Just the Start: How the Biden-Harris Administration Must Build on Its Early Actions for Lasting Change

Zara Ahmed, Guttmacher Institute Ruth Dawson, Guttmacher Institute Megan K. Donovan, Guttmacher Institute Leah H. Keller, Guttmacher Institute Adam Sonfield, Guttmacher Institute
Reproductive rights are under attack. Will you help us fight back with facts?

First published online:

There was a flurry of activities in the first few weeks of the Biden-Harris administration. Within his first 10 days of office, President Biden signed measures to address family planning services, international abortion access, LGBTQ rights, racial disparities and health insurance coverage, among other key issues. These actions signal a return to evidence-based policymaking and an understanding that facts matter when it comes to sexual and reproductive health and rights.  

The administration’s actions sought to undo some of the most egregious policy attacks on health care that occurred during the last four years. They are necessary first steps, but in many cases are just that. Indeed, the advocates behind the Blueprint for Sexual and Reproductive, Rights, and Justice—including those at the Guttmacher Institute—have outlined an extensive list of necessary actions.  

A look at the key sexual and reproductive health and rights policies that the Biden-Harris administration has pursued highlights the administration’s early accomplishments, and the actions that still need to be taken to ensure sexual and reproductive health and rights for all. 

International Sexual and Reproductive Health and Rights 

Initial steps: 

  • Reengaged with the World Health Organization (WHO): President Biden sent a letter to the UN secretary-general retracting a July 2020 letter that began the process of withdrawing the United States from WHO membership.  
  • Reversed the "global gag rule": President Biden issued a presidential memorandum that lifts the global gag rule, which prevents foreign nongovernmental organizations from using non-U.S. funds to provide abortion-related services.  
  • Restored U.S. support to the United Nations Population Fund (UNFPA): Biden’s memorandum also directs the U.S. Department of State to take steps to restore funding to UNFPA, which the Trump administration suspended.  
  • Withdrew from Geneva Consensus Declaration on abortion rights: The memorandum also directs the U.S. Departments of State and Health and Human Services (HHS) to withdraw the United States from the Geneva Consensus Declaration, which is a document signed by 34 countries declaring that "abortion is not an international right." 

Next steps: Repealing the global gag rule alone does not turn the United States into a global champion of reproductive rights. The Biden-Harris administration can—and must—take a comprehensive approach to unraveling the dangerous, punitive and coercive policies the previous administration wove into U.S. foreign policy. In addition to supporting increased funding for global health efforts and institutions, the current administration should: 

  • Support the Global Health, Empowerment and Rights Act: This bill would permanently repeal the global gag rule, ending U.S. interference into what international organizations can do with their own, non-U.S. funds.   
  • Support the Abortion Is Health Care Everywhere Act: This bill would permanently repeal the Helms Amendment, which for nearly 50 years has essentially banned the use of U.S. federal funds to support abortion services abroad.  

U.S. Family Planning 

Initial steps:  

  • Began to undo the Title X "domestic gag rule": The Biden-Harris administration took its first step toward rescinding the domestic gag rule—the destructive Trump-Pence administration overhaul of regulations governing the Title X national family planning program. President Biden signed a presidential memorandum directing HHS to review those regulations and consider whether to suspend, revise or rescind them. 

Next steps: Repealing the Title X rule is just the first step in addressing the prior administration’s attacks on domestic family planning. The Biden-Harris administration must take inventory of the numerous and compounding ways the prior administration jeopardized family planning providers and coverage, and should: 

  • Restore the Title X program: HHS should swiftly issue rulemaking that rescinds the harmful Title X rule and reinstates the program’s previous regulations. The administration should work with Congress to support robust funding for the Title X program, both to restore the half of the program's patient capacity that this rule jeopardized and to fund this effective, yet chronically underfunded, program. 
  • Bolster insurance coverage of contraception: The administration should review and replace its predecessor’s sweeping religious and moral exemptions to the contraceptive coverage guarantee under the Affordable Care Act (ACA); work on new guidance and regulations to bolster contraceptive coverage in private insurance, Medicaid and other types of health coverage; and work with Congress toward a legislative requirement for all types of insurance to fully cover contraceptive care. 
  • Protect family planning providers in Medicaid: The Biden-Harris campaign made explicit promises to protect access to and funding for Planned Parenthood and other family planning providers; the administration should follow through by restoring protective Obama-era Medicaid guidance and rejecting states’ attempts to discriminate against providers who offer abortion-related care.  

U.S. Abortion Access 

Initial steps:  

  • None to date: The Biden-Harris administration has not taken clear action or voiced a strong commitment to advancing abortion rights and access in the United States. To the contrary, the word "abortion" was conspicuously absent from a brief statement issued on the 48th anniversary of the Roe v. Wade decision. While the statement did indicate support for "codifying" the U.S. Supreme Court decision, that reference suggests, at best, an outdated and overly narrow understanding of what must be done to ensure access to abortion.   

Next steps: Much of the harm done by the previous administration was carried out through incendiary rhetoric and lies. It is incumbent upon the Biden-Harris administration to offer a counternarrative that dispels myths, promotes facts and evidence, and destigmatizes abortion. Unfortunately, the White House press secretary, Jen Psaki, has passed up several opportunities  to affirm the administration’s commitment to abortion rights and access. The administration must be unequivocal about its support, including by publicly committing to the following actions: 

  • Issue a budget proposal free of antiabortion restrictions: The president’s first budget proposal to Congress is an important marker of his administration’s policy priorities. President Biden must send a budget to Congress that is free of antiabortion restrictions like the Hyde and Weldon Amendments. 
  • Adhere to the science on medication abortion: The U.S. Food and Drug Administration (FDA) continues to impose onerous and unnecessary restrictions on medication abortion, including an in-person dispensing requirement that is unnecessary in ordinary times and outright dangerous during the COVID-19 pandemic. The administration must immediately issue guidance lifting this requirement until after the pandemic. Next, the FDA should review its full set of medication abortion restrictions in light of the scientific evidence, and modify or remove them accordingly. 
  • Support the EACH Woman Act: This bill would restore insurance coverage of abortion for people enrolled in Medicaid, Medicare and other federal programs. 
  • Support the Women’s Health Protection Act: This bill would establish a federal statutory right for providers to supply and patients to receive abortion care free from unconstitutional bans and medically unnecessary restrictions. 

U.S. Insurance Coverage 

Initial steps:  

  • Required review of Medicaid and ACA policies: President Biden signed an executive order directing federal agencies to review agency regulations, guidance documents and policies, such as work requirements, that may impede people’s ability to get and keep Medicaid and insurance coverage through the ACA.  
  • Opened a special ACA enrollment period: The administration announced it would reopen the ACA health insurance marketplaces from February 15 to May 15 and launch an outreach campaign to encourage uninsured people to sign up for federally subsidized plans during the COVID-19 pandemic. 

Next steps: The executive order is just the beginning of a long but necessary process to reverse the harms of the previous administration’s health care policies; protect the ACA and Medicaid from further attacks in the courts, Congress and the states; and work toward comprehensive health insurance for everyone that meets their sexual and reproductive health needs. 

  • End Medicaid work requirements: As part of the review of Medicaid policy, the administration must rescind the previous administration’s guidelines for states to request harmful work requirement waivers, withdraw the U.S. government’s support for that policy in a pending Supreme Court case and start the process of revoking existing state waiver approvals. 
  • Reverse policies that undermine patients’ rights and encourage discrimination: The administration should quickly review and replace its predecessor’s expansive "refusal of care" regulations and its regulations narrowly interpreting the ACA’s nondiscrimination protections, both of which could potentially undermine access to sexual and reproductive health care and medical care for LGBTQ individuals and other marginalized groups.  
  • Reverse other policies that undermine Medicaid and the ACA: The review of Medicaid and ACA policies must extend to the prior administration’s last-minute regulations and waiver approvals and its numerous other efforts over the previous four years to undermine enrollment, benefits and patient protections. 
  • Include comprehensive sexual and reproductive health services in health care reform legislation: President Biden has publicly committed to ensuring abortion and contraceptive care through his public option plan. His administration needs to work with Congress to ensure that any public option legislation or other expansion to health insurance bolsters access to reproductive health services. 

The Biden-Harris administration has also begun to address a number of its predecessor’s egregious attacks on marginalized communities. This includes (but is not limited to) executive action to embed policies that advance racial equity across the federal government, to preserve and support the Deferred Action for Childhood Arrivals (DACA) program, to begin the process of unifying immigrant families torn apart by the Trump administration’s family separation policy and repealing the Trump administration’s vastly expanded and punitive "public charge" rule, and to broaden antidiscrimination protections for LGBTQ people in work, school, health care and other settings. 

While the Biden-Harris administration should be lauded for its decisive first steps to address the harms of the previous administration, the work is not done. In order to "build back better," the administration must continue to take bold, decisive steps toward evidence-based, equitable policies, including on sexual and reproductive health and rights.