on Medicare policy, aiming to shift incentives and administrative priorities rather than immediately changing statutory benefits.
2. 2025 Executive Moves Targeting Drug Prices and Negotiations—Timing and Tools
In 2025 the Trump administration issued several executive actions aimed at drug-pricing mechanisms that apply to Medicare, including an April executive order that delayed or modified Medicare drug-price negotiations for small-molecule drugs and a May executive order framing a “Most-Favored-Nation” pricing approach; the administration also rescinded Biden-era orders directing agencies to pursue broader payment and delivery reforms [3] [4] [5]. These 2025 orders used executive authority to adjust implementation timelines, extend exemptions for categories of drugs from negotiation, and instruct HHS to pursue legislative changes—moves described by proponents as protecting innovation and by critics as favoring industry interests and weakening cost-control mechanisms designed under prior law [5] [4].
3. What the Orders Change Versus What They Can’t Do Alone
The 2019 EO set regulatory priorities for Medicare; the 2025 orders primarily altered agency implementation and deadlines for Medicare drug-price negotiation programs, including extending exemptions for many small-molecule drugs by several years and rescinding prior agency guidance [2] [5]. Executive action can reshape administrative timelines, enforcement priorities, and guidance documents, but cannot repeal statutory mandates passed by Congress; several 2025 provisions explicitly call for working with Congress to change law if durable alteration is sought. That distinction is crucial: executive orders can slow, delay, or reprioritize programs that affect Medicare but cannot fully overturn laws authorizing drug negotiations without legislative action [5] [4].
4. Conflicting Narratives: Industry, Patient Advocates, and Political Messaging
Coverage and commentary reveal competing portrayals: the administration frames the 2025 orders as protecting innovation and stabilizing access to pill-form medications while pursuing alternative pricing schemes and voluntary deals with manufacturers; critics and patient advocates argue that delaying negotiations and adding exemptions weakens consumer cost protections and benefits pharmaceutical firms [5] [4] [7]. The 2019 EO was pitched as safeguarding seniors’ choices and expanding Medicare Advantage, while opponents warned it could shift resources away from traditional Medicare. These divergent narratives reflect clear political and sectoral agendas—administration officials prioritize market solutions and industry engagement, while advocates stress the immediate cost relief and statutory negotiation mechanisms as key to lowering Medicare drug spending [1] [8].
5. The Bottom Line on What Happened and What to Watch Next
Factually, Donald Trump signed Executive Order 13890 on October 3, 2019, aimed squarely at Medicare policy and regulatory changes, and his 2025 executive actions included rescissions and new orders that directly affected Medicare drug-pricing implementation and timelines—notably delaying negotiations for many small-molecule drugs and promoting most-favored-nation and direct-purchase strategies [1] [3] [5]. The practical impacts will depend on agency rulemaking, litigation risks, and whether Congress enacts statutory changes; observers should watch HHS rule releases, legal challenges, and any congressional bills responding to the 2025 directives, since executive orders can reorient administration policy but cannot permanently rewrite law without legislative action [4] [5].