ACP’s special report on health policy warns of mounting disruptions under the Trump administration

Shari Erickson, MPH, George Lyons Jr., JD-MBA, and Brian Outland, PhD

As the Trump administration rapidly reshapes the federal health policy landscape, leaders at the American College of Physicians (ACP) delivered an urgent briefing to physicians Thursday at the ACP Internal Medicine Meeting 2025. They warned of unprecedented challenges to public health, physician reimbursement, and the regulatory environment.

“This is real,” said Shari Erickson, MPH, ACP’s chief advocacy officer and SVP for governmental affairs and public policy.

Erickson, along with Brian Outland, PhD, ACP’s director of regulatory affairs, and George Lyons Jr., JD-MBA, director of legislative affairs and EVP of ACP services, led the 60-minute session titled “Hot Issues in Health Policy 2025.” Together, they detailed a flurry of executive orders, proposed agency overhauls, and looming Congressional battles with direct implications for internal medicine physicians.

Executive orders, website takedowns and workforce cuts

Among the panel’s top concerns were the unprecedented scale and speed of policy changes.

“Trump has issued over 100 executive orders at this point,” Erickson said. “In the first couple weeks of his term, there are 45 that were issued — 26 on the first day.”

Those orders have already impacted data accessibility. “On Friday, January 31, a whole bunch of websites went down,” she said. “I remember going ‘What in the world is happening?’ I was getting texts and emails and going to pages — ‘Where are they? Where are they?’”

The orders have also targeted federal employment. “There are more than three million Americans that are employed by the federal government,” Erickson said, adding, “there are a lot fewer now; I’ll tell you that.”

Outland expanded on the fallout, specifically pointing to the most recent restructuring of the Department of Health and Human Services (HHS). “They’re looking at reducing the workforce by about 20,000.”

Major restructuring at health agencies

Outland continued, walking attendees through sweeping changes to HHS, including the creation of a new “Administration for Healthy America,” which merges agencies including the Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), Office of the Assistant Secretary for Health (OASH), and parts of the Centers for Disease Control and Prevention (CDC).

“They’re going to also [implement] this new Assistant Secretary for Enforcement,” Outland said. “They’re going to then take this office, combine the Office of Civil Rights, the Office of Appeals, Medicare Appeals.”

He warned that such changes will likely degrade essential services. “How long will it take to get appeals done?” That is something they are looking at.

The Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH) are also being restructured.

“The FDA is going to be losing about 3,500 employees,” Outland said. “This will perhaps cut things [tied] to drug development and create risk to patients and others.” Regarding the CDC, Outland said that they will be “losing approximately 2,400 employees.”

Cuts to public health, DEI programs, and vaccine oversight

The ACP also voiced concern over executive orders targeting diversity, equity and inclusion (DEI) programs and vaccine oversight. “There are a couple of primary DEI executive orders,” Erickson said. She also addressed the postponement of the Advisory Committee on Immunization Practices meeting. “We put out a statement expressing our deep concern with regard to the cancellation or postponement.”

ACP joined 34 other organizations in March to reaffirm vaccine safety amid rising disinformation.

Legislative headwinds and budget threats

Lyons Jr. warned that what physicians have seen so far is only the beginning. “The thunderstorms are coming. They’re on the horizon right now,” he said, citing the debt ceiling, reconciliation legislation, and proposed cuts to Medicaid and Medicare payment.

“One of the big ones — that’s $880 billion out of Medicaid,” he said.

On physician payment, ACP is backing H.R. 879. Lyons elaborated that “it would also avert a 2.83% cut and add 2% for inflation.”

He did express concern about where the bill is heading. “It didn’t get included in the continuing resolution that just passed,” he said. He referenced a conversation between Congressman Greg Murphy (R-North Carolina) and Speaker Mike Johnson (R-Louisiana), noting that although the bill wasn’t included in the most recent continuing resolution, Johnson indicated it would be added to reconciliation — a move he cautioned was far from ideal.

ACP ramps up advocacy

ACP leaders urged members to become more engaged. “Leadership Day is coming up in about three weeks,” Lyons said. “[Today], we have over 440 internal medicine members who will be on [Capitol] Hill advocating for our priorities.”

Asked whether ACP would oppose efforts to move all patients into Medicare Advantage — as suggested by newly confirmed head of CMS, Mehmet Oz, MD — Outland responded, “ACP has never been [in favor of] moving all patients to Medicare Advantage. So, we will make a stand against that.”

Erickson added, “We definitely have raised those issues before” around transparency and advertising in Medicare Advantage plans.

In conclusion, Erickson reassured attendees that “there are definitely ways that I think we can figure this out. It’s just not going to all happen right at once.”