By Dean M. Harris, J.D., Associate Professor (Retired), Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA, Dean_Harris unc.edu

During his first 10 days in office, U.S. President Joe Biden took significant steps toward improving health care and global public health. On the day of his Inauguration, he wrote to the Secretary-General of the United Nations to notify him that the U.S. would continue to be a member of the World Health Organization (WHO). President Biden retracted Donald Trump’s notification of withdrawal from the WHO, which would have taken effect in July of 2021. On President Biden’s Inauguration Day, he also issued a statement on behalf of the United States that he accepted “every article and clause” of the Paris Climate Agreement.

January 22, 2021 was the 48th anniversary of the landmark Supreme Court decision in Roe v. Wade. President Joe Biden and Vice President Kamala Harris took that opportunity to issue a statement which emphasized their commitment to ensuring access to reproductive health care, eliminating health disparities for mothers and infants, and improving outcomes in global health. On January 28, 2021, President Biden took action on that commitment by revoking former President Trump’s Mexico City Policy (the “Global Gag Rule”), which reduced access to reproductive health care and other health services in many countries around the world. Under the Mexico City Policy, foreign non-governmental organisations (NGOs) that get funding from specific agencies of the U.S. government may not use any other funds (including their own funds) for abortion, including advocacy or referral for abortion. Former President Trump had reinstated that restrictive policy in 2017. In addition, Trump had expanded that policy to apply to more types of U.S. government funding, including billions of dollars in funding for HIV/AIDS through the PEPFAR program. On January 28, 2021, President Biden revoked that policy by means of a Presidential Memorandum, which is similar to an Executive Order.  In the same document, President Biden directed his officials to restore U.S. government funding for the United Nations Population Fund (UNFPA), and directed his officials “to ensure that adequate funds are being directed to support women’s health needs globally, including sexual and reproductive health and reproductive rights.” President Biden also directed his officials to withdraw from the Geneva Consensus Declaration, which provides that abortion is not an international right.

On the U.S. domestic front, President Biden started the process of changing the Trump administration’s rule for the federal program known as Title X, which provides funding for family planning services in the United States. The Trump administration had adopted a rule that prohibits organisations which receive Title X funds from making referrals for abortion. According to President Biden’s Memorandum of January 28, 2021, “The Title X Rule has caused the termination of Federal family planning funding for many women’s healthcare providers and puts women’s health at risk by making it harder for women to receive complete medical information.” President Biden directed the Secretary of Health and Human Services (HHS) to consider changing or revoking the Trump administration’s rule for the Title X program.

In addition, President Biden has taken steps to protect and increase health insurance coverage in the U.S. by strengthening the Affordable Care Act (“ACA”), which is former President Obama’s health reform law. Currently, the ACA provides insurance for approximately 20 million people. The ACA also provides protection for individuals who would have difficulty obtaining health insurance, because those individuals have preexisting medical conditions. Politicians in the Republican Party, including the Trump administration, have tried for years to terminate the ACA by means of legislative efforts to repeal the law, legal challenges to its constitutionality, and administrative steps to undermine the effectiveness of the law. On January 28, 2021, President Biden issued an Executive Order that makes it easier for people to enroll for insurance coverage under the ACA. Biden’s Executive Order also begins the process of removing the rules and policies that were imposed by the Trump administration to undermine the effectiveness of the law. In addition, Biden’s Executive Order protects the Medicaid program of health insurance for people who are poor, by directing his officials to consider changing or revoking actions by the Trump administration that imposed barriers to enrollment or reduced the effectiveness of the Medicaid program.

During the first 10 days of President Biden’s term, he issued many other Executive Orders and similar documents on different topics, including COVID-19, climate change, and economic issues. Despite the wide variety of topics, there are at least four common themes that connect these different issues. First, there is a recognition that the U.S. will be working with other nations to achieve our common goals. For example, a National Security Directive issued on January 21, 2021 states that the Biden administration “will work with other nations to combat COVID-19 and seek to create a world that is safe and secure from biological threats.” Similarly, an Executive Order on the climate crisis states that “The United States will work with other countries and partners, both bilaterally and multilaterally, to put the world on a sustainable climate pathway.”   

The second recurring theme in these Presidential actions is a commitment to justice and to eliminating discrimination and disparities. For example, an Executive Order on organizing the U.S. government’s response to COVID-19 includes “coordinating a Government-wide effort to reduce disparities in the response, care, and treatment of COVID-19, including racial and ethnic disparities….” Similarly, Section 219 of the January 27, 2021 Executive Order about the climate crisis explicitly recognizes the importance of environmental justice “for disadvantaged communities that have been historically marginalized and overburdened by pollution and underinvestment in housing, transportation, water and wastewater infrastructure, and health care.”

The third recurring theme in these Presidential actions is the inclusion of health issues in Executive Orders that do not relate exclusively to health. For example, the Executive Order about preventing discrimination on the basis of sexual orientation or gender identity includes a policy statement that “People should be able to access healthcare and secure a roof over their heads without being subjected to sex discrimination.” 

The fourth common theme in these Presidential actions is the reliance on science, data, and evidence-based decision-making. In addition to statements about science in other Executive Orders, President Biden issued a specific document on January 27, 2021 entitled Memorandum on Restoring Trust in Government Through Scientific Integrity and Evidence-Based Policymaking.

That memorandum is directed to the heads of executive departments and agencies in the U.S. government. As President Biden stated in that memorandum, “It is the policy of my Administration to make evidence-based decisions guided by the best available science and data…. Scientific findings should never be distorted or influenced by political considerations.”

Taken as a whole, President Biden’s Executive Orders and statements during his first 10 days in office demonstrate a commitment to making policy decisions on the basis of evidence, working to eliminate disparities, and cooperating with other nations to achieve our common goals for global public health.