In the past two weeks, the Trump administration has spent a remarkable amount of time undoing health orders—not just the Biden administration’s rules, but also its own jarring crackdown.
On day two of Donald Trump’s presidency, the White House ordered a freeze on communications from federal health agencies. The government’s medical-research agency, the National Institutes of Health, devolved into chaos; many employees wondered whether they could continue with basic functions of their job, such as attending scientific meetings and reviewing grants. Days later, a new memo clarified that they could continue their work, but not say anything about it to the public.
This week, after the White House budget office released a memo ordering a freeze on trillions of dollars in federal grants and loans, state Medicaid agencies, hospitals, and community centers were unsure if they could continue operating. The administration had said the freeze would not affect Medicaid, but state administrators were locked out of the federal-funding portal. Soon, states regained access, a judge temporarily blocked the order, and the administration rescinded the memo. (Trump’s orders requiring government agencies to eliminate spending on “woke” ideologies remain in effect.)
Amid all that scrambling, the administration also ordered a pause on international aid, which led health organizations to stop distributing HIV medications purchased with U.S. funds, only to have the State Department walk back that directive. But even after the reversal, clinics remained closed.
It’s all a lot to follow, to say the least. In some of its endeavors, the Trump administration does appear to have a clear set of goals: to overwhelm the opposition and seize power for the executive branch. But so far, the president’s strategy for restoring America to an imagined healthier version of itself seems to consist of no strategy at all. Previously, Trump had suggested that his policies would be whatever Robert F. Kennedy Jr., his nominee for secretary of Health and Human Services, wanted—“I’m going to let him go wild on health,” Trump said at a rally in October. And yet, during his confirmation hearings this week, Kennedy repeatedly deferred to Trump. He elaborated his thoughts on regenerative agriculture (which would not fall under his purview at the Department of Health and Human Services), but when quizzed on hot-button issues such as the abortion drug mifepristone (which would), he parroted the party line. “I will implement President Trump’s policies,” Kennedy said.
The changes that have stuck (so far) are a hodgepodge of policies, and appear more focused on getting rid of ideas and initiatives the president doesn’t like than on fixing the problems of cost and access that pervade America’s health-care ecosystem. Trump issued an executive order requiring that the federal government recognize only two sexes, despite decades of biological research showing that sex is far more complex. He reinstated thousands of service members who were kicked out of the military for refusing the COVID-19 vaccine at the height of the pandemic. He pulled America out of the World Health Organization because, as Trump put it, it’s a rip-off. He reversed key Affordable Care Act elements introduced by Joe Biden that extended enrollment periods, reaffirmed coverage for preexisting conditions, and aimed to lower premiums. He revoked two Biden-administration executive orders that sought to protect access to abortion in the U.S., made plans to rejoin an international anti-abortion pact, and reinstated a ban on funding for overseas nongovernmental organizations that perform or promote abortions—despite election-cycle promises to leave abortion to the states.
Trump is also derailing projects he previously indicated he might like. Even though he has long supported drug-pricing reforms, he rescinded a Biden executive order that created three new drug-pricing models to lower the cost of prescription drugs for people on Medicare and Medicaid.
A decision on Kennedy’s confirmation is expected as soon as next week. If he takes control of the administration’s health-care strategy, its actions might start to look more coordinated. During his confirmation hearings, Kennedy emphasized his desire to combat chronic diseases, suggesting that federal health research should aim to “identify the toxins that are contributing to chronic disease and eliminate them.” Chronic diseases are the leading cause of illness, disability, and death in America, though their causes go far beyond toxins in food and the environment.
In other areas of health policy, though, the flailing may continue. Kennedy appeared disinterested and at times confused when senators asked him about Medicare and Medicaid, which account for the majority of HHS’s budget. Kennedy has also spent decades spreading misinformation about the alleged harms of vaccines, but he told lawmakers at the first hearing that vaccines play a “critical” role in health care, that he supports the childhood-immunization schedule, and that he would not delay or alter how the Food and Drug Administration reviews vaccines. Perhaps the most telling exchange happened on the second day, when Senator Bill Cassidy, a doctor and Louisiana Republican, asked Kennedy whether he planned to reassure parents that vaccines for hepatitis B and measles do not cause autism. “If the data is there, I will absolutely do that,” Kennedy responded. But the data is there. Mountains of it, for decades. Such a basic disregard for scientific inquiry would make Kennedy fundamentally unpredictable as the head of American health.
The Trump administration’s present strategy has plunged much of the government’s health-care apparatus into disarray. The FDA is scrubbing mentions of diversity from its website, leaving researchers uncertain about whether they can still attempt to include diverse populations in clinical trials. Government scientists, as well as hospitals and other health-care providers that receive federal money, still don’t know how funding changes will affect their work. A system outage has left the National Science Foundation unable to pay researchers. The administration may well have plans for drug-pricing reforms and health farms in the works. But through all this chaos, it’s hard to see Trump’s vision for a healthier America.
The post Trump’s Slash-and-Burn Approach to Health Care appeared first on The Atlantic.
