Soon after taking office, President Trump issued several executive orders, some of which may eventually affect group health plan design and administration. Of note, executive orders serve as a directive from the President of the United States. Meaning, executive orders do not make any immediate changes to the law, but rather direct federal agencies (e.g., Departments of Labor, Treasury, and Health and Human Services) to issue various regulations and guidance in the future. Importantly, executive orders help provide direction of what lies ahead for rulemaking.

Below is a high-level summary of recent presidential action via memorandums and executive orders, with potential for forthcoming group health plan impact.

  • Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government: This executive order directs agencies to only recognize the term “sex” as determined at birth, meaning either male or female. Per the order, “sex” does not include the concept of gender identity. Federal agencies are instructed under the order to use this definition when enforcing laws governing sex-based rights and protections, and to revoke guidance inconsistent with the order. Further, prior related guidance under President Biden was rescinded, including workplace harassment guidance that incorporated protections based on the decision in Bostock v. Clayton County (which determined that the Title VII definition of “sex” includes “gender identity”). See our article, HHS Final Rule Impacts Section 1557 Nondiscrimination Protections, for additional context. While this order does not directly pertain to group health plan administration, impact specific to nondiscrimination mandates under the Affordable Care Act (ACA) Section 1557, which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability for certain health programs and activities, is anticipated. For example, protections for gender-affirming care.
  • Protecting Children from Chemical and Surgical Mutilation: This order state that the United States will no longer “fund, sponsor, promote, assist, or support the so-called “transition” of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.” The order requires the Department of Health and Human Services (HHS) to take all appropriate actions to “stop the chemical and surgical mutilation of children” and to withdraw any guidance inconsistent with the order. The order also instructs the Department of Defense to exclude chemical and surgical mutilation from TRICARE coverage. When implemented, nondiscrimination requirements under ACA Section 1557 and ACA essential health benefits will be affected.
  • Initial Rescissions of Harmful Executive Orders and Actions: This order revokes certain administrative orders issued under President Biden, including (but not limited to) Strengthening Medicaid and the Affordable Care Act, Continuing to Strengthen Americans’ Access to Affordable, Quality Health Coverage, Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation and Lowering Prescription Drug Costs for Americans. While the order does not elaborate on further directives outside of rescission of the prior orders, it is important to note that access to, and premium subsidies for, ACA marketplace plans may change as a result of rescinding the prior executive orders. The outcome of the rescission of the order related to prescription drug costs remains unclear. The previous Biden order directed CMS to make efforts to lower prescription drug costs, though President Trump also stated during his campaign that his administration would be supportive of lowering prescription drug pricing.
  • Regulatory Freeze Pending Review: This memorandum directs federal executive departments and agencies not to propose or issue regulations, and to withdraw submitted but not yet published regulations, until such regulations have been approved by an individual appointed by President Trump. Similarly, agencies are directed to consider delaying (for at least 60 days) the effective date of regulations that have been published but are not yet effective for purposes of review. While this directive is broad in scope, there is potential this will stall certain regulations related to health and welfare benefits.

Employer Takeaways

While we expect to see revisions and rulemaking aligned with the directives of the memorandum and executive orders in the weeks to come, employer plan sponsors should not begin to implement changes until additional agency guidance is published with an explanation of any required action. Sequoia will continue to monitor this information closely and will communicate updates on further legislative & regulatory developments.

Additional Resources

Connect with a Sequoia consultant to learn how Sequoia’s compliance services are integrated in our benefits services and tailored solutions. And if you’re already a Sequoia client, stay on top of your employer obligations with your Compliance Checklist that highlights important compliance dates, action items, and resources. 

The information and materials on this blog are provided for informational purposes only and are not intended to constitute legal or tax advice. Information provided in this blog may not reflect the most current legal developments and may vary by jurisdiction. The content on this blog is for general informational purposes only and does not apply to any particular facts or circumstances. The use of this blog does not in any way establish an attorney-client relationship, nor should any such relationship be implied, and the contents do not constitute legal or tax advice. If you require legal or tax advice, please consult with a licensed attorney or tax professional in your jurisdiction. The contributing authors expressly disclaim all liability to any persons or entities with respect to any action or inaction based on the contents of this blog. © 2025 Sequoia Consulting Group. All Rights Reserved.

Diane Cross — Diane is a Client Compliance Consultant for Sequoia, where she works with our clients to optimize and streamline benefits compliance. In her free time, Diane enjoys spending time with her family, live music, and cycling.