Project 2025, the far-right extremist agenda developed by the Heritage Foundation, would increase the power of corporations at the expense of Americans’ health and well-being. It would give more control to health care companies—including some of the most profitable companies in the world—by jeopardizing protections that help many patients access and afford the care they need. Project 2025 would also take us back to a time when corporations were free to pump dangerous toxins into the air we breathe and the water we drink. If Project 2025’s plan for a far-right administration takes effect, corporations will profit while patients are saddled with high bills, less accessible health care, more exposure to toxins, and more harmful health conditions.
1) Ending Medicare drug price negotiation
Project 2025 calls for eliminating the historic Medicare drug price negotiation program created by the Inflation Reduction Act (IRA). According to the U.S. Department of Health and Human Services, in 2023, nearly 9 million Medicare beneficiaries used the 10 drugs that underwent the first round of Medicare price negotiation; had the negotiated prices been in effect that year for the 10 selected drugs, Medicare would have saved an estimated $6 billion. Despite this, the far right is prioritizing the pharmaceutical industry’s fears of revenue loss over patients’ increased access to the medications they need.
As evidenced by a series of industry lawsuits to put an end to drug price negotiation—which some experts consider unfounded and which, so far, have resulted in a dismissal and ruling in favor of the Biden-Harris administration—drug companies fear that price negotiation will cut into their profits when lowering drug prices for widely used prescription drugs. Not only does Project 2025 ensure drug companies are put back in control of access to medication; it calls for a complete repeal of the IRA, which would put an estimated 18.5 million Medicare Part D enrollees at risk of losing out on $7.4 billion in direct savings from the IRA’s drug-related provisions, including its out-of-pocket cost caps.
2) Paving the road to fully privatize Medicare by making Medicare Advantage the default enrollment
Project 2025 calls for making private insurance plans—through the Medicare Advantage (MA) program—the default for all Medicare enrollees. When Medicare enrollees opt in to MA plans, the federal Medicare program pays private companies to operate the plans for a per-member, per-month fee to provide benefits. Yet these plans don’t save taxpayers money and, on the contrary, cost the government $83 billion more per year than government-operated, traditional Medicare would cost to cover the same enrollees.
By laying the groundwork for fully privatized Medicare, Project 2025 gives corporations an opportunity to profit even more off taxpayer dollars and the Medicare trust fund. In fact, an analysis by the Center for American Progress found that if making Medicare Advantage the default enrollment option led to only 50 percent more beneficiaries enrolling in the program, which would bring MA enrollment up to about three-fourths of enrollees, Medicare would waste nearly $200 billion per year—totaling nearly $2 trillion over 10 years—on excess payments to MA plans without any real improvement in health care quality for enrollees. That’s money that could instead be spent on improving the Medicare program, for example, by adding new covered services, such as dental, vision, and hearing, or instituting an out-of-pocket cap for all Medicare enrollees.
Beyond the fiscal consequences, making Medicare Advantage the default option for all enrollees could lead to adverse health consequences if Medicare beneficiaries—especially those who are socially or economically vulnerable—are automatically enrolled in plans that don’t actually meet their specific health needs.
3) Removing consumer protections from nonsubsidized ACA marketplace plans
Project 2025 calls for removing the historic consumer protection provisions of the Affordable Care Act (ACA) for nonsubsidized marketplace plans. Before the ACA, insurers could deny or charge people with preexisting conditions—as many as 1 in 2 Americans—more for coverage, set stringent annual and lifetime coverage limits, and even deny or increase the costs of coverage for women based on their gender.
Under Project 2025, these protections would be stripped away for nonsubsidized ACA marketplace plans—in other words, for people who buy ACA marketplace insurance without federal subsidies. Those plans would also have no limits set on how much of people’s premiums have to be spent on actual health care, enabling insurers to once again reap profits at the expense of patients.
4) Promoting junk insurance plans that expose consumers to financial catastrophe
The extremists behind Project 2025 call for making it easier to buy “junk” insurance plans that leave enrollees vulnerable to high out-of-pocket costs, specifically association health plans and short-term plans. In theory, these plans enable healthy people who assume they won’t use much medical care to pay lower premiums for less comprehensive coverage. However, when unexpected health needs hit, these enrollees find themselves saddled with high bills or discover that they don’t actually have coverage for the services they need. Companies would profit when they bring in premium dollars without paying out claims. There are countless stories of consumers who have bought junk insurance and didn’t realize they got a bad deal until it was too late.
5) Enabling corporations to more easily expose Americans to dangerous pollutants and hazards
Project 2025 calls for pausing and revisiting Environmental Protection Agency (EPA) rules and revoking critical EPA powers, which would greatly limit the agency’s ability to protect Americans from environmental toxins such as lead poisoning, per- and polyfluoroalkyl substances (PFAS) known as “forever chemicals,” soot, and other environmental hazards. Large corporations are behind much of the most egregious environmental harms: Since 1988, nearly three-fourths of global industrial greenhouse gas emissions were linked to a mere 100 companies. Emissions are tied directly to Americans’ health; exposure to water pollution and air pollution is associated with a variety of health conditions, such as lung, kidney, and heart problems as well as emergency department visits, hospital admissions, child development problems, and increased mortality.
Project 2025’s proposed rollback of environmental regulations, corporate oversight, and enforcement would bring the United States back to the days when it was easy for corporations to pollute and profit while regular people suffered the health impacts.
Conclusion
By reversing consumer protections against bad business practices and environmental harms, further privatizing the Medicare program, and letting the pharmaceutical industry win by ending drug price negotiation, Project 2025 would help corporations bring in profits, while saddling people with higher health care costs and worse health outcomes. Project 2025’s agenda to put profits ahead of patients would hurt American consumers for decades to come.
About the authors: Nicole Rapfoge is on staff at the Center for American Progress. Jill Rosenthal is the director of public health policy at American Progress. Marquisha Johns is the associate director for public health policy at American Progress. Brian Keyser is a research associate for health policy at American Progress. Andrea Ducas is the vice president of health policy at American Progress.
This article was published by the Center for American Progress.
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