Medicare’s new ability to negotiate lower prescription drug prices for seniors, established through the Inflation Reduction Act (IRA), will be transformative for millions of seniors in the United States.

According to the Center for American Progress, these negotiations are targeting some of the most expensive drugs frequently used by seniors, saving hundreds of thousands of dollars in drug costs each year. These negotiations are also critical for advancing health equity, given that many of the prescriptions targeted by the negotiations treat conditions disparately experienced by people who have historically experienced marginalization because of their race or gender.

While Project 2025’s plan is to specifically instruct Congress to repeal this part of the IRA, they could also easily advise the Department of Justice (DOJ) to stop defending Medicare’s ability to negotiate drug prices in courts, where the program currently faces numerous challenges.

Project 2025’s attacks on Medicare’s ability to negotiate drug prices would negatively impact millions of  elderly Americans, particularly elderly people of color and those with low incomes.

From page 465 of the Mandate for Leadership.

Over two decades of medical practice show that mifepristone — medication abortion — is safe and effective. In fact, just last year, nearly two-thirds of all pregnant people relied on medication abortion for their abortion care.  This is one of the last lifelines for millions of pregnant people across the United States, as many state governments are ramping up attacks.

The anti-abortion extremists behind Project 2025, not content with merely overturning Roe v. Wade, want to attack access to medication abortion nationwide by any means necessary. 

a. Project 2025 would weaponize the long-dormant Comstock Act to try and make the delivery of medication abortion by mail illegal.

Originally passed in the 19th century to restrict the types of things that could be mailed, the Comstock Act is, today, in District Court Judge Robert Chambers’ own words: a “widely abrogated 19th century statute.”

Despite the DOJ, the courts, and Congress already making clear that the Comstock Act does not apply to legal abortion care, Project 2025 plans to weaponize the DOJ and resurrect this Act to ban nationwide medication abortion access.

From page 562 of the Mandate for Leadership:

b. Project 2025 would have the FDA reverse approval of this safe and effective medication. 

Reversing federal approval of medication abortion could deprive people of essential health care, even in states where abortion remains legal. In states where abortion is banned or restricted, this would further subject people to the whims of state legislatures, many of which have actively pushed or enacted abortion restrictions since the Supreme Court overturned Roe v. Wade.

From page 458 of the Mandate for Leadership:

c. Project 2025 would further undermine medication abortion by mail by reimposing unnecessary and burdensome requirements that mifepristone be dispensed in person and by a doctor. 

Post-Dobbs, the FDA has played an important role by allowing the distribution of mifepristone by mail and at certain pharmacies. This has allowed increased access to care, given that not everyone has the privilege of convenient in-person doctor access. If these plans were implemented, it will become harder for everyone to access abortion care, particularly low-income pregnant people and those in rural communities.

From page 459 of the Mandate for Leadership:

d. If all else fails, Project 2025 would turn to the EPAto apply restrictive regulations to medication abortion. 

Project 2025 wants an anti-democratic president to direct the EPA to classify medication abortion as containing ‘forever chemicals’ — which are subject to stricter regulations. If the EPA were to classify medication abortion as a “forever chemical,” it would stifle the approval and distribution of medication abortion.

From Politico’s ‘Anti-abortion forces plan for a Trump return’:

While many of Project 2025’s plans for Medicare require congressional action, they also encourage a future administration to use all possible levers, including the Centers for Medicare and Medicaid Services (CMS), to alter this critical program however they can.

Several of their proposals would push people towards private Medicare alternatives, which are not real alternatives at all — with reports showing that “Medicare Advantage plans threaten rural hospitals and patients” and misled people into signing up for them. While Project 2025 may pitch these Medicare ‘reforms’ as encouraging consumer choice, in reality they will leave seniors worse off across the country — putting the health of many of the 33 million people enrolled in traditional Medicare at risk.

From page 463 of the Mandate for Leadership:

In the immediate aftermath of the Dobbs decision that overturned Roe v. Wade, the Biden administration issued HIPAA guidance  to “ensure doctors and other medical providers and health plans know that, with limited exceptions, they are not required – and in many cases, are not permitted – to disclose patients’ private information, including to law enforcement.” The administration later finalized a rule to shield the medical records of patients from criminal investigations if they cross state lines to seek an abortion where it is legal.

Even as extremists in Texas actively try to use the courts to access information about people receiving abortions out of state, Project 2025 claims that the Biden administration’s privacy guidance is “fear mongering” and would have a future administration withdraw it. As more states move to pass increasingly severe efforts to criminalize abortion, this would put medical providers and all pregnant people at increased risk.

From page 497 of the Mandate for Leadership: