Decoding Project 2025: A Danger to Healthcare Access

by Center for Education, Research, and Advocacy

Project 2025 is a comprehensive plan to enact extreme conservative policies that would reduce access to healthcare, economic security, and social services support. Project 2025’s goal is for conservative ideals to be enacted across every level of federal and state government. One of the primary goals of Project 2025 is to reduce access to necessary healthcare services specifically for LGBTQ+ people and other marginalized communities. We must take action now to stop the elimination of vital healthcare services and non-discrimination protections in healthcare!

Medicaid and Medicare Access

Project 2025 recommends that the Department of Health and Human Services (HHS) evaluate some of its programs for cuts or alterations to services. For example, Project 2025 calls to restructure the 340B Drug Pricing program. The Federal 340B drug discount program has required pharmaceutical manufacturers to sell drugs at a discount to covered entities, including safety net hospitals and FQHCs that care for uninsured and low-income patients. This allows FQHCs to pass along the discounts directly to uninsured patients to help them afford their medications. When we dispense medications to insured patients, we can generate 340B in savings or revenue—at no cost to the patient—that FQHCs use to provide and expand essential services and programs. For example, Howard Brown uses our 340B savings to help fund our HIV and PrEP navigation programs, our trans and non-binary health teams, our Broadway Youth Center, and other crucial services for our patients that are often poorly reimbursed and underfunded. Project 2025 would restructure this program restricting the amount of revenue FQHCs could generate. This would result in fewer affordable medications for underinsured or uninsured patients and a critical funding loss for community health centers.

Project 2025 also calls for stark reductions in funding to state Medicaid programs. Currently, the federal government guarantees to match payments made by the states for services provided to Medicaid patients with no pre-set limits. In states with lower per capita incomes, the federal government pays a larger share of Medicaid funding. Project 2025 proposes a “balanced or blended match rate,” which would provide a flat funding rate to all states. This would eliminate a substantial amount of federal funding for state Medicaid programs, ultimately resulting in reductions in the medical workforce and services for low-income Americans. Project 2025 also calls for more stringent and burdensome eligibility requirements for Medicaid coverage, including work requirements. Work requirements for Medicaid coverage have been shown to be ineffective in helping Medicaid recipients attain employment, and instead just result in many low-income patients losing their Medicaid coverage. For example, when Arkansas briefly implemented work requirements in Medicaid, 1 in 4 participants lost their health coverage. Project 2025 also recommends applying lifetime coverage caps for Medicaid. This would mean that once a person has been on Medicaid for a set amount of time, they can no longer access Medicaid benefits. People who have been on Medicaid for a certain number of months or years could immediately lose eligibility for Medicaid coverage. Project 2025’s eligibility requirements would result in around 18.5 million people at risk of losing their coverage.

Medication Affordability

Project 2025 also proposes the repeal of the Inflation Reduction Act (IRA). The IRA greatly helped reduce the out-of-pocket drug costs for more than 1.5 million Medicare Part D enrollees. Importantly, it capped out-of-pocket costs at $2,000. Medicaid Part D recipients are some of the most vulnerable patients with significant health needs, and repealing the IRA would see Part D enrollees lose upwards of $7.4 billion in out-of-pocket savings next year. This would be especially harmful to people living with HIV (PLWH). When it comes to the costs of HIV treatment including doctor visits, labs, mental health access, and ART medication, about 60% of these costs come from the high cost of medications alone. The costs of HIV medications are estimated to run between $500-$4500 each month during a person’s lifetime.  Increasing the costs of HIV treatment or having HIV treatments be mostly, if not fully out-of-pocket, will lead to less PLWH being able to afford their life-saving medications.

Abortion and Reproductive Healthcare

Since the Dobbs v. Jackson Women’s Health Organization decision eliminated the constitutional right to an abortion, Project 2025 now aims to enact policies that would amount to a nationwide abortion ban. These attempts to erode or eliminate access to abortion access will lead to providers denying care due to fear of being prosecuted and ultimately result in increased health disparities and poorer health outcomes. States that currently have abortion restrictions report fewer reproductive health providers. There is a 32% lower ratio of obstetricians to births and a 59% lower ratio of certified nurse midwives to births. States with abortion restrictions experience 62% higher maternal death rates than states with full abortion access. States with abortion bans also see higher rates of mental health conditions, including suicide and substance use disorder overdoses, as the most frequently reported causes of preventable pregnancy-related deaths. According to the Center for American Progress, if a nationwide abortion ban is enacted, the overall number of maternal deaths would rise by 24%. Maternal deaths for Black women would rise by 39%. Abortion access is also an important healthcare issue for LGBTQ+ people. A survey by the Guttmacher indicates that LGBTQ+ people make up as many as 16% of U.S. abortion patients.

Project 2025 also focuses on eliminating access to abortion pills via the mail. Project 2025 would try to weaponize the long-dormant Comstock Act to try and make the delivery of medication abortion by mail illegal. Without a mailing option for medication abortion, the steep logistical and financial burdens of travel will put abortion care out of reach for many patients. Project 2025 also calls to eliminate access to free no-cost emergency contraception that millions of people rely on. This could result in over 47 million reproductive-age women losing access to no-cost contraception.

LGBTQ+ Non-discrimination Protections

Project 2025 aims to eliminate non-discrimination protections for LGBTQ+ patients by reverting Section 1557 of the ACA to the 2020 version enacted under the Trump Administration. This would mean eliminating the general prohibition on discrimination based on gender identity and sex stereotyping and adopting blanket religious freedom exemptions for health care providers making it easier for LGBTQ+ patients to be denied care based on a provider’s religious beliefs. The Trump Section 1557 rule also removed sexual orientation and gender identity nondiscrimination protections in several Centers for Medicare & Medicaid Services (CMS) programs. This was especially heinous as many of the impacted CMS programs disproportionately benefit LGBTQ+ individuals.

LGBTQ+ people have long experienced discrimination and barriers when seeking healthcare. Based on a 2022 survey by the Center for American Progress (CAP), 15% of LGBQ respondents—and 23% of LGBQ people of color—experienced care refusal by a provider in the past year. For trans and non-binary (TNB) individuals, 32% reported that they experienced care refusal by a healthcare provider in the past year. Rates of discrimination were even higher for TNB people of color, with 46% reporting care refusal. The CAP survey also showed that 55% of intersex respondents reported a healthcare provider refused to see them because of their sex characteristics or intersex variation. For TNB patients, having their insurance cover necessary and affirming medical care has become an ever-increasing obstacle. In the past year, 30% of TNB patients, including 47% of TNB patients of color, reported at least one form of denial by a health insurance company, including denials for necessary gender-affirming hormone therapy or gender-affirming surgery. Delaying or avoiding healthcare due to discrimination contributes to poorer health outcomes for LGBTQ+ individuals, including higher rates of chronic diseases like heart disease, certain cancers, asthma, and strokes. Discrimination also takes a toll on mental health, with LGBTQ+ patients having higher rates of mental health distress and suicidality. With the increasing number of anti-LGBTQ+ legislation, including gender-affirming care bans, the elimination of anti-discrimination polices for LGBTQ+ patients will result in increased poor health disparities.

Conclusion

Project 2025 will infiltrate many levels of healthcare access and patients’ ability to afford their treatments. Creating barriers to accessing Medicaid, enacting harsh abortion restrictions, and eliminating non-discrimination protections would be detrimental to the health of all Americans.

It is vital we understand these threats. You can read more info about what Project 2025 is and how extensive Project 2025 goals are. You can also read our blog on the state of anti-LGBTQ+ legislation.

With the Presidential election coming up in November, it is important to vote for candidates that support the civil rights and equity of everyone. Be sure you are registered to vote. To register to vote, receive information on voting by mail, find a polling location, or get updates on the upcoming election you can visit your local election boards for more information.

To learn more about how Howard Brown Health contributes to vital advocacy work and has an impact on local, state, and federal policymaking, please visit our Advocacy webpage.

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