When he ran for office in 2016 and 2020, Donald Trump focused heavily on abortion, vowing to nominate Supreme Court justices who would overturn Roe v. Wade — which he did as president.

But this year, with Roe now overturned, the 2024 GOP presidential nominee and the Republican Party have a new health-related social issue: transgender care.

While the 2024 GOP platform makes minimal mention of abortion — and shies away from the suggestion of a national abortion ban, which it called for in 2016 — it prioritizes limited access for gender-affirming care, vowing to “ban Taxpayer funding for sex change surgeries, and stop Taxpayer-funded Schools from promoting gender transition.”

The focus on transgender issues is perhaps the most visible part of Trump’s health policy platform. On other bread-and-butter health policy issues, like drug pricing, insurance costs and health care for seniors, Trump largely echoes what the party has called for: lower costs, more transparency and more access to care.

“Health care issues are probably less prominent in this election than they’ve been in many cycles. But the consequences of the election, the outcome of the election, will still have enormous consequences for the direction of health care,” said Larry Levitt, executive vice president of KFF, a health care think tank.

The shift from abortion to transgender issues was in part spurred by Roe’s overturn, but also by political precariousness for Republicans: The majority of Americans support federal abortion protections, according to multiple polls, and voters backed abortion rights in all seven abortion-related state ballot initiatives since Roe’s overturn — even in states where Republicans control the majority of the state government.

That has left gender-affirming care as the GOP’s galvanizing issue this cycle.

Twenty-five states have acted to put restrictions on health care for transgender individuals, according to the Human Rights Campaign.

Trump has pledged to take multiple steps to limit care at the national level and has said that on day one of his presidency he would issue an executive order instructing all federal agencies to cease programs that promote sex and gender transition at any age.

Trump’s running mate, Sen. JD Vance, R-Ohio, introduced a bill in July 2023 to criminalize providing hormones or surgery to transgender minors, punishable by up to 12 years in prison.

“The left-wing gender insanity being pushed on our children is an act of child abuse,” Trump said in a video posted on his campaign website.

In May of this year the Biden administration overturned Trump’s policy allowing health care providers to object to providing care to transgender individuals. That rule is currently being challenged in the courts, and a second Trump administration would likely undo Biden’s move.

The 2024 Republican platform refers to “radical gender ideology,” and on the campaign trail Trump often talks about banning transgender people from sports, getting rid of any government funds that go toward gender-affirming care and reversing Biden’s changes to Title IX education regulations. The platform also says the GOP will defund schools that participate in “gender indoctrination.”

“It’s become a battleground like abortion has been historically,” Levitt said.

Drug pricing

As president, Trump seized on public anger over drug costs.

His administration created a demonstration program capping insulin costs at $35, issued a rule to tie Medicare reimbursement for certain drugs to rates paid in other countries and issued hospital price transparency rules.

He also issued regulations for states to import prescription drugs from Canada — but Canada was unwilling to participate.

The 2024 GOP platform calls for increasing health cost transparency and expanding choice, competition and access to prescription drug options.

“Anytime you see a platform call for more options, it is usually a code word for less regulations,” Levitt said, referring to the Trump campaign’s drug pricing proposals.

It’s unclear whether Trump, if elected, would implement the Biden administration’s 2022 Inflation Reduction Act, and whether a Trump administration would continue with plans for the federal government to negotiate the cost of certain prescription drugs. Trump supported drug price negotiation during his 2016 campaign, but opposed Biden’s plan.

It may be difficult for a new administration to stop drug negotiations before the new prices go into effect in 2026. However, a new Trump administration could negotiate subsequent prices to be close to what insurers already pay, so there would be minimal impact in later years.

“He’s not been pharma-friendly, and I wouldn’t expect him to be,” Rodney Whitlock, a health consultant with McDermott+Consulting and a former Republican congressional staffer, said of Trump. “I keep my expectations low of anything that is net positive for pharma out of this administration.”

Abortion

The Trump campaign has made a concerted effort to distance itself from Project 2025, a lengthy document outlining what a cadre of high-profile conservative groups would like to see a Republican president do in 2025.

That plan’s Health and Human Services section, authored by Trump’s former HHS Office for Civil Rights Director Roger Severino, repeatedly says the government should not treat abortion as health care and calls for several policies to limit abortion access, including reversing approval of medication abortion and removing the morning-after pill from the contraceptive mandate.

The Heritage Foundation, the main architect of Project 2025, refused comment for this story and emphasized that Project 2025 does not speak for any candidate or campaign.

Trump, in an interview that aired Monday on Fox News, criticized Project 25’s priorities related to abortion as going “really too far.”

“Frankly, the people are voting … quite liberally,” Trump said, pointing to ballot initiatives in Ohio and Kansas that favored not adding anti-abortion language to the state constitution. “They can vote the way they want. It’s not a federal issue. It’ll never be a federal issue again.”

If reelected, Trump is expected to reinstate or expand several executive actions related to abortion and family planning. Trump was widely praised by anti-abortion advocates for his attention to those issues during his term and has claimed credit for the Supreme Court’s decision to overturn Roe v. Wade.

Public health and pandemic preparedness

One of Trump’s most significant accomplishments during his presidency is one he often refuses to take credit for: the research and development of the COVID-19 vaccine.

While Operation Warp Speed, the public-private partnership to develop COVID-19 vaccines, remains one of the lasting health policy successes of his presidency, the Republican base is quick to dismiss the importance of the shots and Trump’s role in their development and rollout.

On the campaign trail, Trump has repeatedly vowed to cut funding to schools with COVID-19 vaccine requirements. But all public schools in all 50 states require childhood vaccinations as a condition of enrollment, and many colleges have vaccine requirements too.

The 2024 Republican platform does not mention vaccine policies. Project 2025 does, calling on the Trump administration to stop enforcing the Biden administration’s COVID-19 vaccine mandate for Medicaid and Medicare hospitals and refrain from imposing COVID-19 mask mandates on health care facilities.

Severino also calls for removing vaccine mandates in the Head Start program and allowing for more accommodations for individuals, including doctors, who cannot take or administer vaccines because of religious beliefs.

Trump’s health priorities would likely depend on whom he picks for his Cabinet.

Trump’s former HHS Secretary Alex Azar, for example, was given wide breadth to forge ahead on regulatory policy without much input from the White House, especially on PBM rebates.

“Personnel will determine so much of what we end up seeing here,” Whitlock said.

This report has been corrected to reflect the timing of implementation of a 2022 drug negotiation law.