The landscape of health care in America is poised to undergo a monumental shift—and not for the better—once Donald Trump takes office for his second, non-consecutive presidential term.
Trump has promised to shake things up by appointing loyal supporters to prominent administration positions. Perhaps his most controversial decision thus far has been the nomination of Robert F. Kennedy Jr. to head the Department of Health and Human Services, which governs a wide array of other agencies related to public health, including the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health. Kennedy has already indicated that he will alter the country’s public health infrastructure, having pushed in recent weeks for the end of water fluoridation and the possible removal of some vaccines from the market.
Other candidates nominated by Trump for important public health positions are also concerning. Former TV show host and surgeon Mehmet Oz, who Trump picked to run Medicare, has a long history of promoting nutritional supplements and other treatments that have little evidence for their claimed benefits. And much like RFK, Trump’s proposed choice to run the CDC, physician and former House Representative Dave Weldon, has also endorsed a long-discredited link between vaccination and autism spectrum disorder. Perhaps scarier than any single administrative pick is the Republican party’s stated agenda, which has included limiting women’s access to reproductive healthcare and preventing reforms aimed at lowering ever-expanding drug prices.
No prior nominee has had this kind of record of mis- and disinformation on public health matters.
Given the high stakes involved, some researchers and health care professionals have spoken publicly about how Trump and the GOP could imperil the country’s health. Gizmodo recently interviewed Nicole Huberfeld, a professor of health law at Boston University’s School of Public Health and co-director of the BU Program on Reproductive Justice. In September, Huberfield and others published a paper in the journal JAMA detailing how a second Trump administration might affect the future of medicine in the U.S.
Huberfeld spoke to us about the most egregious health care-related changes proposed by Trump and the GOP, the reasons why RFK’s potential nomination to HHS worries experts, and what, if anything, can be done to forestall the worst impacts to public health that could arrive in the era of Trump. The following conversation has been lightly edited for clarity and grammar.
Ed Cara, Gizmodo: Your editorial discussed how a Trump administration could shape the future of medicine, particularly through the aims and plans outlined by Project 2025, an expansive list of policy proposals recommended by the conservative think tank the Heritage Foundation. What from Project 2025 most concerns you and your co-authors?
Nicole Huberfeld: Three key priorities are especially worrisome in Project 2025’s Chapter 14, in which Roger Severino wrote to address the Department of Health and Human Services (and would rename it the “Department of Life,” symbolizing the prioritization of fetal life and religious free exercise over health care goals).
The three broad categories of concern include privatizing public health insurance and health care programs and deregulating them to give more flexibility to corporations, a policy choice that has a history of harming patients; undermining the health care safety net through defunding federal health care programs and returning to a discriminatory dichotomy between who is “deserving” of government assistance in health care by attacking Medicaid eligibility and the program as a whole; and fostering discrimination in health care by penalizing patients and their physicians for care reflecting that they are not straight, cisgender, or part of a socially conservative traditional family formation.
Though they may feel distant, these appointments will matter for everyday issues in the lives of patients, providers, and for the public’s health.
Gizmodo: Have you seen any evidence that Trump and his backers are any less committed to an “antiscience” agenda, as you put it, since winning the election?
Huberfeld: So far, the evidence is that the new Trump administration remains committed to an antiscience, antidata, and antimedicine agenda. Trump’s naming of RFK Jr. for his nomination of the Secretary of HHS is just one example. RFK Jr. has stated many ideas that are far outside the public health, medical, and scientific mainstream, such as anti-vaccination conspiracy theories and a deep misunderstanding as to how the Food and Drug Administration works.
For example, he is not wrong that many processed foods contain additives that can harm humans, but the FDA lacks authority to address such additives in most circumstances—the food industry is the problem, not the agency. Likewise, the FDA has to rely on industry funding because Congress has not adequately funded the scientific work the agency performs—meaning that a meaningful answer would be better funding, not destroying the FDA. Such misinformation and disinformation become more potent with the metaphorical bullhorn a political appointee such as the HHS Secretary has. No prior nominee has had this kind of record of mis- and disinformation on public health matters.
It is important to stay connected to reliable information and to discern the difference between opinions and facts.
Gizmodo: What are the changes that people are most likely to personally experience or see under the Trump administration when it comes to their health, and how might they come about?
Huberfeld: The public can expect shifts in regulation of health care, health insurance coverage, and access to care. This is likely to occur through different legal paths that will include the President’s policy preferences, which come about through actions like executive orders and appointments of officials who lead federal agencies.
Changes in policies and personnel will have ripple effects, such as revoking regulations and reversing ongoing litigation positions. In addition, the President can suggest policies to Congress that may become law, though Congress has not been especially productive in recent years (except for COVID relief bills). If the Senate maintains current filibuster rules, then the Republican majorities still need Democrats to agree to major laws (or only budget reconciliation bills, which address taxing and spending only, will get through Congress). These paths to legal and policy change are important for the public’s health, but officials like the HHS Secretary cannot single-handedly dismantle agencies. The Secretary of HHS is a political appointee whose job is often perceived to be politics more than policy work. Yet, HHS is responsible for health insurance and health care access of more than 40% of the U.S. population. And actions the first Trump administration initiated, like work requirements in Medicaid, may swiftly recur.
Relatedly, the HHS Secretary could take actions such as revoking the Biden administration’s letter to hospitals explaining that the Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals to provide medical emergency care that includes abortions even in states that criminalized abortions (which would possibly end the Idaho v. U.S. case over EMTALA). Likewise, a new FDA Commissioner could revisit protocols for mifepristone use, which could limit access to medication abortion (that accounts for more than 60% of abortions nationwide post-Dobbs). In other words, though they may feel distant, these appointments will matter for everyday issues in the lives of patients, providers, and for the public’s health.
Gizmodo: Is there anything that health care professionals, lawmakers, or the public can do to mitigate some of the harms you’ve described?
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