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Project 2025, a conservative policy initiative, has drawn significant national attention for its proposals to expand executive power and reshape federal governance. While the Republican presidential nominee has distanced himself from the initiative, many of his advisors and campaign policies align closely with its goals. Initially focused on policy advocacy, Project 2025 has shifted its strategy to building a federal personnel apparatus, signaling serious intent to implement its controversial proposals. Key areas targeted by the initiative include reproductive health care and labor policies, raising concerns about their potential impact on clinicians, patients, and public health.
Abortion Restrictions Could Deepen Workforce Challenges
Project 2025 proposes significant restrictions on abortion at the federal level, building on state laws that have already caused ripple effects across the healthcare sector. These policies could criminalize routine medical practices, such as miscarriage management, in-vitro fertilization (IVF), full-scope pregnancy care, and contraception services. Current state-level restrictions have already led to legal risks for obstetricians and gynecologists (OBGYNs), prompting some to leave the profession or curtail their scope of practice. By mandating local prosecutors enforce abortion restrictions under threat of federal penalties, Project 2025 would escalate these pressures nationwide.
Project 2025 also targets existing Health Insurance Portability and Accountability Act (HIPAA) protections for abortion-related medical records. By rescinding HIPAA guidance that protects patient confidentiality, Project 2025 would enable law enforcement to access sensitive patient information for prosecuting abortion-related cases. This policy could deter patients from seeking essential care, endangering their health while exacerbating provider shortages.
Threats to Reproductive Health Training and Access
Project 2025 proposes eliminating mandatory abortion-related training in medical programs, jeopardizing the future pipeline of OBGYNs and other reproductive health specialists. Medical trainees already face barriers in accessing such training, often traveling out of state at high personal expense. A lack of standardized training could further deter students from pursuing careers in reproductive health care. Surveys show that the Dobbs decision, which overturned Roe v. Wade, has already impacted residency program choices, with prospective OBGYNs favoring states with fewer abortion restrictions.
The Project 2025 initiative also advocates replacing the American College of Obstetricians and Gynecologists (ACOG) as an advisor to federal women’s health mandates, favoring groups aligned with anti-abortion views. This shift could limit access to reproductive health services, particularly in underserved areas known as maternal health deserts.
Labor Policy Changes Could Undermine Health Workforce Protections
Beyond reproductive health, Project 2025 proposes labor reforms that could weaken protections for healthcare workers. Key among these is a redefinition of independent contractor status under the National Labor Relations Act (NLRA), making it easier for employers to classify healthcare workers as contractors. This reclassification would strip workers of collective bargaining rights and protections against retaliation, affecting roles like nurse anesthetists and home care aides.
Project 2025 supports the controversial TEAM Act, which would permit employer-controlled worker organizations to replace traditional unions. Critics argue this change would undermine union influence and erode workplace protections. Research shows unions in healthcare improve patient outcomes, including reduced rates of in-hospital deaths and infections. Weakening labor protections could, therefore, harm both workers and patients.
Implications for Public Health and Workforce Stability
Project 2025’s sweeping policy proposals risk exacerbating existing challenges in healthcare, including provider shortages and burnout. Efforts to restrict reproductive health care, curtail labor protections, and politicize health policy could destabilize the workforce and reduce access to essential services. Addressing these risks will require careful policy responses, including maintaining robust workforce protections and safeguarding access to care.
For further details on Project 2025's policy framework, refer to the full report here.
