Above photo: Donald Trump and Robert F. Kennedy Jr. Wikimedia Commons.
“Much, Much Better And Far Less Money.”
On November 14, Robert F. Kennedy Jr. was named Secretary of Health and Human Services in Donald Trump’s second administration, embodying many of the concerns health workers have about upcoming changes to US health policy
The 2024 election of Donald Trump as president of the United States has worried many, with the question of health as one of the primary concerns. Health professionals fear the damage a second Trump presidency will have on access to healthcare and on the health of marginalized populations. These concerns include leadership of governmental health agencies, access to insurance, and restrictions on reproductive health and gender affirming care.
One of the gravest concerns is the figure of Robert F. Kennedy Jr.’s (RFK Jr.) and what his role in public health policy will be in his quest to “Make America Healthy Again”. It was first reported that Kennedy was recommending appointees for Secretary of Health and Human Services (HHS) and Commissioner of Food and Drugs. On November 14, Trump announced that RFK Jr. himself will be HHS Secretary.
RFK Jr. is known for his relentless anti-vaccination rhetoric and for promoting false information linking vaccinations to autism. RFK Jr. has been recommending that fluoride, a naturally occurring mineral that prevents tooth decay, be removed from US drinking water supplies as he believes fluoride is a neurotoxin associated with “arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.”
However, beyond concerns of misleadership, health activists worry about how proposed structural changes may further limit the country’s already unequal healthcare system.
What To Expect In Health Insurance And Medical Debt?
During President Trump’s campaign for his first term in office, he promised to repeal the Affordable Care Act (ACA, aka Obamacare), but was unsuccessful in this endeavor. During the 2024 campaign, Trump emphasized not repealing, but making the ACA “much, much better and far less money”.
Regardless of the administration, however, the US simultaneously ranks as one of the richest countries in the world and one with the worst health indicators compared to other countries, particularly in the Global North. This is not a new phenomena: it has been a facet of the country for decades. Virtually all other Global North countries offer more extensive healthcare coverage at lower cost.
Weaknesses of the US healthcare system include high out-of-pocket expenses and inefficiency due to its unique and extreme complexity. Based on the 2021 US Census, 20 million people owe some type of medical debt, summing up to over USD 220 billion. The US system values profit over health, the real reason for inaccessibility of healthcare in the US. Still, Vice President-elect JD Vance promised the administration would increase “competition in the healthcare markets,” a term used to mask the profit-making motives of the health industry.
Reproductive And Gender Justice
Arguably one of the longest-lasting legacies of Trump’s presidency is his influence on the Supreme Court of the United States (SCOTUS). Supreme Court justices have lifetime appointments, and Trump appointed 3 of the 9 seats to Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett during his first term. This has led to a conservative majority in SCOTUS with many consequences, including the 2022 overturn of Roe v. Wade. This ended federal protection for abortions and has consequently caused the criminalization of abortion in some states.
During Trump’s first presidency, his administration restricted many clinics receiving federal Title X funds from providing referrals and information about abortions. Trump has stated that he will not use legislation like the Comstock Act to ban medication abortion (e.g. mifepristone), yet access to such pills remains vulnerable. On the other hand, although the Biden administration claimed to support the right to abortion, it took no substantive steps to protect access (e.g. decriminalization, funding abortion on federal land/buildings). All these attacks have had devastating effects, including a 7% rise in US infant mortality.
Trump’s first term also birthed new attacks on LGBTQ health and gender-affirming care. In Executive Order 13798, entitled Promoting Free Speech and Religious Liberty, Trump enabled health providers to deny care to LBGTQ+ people based upon “conscience-based objections”. The Biden administration reversed some of these policies, effective as of March 2024. However, under the Biden administration, state laws have been allowed to grossly attack this type of care as seen in Ohio, where laws banning gender-affirming care for minors are upheld.
The Health Of Migrants And Global Health
As of 2023, immigrants represent over 14% of the US population and exceed 47 million in number. After the end of Trump’s border closing policy (Title 42), the Biden administration saw a massive influx of migrants entering the US. Resources, including healthcare, were not sufficiently provided by federal, state or city governments to migrants. Both administrations discouraged people, particularly those coming from Central America, from entering the US, ignoring the country’s direct role in destabilizing Global South countries and thus forcing migration.
Further affecting global health, Trump previously reinstated the Mexico City Policy, which prevents US funds from supporting organizations that promote or provide abortions. Trump also withdrew the US from the World Health Organization (WHO), a decision that the Biden administration reversed.
Both administrations have been avid proponents of war and are responsible for the deaths of hundreds of thousands as epitomized by the current genocide of the Palestinian people. Israel has targeted hospitals and healthcare workers, destroying Gaza’s health system. Trump, a defender of Israel, would not oppose these war crimes and would likely support the annexation of and reign of terror in the West Bank as well.
Trump appears determined to use his second term in office to cause major set backs in the already unequal, privatized US healthcare system. While millions already struggle to access the care and support they need, Trump’s policies will further deepen these inequalities.