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The new Trump Administration has kicked off their federal regulatory season with proposals to eliminate many health equity and Social Determinants of Health (SDOH) policies. Environmental stewardship and other policy incentives related to climate resilience are also on the regulatory chopping block. The Centers for Medicare and Medicaid Services (CMS) are currently accepting comments on these proposals, although many are expected to be finalized. Below are highlights of the Administration’s proposals rolling back health equity and/or environmental sustainability.  Health Equity and Health Related Social Needs  Below are policies categorized as “health equity” under the Biden Administration that CMS is proposing to change.  

• Eliminating the following measures relating to health equity from the Hospital Inpatient Quality Reporting Program (IQR).  

• Health Equity Commitment - No longer requiring that hospitals attest to their commitment to health equity.  

• Screening for Social Drivers of Health – Removing from quality programs 

• Screen Positive Rate for Social Drivers of Health – Removing from quality programs 

• Changing or fully removing the following measures: 

• COVID-19 Vaccination Coverage Among Health Care Personnel 

• Renaming (not eliminating) the Social Needs Risk Adjustment Factor to be the “Beneficiary Economic Risk Adjustment Factor.”  

Value-Based Models Remove the voluntary health equity plan and health-related social needs data from the Transforming Episodic Accountability Model “due to the new Administration’s priorities.” The new Administration clarifies, “We recognize that asking TEAM participants to submit health equity plans or report health related social needs data, even on a voluntary basis, could add an additional burden that CMS does not intend to add in the model.”   Environmental Stewardship & Air Quality 

• CMS proposes to remove the Decarbonization and Resilience Initiative from hospital quality programs in FY 2026, as proposed in this year’s IPPS rule.  

• The Administration also seems to be opposed to many clean air and climate-related initiatives, but this could make managing chronic diseases like asthma more challenging.  For example, unclean air puts lives in danger, with poor air quality projected to cause 100 million asthma attacks and 200,000 premature deaths over the next 25 years.  

• Lee Zeldin, Administrator of the Environmental Protection Agency, shared on X his promise to reduce the EPA’s spending by 65%, despite it being unclear whether the EPA could continue its scientific research with the drastic reduction in resources.  

AHPA extends our gratitude to Jenna Wilson, guest co-author of this article.  Jenna is a graduate student in the School of Global Health Management and Informatics program at the University of Central Florida.