Data Note
January 2024
Sara Rosenbaum
The first week of the Trump Administration has witnessed a large number of White House Executive Orders (EOs). Many are of significant importance to the community health centers, primary care associations, and the medically underserved populations and communities they serve.
This Data Note provides an overview of key Week One EOs.
Initial Rescission of Harmful Executive Orders and Actions
- Repealing, among other Biden Administration EOs
- EO 13985 Advancing Racial Equity and Support for Underserved Communities Through the Federal Government (directing all agencies to take a comprehensive approach to promoting equity for historically marginalized communities).
- EO 13988, Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation, (promoting enforcement of civil rights laws barring discrimination based on sex or gender and requiring agencies to apply the meaning of sex and gender established by the Supreme Court in Bostock v Clayton County, which held that federal employment discrimination laws ban discrimination based on sexual orientation and gender identity).
- EO 14009 Strengthening Medicaid and the Affordable Care Act (creating a special enrollment periods for marketplace plans; ordering reviews of agency regulations that impede access to Medicaid and ACA coverage).
Protecting the Meaning and Value of American Citizenship
In addition to orders related to ending asylum, pausing refugee programs, and ending resettlement and social services for refugees (many of which may be offered by or through CHCs), the administration has addressed US citizenship itself.
- Purports to end birthright citizenship for children born to mothers either not lawfully present or present only on a temporary basis (e.g., student visa) and without a father who is either a citizen or permanent resident (nationwide temporary restraining order issued on January 23rd.)
- Ends “forced taxpayer funding of elective abortions".
- Revokes Biden Administration EO 14076 “Protecting Access to Reproductive Health Services” in the wake of the Supreme Court decision overturning Roe v Wade. Defined “reproductive healthcare services” to mean “medical, surgical, counseling, or referral services relating to the human reproductive system, including services relating to pregnancy or the termination of a pregnancy”. The EO encompassed information privacy, family planning, maternal health care, and abortion/pregnancy loss. (This EO included specifically a direction to HRSA to increase awareness of reproductive health services available through CHCs). All regulations and enforcement actions related to this EO thus are expected to be a focus of federal agencies, including special policies and enforcement actions related to EMTALA (the federal emergency care act governing all Medicare-participating hospitals), family planning coverage, health information privacy, maternal health care access, and other matters.
- Revokes EO 14079 banning discrimination in the provision of necessary health care on the basis of pregnancy.
Ending Illegal Discrimination and Restoring Merit Based Opportunity
- Classifies DEI programs aimed at promoting equity in education and employment as a violation of U.S. civil rights law. (DEI programs trace their history to the 1964 Civil Rights Act barring discrimination in employment on the basis of race, national origin, color and sex, as well as by federally assisted programs. Over DEI efforts have come to embrace efforts to end discrimination based on disability and age).
- Ends DEI efforts, and specifically calls out the “medical industry” along with “large commercial airlines, law enforcement agencies, and institutions of higher education” for adopting and “actively us[ing] dangerous, demeaning, and immoral race- and sex-based preferences under the guise of so-called “diversity, equity, and inclusion” (DEI) or “diversity, equity, inclusion, and accessibility” (DEIA) that can violate the civil-rights laws of this Nation.”
- Specifies that ending DEI programs constitutes civil rights enforcement across all sectors including both government and private employment as well as higher education. Bans “environmental justice” initiatives.
- Revokes the 1965 Equal Employment Opportunity EO issued by the Johnson Administration.
- Bars diversity, affirmative action, and requires grantees to affirm that they are in compliance with the ban on diversity and affirmative action efforts.
- Directs the Justice Department to develop a litigation strategy to pursue enforcement of the new policy banning DEI and affirmative action.
Bottom Line
Look for relatively rapid action on the part of DOJ to reverse its positions on EMTALA, mifepristone access, and new guidelines on federal grantee compliance with the DEI directive. Also look for rapid efforts to reduce access to Medicaid and ACA coverage through reversal of Biden guidelines on enrollment and renewal simplification, special enrollment, and enrollment assistance services. Also look for an end to all support services for immigrants and immigrant health, along with stepped up ICE enforcement now underway across the country, with staging at health care sites, schools, and other community sites in addition to places of employment.