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By the end of the first Trump administration, nearly 400,000 people had died from Covid-19, a high mortality rate that could have been largely prevented with a more effective federal government response to the pandemic. While public health officials worked to effectively disseminate information regarding disease transmission and prevention, the Trump administration actively antagonized health experts at both the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH), touting nonsensical misinformation about treatment in a bid to imagine the national health crisis away.
Much of the Trump administration’s initial failures on Covid-19 can be attributed to an extreme level of mismanagement and incoordination—an obvious concern for any public health expert evaluating a potential second Trump administration. In fact, mismanagement, poor coordination, and continuous attempted defunding were a reflection not just of Trump’s last year in office, but of the first three as well.
Trump has failed to demonstrate remorse for his administration’s active disregard for public health, nor any interest in a different approach to expertise and the American healthcare system.
In our Trump Retrospective memos, released several weeks ago, we talked about Trump’s first term record on healthcare, across departments such as HHS, the CDC, the NIH, and the Food and Drug Administration (FDA). But from what we can see between Project 2025, and Trump and the GOP’s own Agenda 47, an administration characterized by ethics scandals, conflict with public health experts, and corporate friendliness only plans to cement those interests in a future term. Giving Trump the power to enact Project 2025 would lead to the weaponization of federal agencies to appeal to ideological interests and corporate supporters, and exercise a vengeance with public health departments he disagreed with during his first term.
Much of the Trump administration’s public health record has been discussed within the context of Covid-19 mismanagement, but its problems long preceded the pandemic. Throughout his first term, his leadership team helped shift the focus away from science and prevention. Examples of this approach vary from disbanding the global health security team at the National Security Council to dismantling several offices across HHS, including the Science and Medicine team.
Project 2025 and Agenda 47 propose a continuation of this warped approach, with drastic plans to shift the management of many federally funded and directed insurance programs to private insurance companies under the premise of “limiting abuse and fraud.” Moving past the fuzzy slogan of “repeal and replace” on the Affordable Care Act, Project 2025 instead seeks to structurally adjust individual components of our federal healthcare system to be more welcoming to privatization and industry profit. Plans in Project 2025 include removing reimbursement restrictions for Medicare and Medicare Advantage and allowing for more private options and plan delegation within Medicaid. Both of these proposals would create additional loopholes for private insurance plans to mark up plans and services, which would lead to higher costs for federal and state governments and ultimately result in worse care and higher costs for beneficiaries.
Trump’s first-term policies around Medicaid sought to do similar things, such as increasing eligibility requirements and delegating additional power to state governments. Although these policies were framed as measures to increase personal responsibility, the actual impact was an increase in the number of uninsured nationwide and significantly higher costs for patients. Plus, Trump and Project 2025 have already railed against current drug price negotiation provisions passed under the Inflation Reduction Act, and plan to repeal the policy, which would result in significantly higher drug costs for seniors.
While in office, Trump significantly hampered the ability of the CDC and the NIH to effectively disseminate information and guidance needed to manage the spread of Covid-19. Instead, administration leadership attacked public health officials across both departments, created conflicting messages around treatment and prevention methods, and refused to support coordination between agencies to address the pandemic more swiftly. His plans for a future term are no different. Project 2025 authors have proposed splitting up the CDC to limit the quantity of research-enforced recommendations that can be issued. Such a separation of research from policy and guidance would significantly hamper the efficacy of the CDC’s current work, and decrease the agency’s efficacy on addressing public health issues. Additionally, plans to limit HHS from declaring public health emergencies also weaken executive power when crises do arise, and potential responses to future health crises.
Structurally, this is alarming, as it attempts to divorce medical research from public health policy and recommendations, ignoring their inherent interrelatedness (and the need for coordination between them). But given that Covid-19 still exists across the nation, and we still face imminent public health threats, a Trump administration which has already broken the public’s trust would likely be unable to mount an effective response if given another opportunity.
Project 2025’s culture war extends to health care, with plans targeting healthcare rights for the most marginalized across the nation, creating more hostile conditions for access to care nationwide. The broad vision is to shift the focus of HHS to be the Department of Life—an effective focus on opposing abortion and other reproductive, sexual, and gender-affirming care—undermining its established mission around health access, financing, and outcomes.
Current plans to increase limits on abortion, and potentially pursue a federal abortion ban, combined with restrictions on emergency contraception, only guarantee an increase in mortality and harm to pregnant people nationwide. Taken with proposed restrictions on queer and trans healthcare, it’s evident that the plan isn’t to “protect children,” but instead to actively interfere with medical research and practice by limiting critical sexual and reproductive healthcare for anyone. Notably, the healthcare section of Project 2025 is written by Roger Severino, who served as Director of the Office of Civil Rights at Trump’s HHS. Severino has described Project 2025 healthcare plans as an effort to return to a strictly established family structure in response to a purported undermining of the nuclear family by the Biden administration.
The Trump administration caused significant harm to health outcomes, through mismanagement of health agencies, perpetuation of medical misinformation, and centering corporate interests. Project 2025 attempts to build on the Trump record on healthcare by putting it on steroids.