The national Democratic Party and the media have focused their attention on a conservative plan for America’s future developed by the Heritage Foundation.
Project 2025 is a program focused on policy recommendations, and recruitment and training of personnel, for a potential Republican presidential administration. The project includes a policy document, Mandate for Leadership, which the Heritage Foundation began publishing in 1980. The new edition, published in 2023, addresses the border crisis, inflation, the economy, crime, education, and health care, along with numerous other policy and cultural topics impacting modern America. More than 50 conservative think tanks and groups contributed to building out the plan.
The health care portion of the paper was written by Roger Severino, who was the head of the Office of Civil Rights at the U.S. Department of Health and Human Services (HHS) under the Trump administration.
Trump, Media Response
In recent weeks, former President Donald Trump has distanced himself from the project, specifically issuing a statement disavowing involvement with the plan in July.
“Reports of Project 2025’s demise would be greatly welcomed and should serve as notice to anyone or any group trying to misrepresent their influence with President Trump and his campaign…” said Susie Wiles, campaign senior advisor, and Chris LaCivita, top advisor, in a statement.
The co-chair of the Republican National Committee (RNC), Lara Trump, recently added to the negative pile-up, calling the plan an “absurd vision,” in a Washington Times opinion piece.
Mainstream media responded quickly and vigorously, predicting the imminent collapse of the effort. An article in The Wall Street Journal pointed out that abortion is mentioned 200 times in the document. The Hill published an article on August 4, titled “Trump campaign’s Project 2025 Bashing irks conservative loyalists.”
Paul Dans, Project 2025 director and a former Trump administration official, stepped down from his role on July 30.
Project 2025’s Health Vision
Despite the negative media attention, there is little dispute that Project 2025 is comprehensive, at 823 pages, and focuses on near-term political problems and social issues. The section on health care covers 54 pages and outlines the failures, corruption, and shortsighted actions of U.S. regulatory agencies over the past several years, particularly during the COVID-19 pandemic. The section offers detailed policy remedies.
In a chapter addressing HHS, Severino described protecting life, conscience, and bodily integrity “from day one until natural death,” as a necessary underpinning for reform.
“Health care reform should be patient-centered and market-based and should empower individuals to control their health care-related dollars and decisions,” Severino wrote, recommending states should primarily regulate the medical profession, and the federal government should reform “irrational Medicare and Medicaid reimbursement schemes.”
The section states federal health agencies should be free from biopharmaceutical funding and regulators should be banned from working for a company they have regulated for 15 years. Scientific data-gathering and public health recommendations should function under separate branches at the Centers for Disease Control and Prevention. The Food and Drug Administration should concentrate on the generic drug market and reverse its approvals regarding chemical abortion pills. It recommends curbing the influence of gender ideology in federal health policy.
Regarding Medicare and Medicaid, the section recommends more vigilance to prevent waste, fraud, and abuse.
Trump-Era Executive Orders Absent
Though Heritage facilitated Health Care Choices, a document published during the Trump administration endorsed by more than 80 right-of-center organizations and distributed to members of Congress and candidates for office, most of the reforms in that document do not appear, or get little attention, in Project 2025.
Project 2025 favors telemedicine, but not necessarily across state lines. While price transparency is addressed, reference pricing is generally absent. Direct primary care is lauded as a health care solution but doesn’t expand on extending DPCs and Health Savings Accounts (HSA) to Medicare, Medicaid, and those purchasing insurance on the exchanges.
“Surprisingly, there is no mention of Trump’s executive orders allowing many things that could move the health care market in the right direction,” said John Goodman, president of the Goodman Institute for Public Policy Research and co-publisher of Health Care News. “Those include HSAs for the chronically ill, personal and portable employer health care insurance, and removing barriers to short-term insurance, basically a free market alternative to Obamacare.”
A better alternative to Obamacare, drawing on bipartisan ideas, would be, “to model the exchange to Medicare Advantage, to allow providers to compete for the sickest enrollees,” said Goodman.
There are other areas the Mandate for Leadership could have addressed, says Devon Herrick, a health care economist, and policy advisor to The Heartland Institute, says there is another reform the Mandate for Leadership.
“The Heritage Foundation proposes to protect both doctor and patient autonomy in ways that promote consumerism and competition. That is a worthy goal but somewhat elusive in health care. Another goal would also promote competition by increasing transparency, accountability, and governance of sectors like drug makers. An example given was to close the loopholes that allow drug makers to protect monopolies longer than the term of initial patents.”
‘Distracted by Fear-Mongering’
While reformers like Goodman are disappointed by the absence of specific recommendations in Mandate for Leadership, that does not mean the plan should be rejected, especially by the Trump campaign.
“Trumpworld bows down to left-wing media lies, and keeps signaling he doesn’t want his most loyal foot soldiers—who kept with him even when very few others did—or their conservative ideas in his next administration. Interesting,” wrote Mollie Hemingway, editor-in-chief of The Federalist, in a discussion on X.
“Project 2025 has become a political football, which is too bad because at least as far as health care goes, there are very stark differences between what the Trump administration has done and where Joe Biden and Kamala Harris have taken it,” said Matt Dean, senior fellow of health care policy outreach at The Heartland Institute, which publishes Health Care News.
“We are marching toward socialized medicine, and we should not allow ourselves to be distracted by fear-mongering taking place on both sides of the fence if we want to return health care back to patients,” said Dean.
Ashley Bateman (bateman.ae@googlemail.com) writes from Virginia.
Internet info:
“The Truth About Project 2025” The Heritage Foundation.
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This article was updated to include a quote from Devon Herrick and updated headline.
