5 Ways Project 2025 Could Impact Your Health
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As we get closer to what feels like one of the most important US presidential elections ever, it’s becoming harder to ignore the spooky boogeyman in the corner: Project 2025. You may have heard of the 922-page Republican playbook when former president Donald Trump said during the September 10 presidential debate that he “had nothing to do” with the entirety of its extremely far-right policy ideas. (Or maybe you have conservative friends, family members, or neighbors who won’t stop bringing it up.) Whatever your reason for being here is, we’ve got you covered—because if there’s one thing the policies in this agenda could do is affect your health and well-being—and likely not for the better. (We read the entire thing to get a sense of what this agenda has planned for our future.)
“Project 2025 is a threat to basically all Americans’ health,” Andrea Ducas, vice president of health policy at the Center for American Progress, tells SELF. “Often people are thinking in hypotheticals about what might happen if the election goes this way or that way. But in this instance…it’s all out there. It’s not a surprise.”
Project 2025 is the current version of the longstanding “Mandate for Leadership,” published before each presidential election by a conservative political think tank called the Heritage Foundation. Put simply, incoming Republican administrations can consider adopting some or all of its policies, which address every part of the federal government. Heritage has been releasing versions of this document for more than four decades, but this year’s ninth edition has caught the public’s attention unlike any other before, partially because of its brutal views on what health care should look like in America.
Although Heritage claims that “Project 2025 does not speak for any candidate or campaign,” there’s evidence to suggest that Trump and his running mate, Senator J.D. Vance, are fully onboard with much of the agenda. During a 2022 Heritage event in Florida, Trump gave a keynote speech and said that its proposals “detail plans for exactly what our movement will do.” Meanwhile, a CBS News review found that more than a third of the policies Trump had enacted in his first term, or at least promised to implement during his current campaign, mirror those found in Project 2025. And according to the Heritage’s own review, Trump “embraced nearly 64% of the 2016 edition’s policy solutions after one year.” Plus, Vance has openly acknowledged that there are some “good ideas” in Project 2025.
To put it plainly, Project 2025 is a recipe for disaster on the health front. Here are some of the major ways that the agenda could impact your well-being if the next Republican administration decides to adopt its policies.
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Millions of people may lose access to Medicaid.
Your access to reproductive health care could be seriously limited.
The next pandemic could be much harder to fight.
Prescription drugs may become a lot more expensive for people with Medicare.
Queer people may lose a lot of protections, as well as access to gender-affirming care.
Millions of people may lose access to Medicaid.
Of all the health care–related proposals that Project 2025 lays out, its suggestion to slap “time limits or lifetime caps” on Medicaid benefits is perhaps the most barbaric. The health insurance program serves roughly 74 million people with a very low income, as well as children, pregnant folks, and people with disabilities. These caps would essentially kick them off of their health insurance plan after a set amount of time, no matter what their financial situation looks like. (The document does not specify if this would apply to all adults and children on the plan.) And so it’s no surprise that those who qualify for Medicaid based on income alone—about 18.5 million people!—would face the greatest risks of being booted out. It’s just “the most draconian and cruel proposal that’s in here,” Ducas says. “The point of Medicaid is to make sure that everyone in this country has affordable access to health care, even if you have fallen on tough times…. This is not how this program is designed to function.” These extra limitations, experts say, would just continue to force the most vulnerable folks out there to skip or delay their medical care because they can’t afford it, which not only jeopardizes their health, but also their ability to find or keep a job.
Speaking of jobs, Project 2025 also suggests states impose “work requirements for able-bodied adults”—but the reality is that most people on Medicaid already have a job. “There’s this idea that like, Oh, we got to get people off of dependency on the government. I mean, it’s just a complete mischaracterization of who even uses these plans,” Ducas says. “By and large, it’s a safety net for folks, and it should tell you something that most of the people in the program are working and can’t afford or don’t have access to job-based coverage.” The result would be truly catastrophic. Up to 4 million adults on Medicaid could lose their health insurance if all states were to enforce work requirements, according to a 2018 analysis, even if they work enough hours to qualify for the program. This is largely because of the messy paperwork and reporting requirements necessary for enrollees to qualify for or keep their work exemptions, which can be really difficult to navigate, particularly if you’re dealing with a chronic illness. Additional research suggests that women, adults with disabilities, people with HIV, and those ages 50–64 would bear the brunt of these restrictions.
Even more unnecessary? Project 2025 no longer wants states to offer Medicaid benefits and services related to the health impacts of climate change, such as air conditioners and filtration devices that can protect people from extreme heat or wildfire smoke. “More progressive states try to reflect the reality that there are many different things that influence a person’s health. It’s not just whether they can get a prescription, but also is their apartment cool enough to keep that prescription stable?” Ducas says. “It’s pretty prudent for payers of health care services to be thinking about what they can do to keep the people they’re covering healthy. So again…what does that accomplish?”
Your access to reproductive health care could be seriously limited.
Project 2025, with a scrutiny not seen with its other policy proposals, wants to fan the flames of an already dangerous trend that rolled out following the overturn of Roe v. Wade. It’s so bad, in fact, we have an entire article that details how the agenda would impact your reproductive health, but here’s a little summary in the meantime. (FYI: “Abortion” is mentioned nearly 200 times in the entire agenda, more than any other election issue, including immigration, the economy, violent crime, and climate change.)
Project 2025 explicitly states that “abortion is not health care” and that life begins at conception, which echoes the bigger movement among conservative politicians to give “personhood” rights to a fertilized egg—logic that’s not based on science and can threaten access to birth control and even fertility treatments like IVF, according to Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute, a research and policy group that works to support and advance sexual and reproductive health rights. And in what is likely the biggest threat to abortion access, Project 2025 says that the FDA should “reverse its approval” of abortion medications that can end a pregnancy, which are used in 63% of all abortions in the US. Such a move could not only force hundreds of thousands of people to carry an unintended pregnancy to term, but also slam clinics with demand for the surgical procedure.
If that doesn’t pan out, Project 2025 suggests a “bare-minimum policy” to shorten the period people can take abortion medications from about 10 weeks of pregnancy to seven, and allow pharmacists to refuse to give you your abortion meds if it violates “their sincere moral or religious objections.” The agenda also wants to totally do away with getting abortion pills via mail and make it a lot harder to access the most effective type of emergency contraception. And if that wasn’t enough, Project 2025 suggests eliminating Medicaid funding for Planned Parenthood and “all other abortion providers,” which means the clinics wouldn’t be reimbursed for offering some of its other services. The result? Seriously limited access for millions of people to things like breast cancer screenings, Pap smears, and HIV testing and treatment support—because yes, these organizations offer so much more than abortion care.
“It’s a really, really dangerous vision,” Friedrich-Karnik tells SELF.
The next pandemic could be much harder to fight.
Project 2025 acknowledges the global impact of COVID-19 (albeit with some incorrect claims), but it goes on to suggest a number of policies that could make the next pandemic so much harder to prevent or get under control. Its biggest target? The Centers for Disease Control and Prevention (CDC), of course, which Project 2025 says should be slashed into two separate agencies: one that collects and publishes data, and another that is responsible for public health yet has what is described as “a severely confined ability to make policy recommendations.” As an example, the document says that the CDC had no business suggesting that churches close down in 2020 to prevent COVID’s spread—“What is the proper balance of lives saved versus souls saved?” the agenda’s authors write, adding that the CDC “should be required by law to stay in its lane.”
Leighton Ku, MPH, PhD, director of the Center for Health Policy Research at George Washington University, tells SELF it’s ironic that Project 2025 talks at length about the importance of being prepared for the next pandemic, but then “takes apart the agency that deals with this problem.” You might think that the agenda would instead offer ways to invest in disease monitoring and technology to help us respond to health threats more quickly, but nope—“not one word,” Dr. Ku tells SELF. He adds that Project 2025 is just all around “weird” and doesn’t actually get to the heart of some of the most important issues facing this country, like mental health challenges, cancer, and diabetes.
Project 2025 goes on to say that the CDC “is not qualified” to offer professional medical opinions, shouldn’t be allowed to say that kids “should be masked or vaccinated” to protect their own or other’s health, and in the future, these policy calls should be left to—are you ready for this?—“politically accountable parties.”
In other words, politicians, not highly trained scientists and health care providers, would determine what is and isn’t safe next time a deadly virus spreads out of control. Case in point: The agenda wants Congress to “establish a set time frame for any public health emergency,” as if we know exactly when a virus decides it’s done doing its thing. “I could see there might need to be more discussion about how we determine when there’s a public health emergency,” Dr. Ku says, “but to sort of say, ‘Gee, let’s set a time limit in advance’ doesn’t make any sense whatsoever.”
Prescription drugs may become a lot more expensive for people with Medicare.
Just this year, the more than 1.5 million people enrolled in Medicare Part D—a program that helps cover the costs of prescription drugs and vaccinations for adults ages 65 and older, plus some folks with disabilities—finally felt some financial relief from hefty out-of-pocket costs. It was all thanks to a law enacted in 2022 called the Inflation Reduction Act, which capped annual out-of-pocket drug costs at $3,300 for 2024 (it’ll drop to $2,000 next year), limited insulin costs to $35 per month, and made all recommended vaccines completely free for enrollees. It also introduced a program that gave Medicare the ability to negotiate prices directly with manufacturers; because of this, 10 common drugs for conditions like diabetes and blood clots will now be up to 79% cheaper beginning in 2026.
But (and I think you know where we’re going with this) Project 2025 wants to get rid of it all by repealing the Inflation Reduction Act altogether, a move that experts say will undoubtedly increase drug prices for those with complex health needs. “This was a huge win that was a long time coming,” Ducas says—but this proposal, if implemented, would seriously threaten the health and economic security of older adults and people with disabilities, she adds.
Older people, for example, could have to pay an average of $400 extra for their medications in 2025 if this repeal goes into effect. Meanwhile, those who take oral chemotherapy drugs could see their costs go up by roughly $7,000 annually, according to a 2024 study published in JAMA Network Open, which compared out-of-pocket costs before and after those caps went into effect. Not to mention, enrollees in this program would lose access to free vaccines for things like shingles, RSV, and the flu. “That's not only bad for individuals,” Ducas says, “but bad for the country as a whole.”
Queer people may lose a lot of protections, as well as access to gender-affirming care.
If there’s one thing Project 2025 makes ultra clear, it’s that the queer community is absolutely not welcome in their world. In fact, the first page of the entire agenda equates “transgenderism” to “pornography” that invades “school libraries,” and then later says that educators and librarians who share said “pornography” (again, to be clear, this could include books about simply…being trans) should be registered as sex offenders. And unfortunately, that’s just the tip of a very problematic iceberg.
The agenda wants the definition of “sex” to only refer to “biological sex recognized at birth,” which quite literally assumes that some people in the LGBTQ community don’t even exist, Leslie Cooper, deputy director of the ACLU’s LGBT & HIV Project, tells SELF. In the same vein, Project 2025 suggests wiping any mention of sexuality and gender identity from pretty much all federal departments, websites, and policies, including within nondiscrimination protections; it even goes as far to say that employers can fire or simply not hire a trans person, for example, just because they don’t want to or because they believe being trans is against their religion.
These implications extend far beyond the workplace, Cooper says, and would bleed into schools, health care systems, and housing applications, “even in what people might feel are safe blue states,” she says. These policies are demonstrably harmful: Surveys have found that discrimination increases the chances that queer people are physically attacked, avoid or postpone their medical care, and experience mental health issues.
Even worse, Project 2025 is pushing to erase as much funding for and access to gender-affirming care as possible, including slashing Medicare coverage for it. Contrary to the agenda’s claims, this type of health care saves lives and has been shown in multiple studies to lower the odds of depression and suicidality among young transgender and nonbinary adults—which is why it’s not surprising that most major medical organizations, including the American Academy of Pediatrics and the American Medical Association, support it. “We know this treatment is critical and necessary for the well-being of many people with gender dysphoria,” Cooper says. “It’s an extremely debilitating condition that can affect every aspect of someone’s life.”
No matter who you are, what you believe in, or how healthy you seem to be, Project 2025’s iron-fisted vision could make it so much harder to take care of yourself and those you love. It’s unnerving to contemplate what seems like an attack on fundamental human rights, but remember that you can help ensure that we all have access to the health care and respect we deserve.
Your health is always on the ballot—and your vote is more powerful than you realize! Read all of SELF’s coverage of the 2024 election and make sure you're registered to vote.
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Originally Appeared on Self
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