The health care landscape in America is poised for major change—not for the better—when Donald Trump takes office for his second, nonconsecutive term as president.
Trump has promised to shake things up by appointing loyalists to top administration positions. Perhaps his most controversial decision to date has been the nomination of Robert F. Kennedy Jr. to run the Department of Health and Human Services, which oversees a number 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 indicated that he will change the country’s public health infrastructure, as in recent weeks he has stopped flooding and removed other vaccines from the market.
Some of Trump’s nominees for key public health positions are also concerned. Former TV host and surgeon Mehmet Oz, Trump’s pick to run Medicare, has a long history of promoting nutritional supplements and other treatments with little evidence of their claimed benefits. And like RFK, Trump’s proposed choice to run the CDC, physician and former House representative Dave Weldon, has also endorsed the long-discredited link between vaccinations and autism spectrum disorder. Perhaps more frightening than any single administration choice is the Republican party’s stated agenda, which has included limiting women’s access to reproductive health care and blocking reforms aimed at lowering ever-increasing drug prices.
No previous appointee has had this kind of record of ineptitude and misinformation on public health issues.
Given the high stakes involved, some researchers and health professionals have spoken publicly about how Trump and the GOP could endanger the health of the country. Gizmodo recently interviewed Nicole Huberfeld, professor of health law at Boston University’s School of Public Health and associate director of BU’s Reproductive Justice Program. In September, Huberfield and others published a paper in the journal STOP explains how a second Trump administration could affect the future of medicine in the US
Huberfeld spoke with us about the worst health care reforms proposed by Trump and the GOP, the reasons why RFK’s potential appointment to HHS worries experts, and what, if anything, can be done to prevent the worst public health impacts that could come in the Trump era . The following discussion has been slightly edited for clarity and grammar.
Ed Cara, Gizmodo: Your editorial discussed how the Trump administration could shape the future of medicine, particularly with the goals and plans outlined by Project 2025, a broad list of policy proposals recommended by the conservative research group The Heritage Foundation. What comes out of Project 2025 that worries you and your fellow writers the most?
Nicole Huberfeld: Three key issues are of particular concern in Project 2025’s Chapter 14, where Roger Severino writes about the Department of Health and Human Services (and will rename it “The Department of Health,” indicating the prioritization of the child’s health and the exercise of religious freedom over health. goals of care).
Three broad categories of concern include privatizing public health insurance and health care systems and deregulating them to provide more flexibility to corporations, policy choices that have a history of harming patients; undermining the health care safety net by defunding federal health care programs and returning to a discriminatory dichotomy between who “deserves” government assistance in health care by attacking the eligibility of Medicaid and the program as a whole; and promoting discrimination in health care by penalizing patients and their doctors for receiving care that indicates they are not straight, cisgender, or part of a traditional conservative family structure.
Although they may feel distant, these appointments will be important in the daily lives of patients, providers, and public health.
Gizmodo: Have you seen any evidence that Trump and his supporters have become less committed to the “anti-science” agenda, as you say, since he won the election?
Huberfeld: So far, the evidence is that the new Trump administration remains committed to an antiscience, antidata, and antimedicine agenda. Trump naming RFK Jr. his appointment of Secretary of HHS is just one example. RFK Jr. it has presented many ideas that are very outside of public health, medicine, and mainstream science, such as anti-vaccination conspiracy theories and a profound misunderstanding of how the Food and Drug Administration works.
For example, it is not a mistake that many processed foods contain additives that can harm people, but the FDA does not have the authority to deal with such additives in most cases—the food industry is the problem, not the agency. Similarly, the FDA must rely on industry funding because Congress has not adequately funded the agency’s scientific work—which means the logical answer would be better funding, not destroying the FDA. Such misinformation and misinformation is amplified by the metaphorical horn of a political appointee as HHS Secretary. No previous appointee has had this kind of record of ineptitude and misinformation on public health issues.
It is important to stay connected to reliable information and distinguish the difference between opinions and facts.
Gizmodo: What changes are people most likely to experience personally or see under the Trump administration when it comes to their health, and how might they happen?
Huberfeld: Society can expect changes in health care management, health insurance coverage, and access to care. This can be done through various legal mechanisms that will include the President’s preferred policy, which is done through actions such as executive orders and the appointment of officials who lead government agencies.
Changes in policies and personnel will have undesirable consequences, such as the repeal of laws and the reversal of ongoing case positions. In addition, the President can propose policies to Congress that can become law, although Congress has not been particularly productive in recent years (except for the COVID relief bills). If the Senate maintains the current filibuster rules, then the Republican majority still needs Democrats to agree to major legislation (or only budget reconciliation bills, which only deal with taxes and spending, will enter Congress). These approaches to legislative and policy change are important to public health, but officials like the HHS Secretary cannot dismantle agencies alone. The HHS Secretary is a political appointee whose job is often seen as more political than policy work. However, HHS is responsible for health insurance and access to health care for over 40% of the US population. And actions initiated by the Trump administration, such as work requirements for Medicaid, could happen sooner.
Relatedly, the HHS secretary could take steps such as withdrawing the Biden administration’s letter to hospitals explaining that the Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals to provide emergency medical care including abortions even in states where abortion is a crime (which may end). the case of Idaho v. US via EMTALA). Accordingly, the new FDA Commissioner may revisit the protocols for the use of mifepristone, which would limit access to medical abortion (including more than 60% of abortions nationwide after Dobbs). In other words, even though they may feel distant, these appointments will be important in the daily lives of patients, providers, and public health.
Gizmodo: Is there anything health care professionals, lawmakers, or the public can do to reduce some of the risks you’ve described?
