Donald Trump policies at odds with ‘MAHA' push
Stephanie Armour,
Tribune News Service
In his March address to Congress, President Donald Trump honored a Texas boy diagnosed with brain cancer. Amid bipartisan applause, he vowed to drive down childhood cancer rates through his 'Make America Healthy Again' (MAHA) initiative. A few days later, the administration quietly dropped a lawsuit to cut emissions from a Louisiana chemical plant linked to cancer. At first glance, Trump appears to have fully embraced the MAHA movement championed by Health and Human Services Secretary Robert F. Kennedy Jr. From proclaiming in his congressional speech a goal to 'get toxins out of our environment' to launching a new commission to study cancer and other ailments, Trump has vowed to end what he calls an epidemic of chronic disease. But even as he extols MAHA, Trump has unleashed a slew of policies likely to make Americans less healthy. He's slashing 20,000 full time positions from HHS and cutting more than $4 billion in indirect costs related to health research grants, including studies into treatment for Alzheimer's and cancer. He also supported a GOP plan likely to kneecap Medicaid, a joint federal-state program that covers about 72 million Americans.
The contradictions raise doubts about the sincerity of Trump's support for the MAHA agenda and his administration's commitment to making a dent in chronic disease — conditions that afflict about 133 million Americans and account for roughly 90% of the $4.5 trillion spent annually in the US on health care. The administration's attention to chronic disease is also notable for its lack of focus on expanding health insurance. Research shows people with coverage have lower death rates; insurance provides free or low-cost preventive care that can help manage chronic disease and reduce risks of serious complications. 'The layoffs at HHS, cuts to Medicaid, and reduction in research could all end up resulting in less healthy Americans,' said Larry Levitt, executive vice president for health policy at KFF. 'They're talking about getting at the root causes of chronic disease. Less research and protections will undermine that goal.' KFF is a health information nonprofit that includes KFF Health News.
HHS leaders have said that they focused personnel cuts at agencies on redundant or unnecessary administrative positions. The administration has said the job cuts will save money and make HHS more responsive. 'Streamlining bureaucracy and eliminating redundancies is how we deliver on the mission of Making America Healthy Again — not by preserving a bloated system that's failed to improve outcomes despite record spending,' HHS spokesperson Vianca Rodriguez Feliciano said in an email. Public health advocates say the staffing cuts run counter to the promise of a MAHA agenda dedicated to reducing chronic disease. 'HHS declared that their mission is to Make America Healthy Again,' said Sharon Gilmartin, executive director of Safe States Alliance, on a press call. The alliance is a nonprofit focused on preventing injury and violence. 'How can we do that when the people who have spent decades of their life combating the health issues of our nation are being tossed out with no notice?' The HHS workforce reductions decimated divisions focused on chronic disease.
Gone is most of the Centers for Disease Control and Prevention's population health division, which conducted research and developed public health programs on chronic disease. Gone, too, are staffers at the National Institutes of Health who focused on Alzheimer's research. After HHS staffers working on Alzheimer's projects were put on administrative leave, the Alzheimer's Association sounded the alarm about the cuts, saying in an April 1 statement that the reductions 'could cause irreversible damage.' And gone is the CDC's Office on Smoking and Health, which worked to protect the public from the harmful effects of tobacco use. The administration also gutted the FDA's Center for Tobacco Products, which enforces advertising restrictions. Tobacco use is the leading preventable cause of disease, disability, and death in the country. 'Cuts to CDC and FDA tobacco control programs are devastating,' Tom Frieden, who served as director of the CDC from 2009 to 2017, said April 18 on the social media platform Bluesky.
According to administration fact sheets and press releases, the staffing cuts will save $1.8 billion a year and shrink HHS' workforce from 82,000 to 62,000 full-time employees. HHS will be retooled to focus on 'safe, wholesome food, clean water, and the elimination of environmental toxins,' according to a March 27 press statement. The restructuring will improve Americans' experience with HHS by making the agency more responsive and efficient, the statement said. Roger Severino, a lawyer who led the HHS Office for Civil Rights during the previous Trump administration, said the job cuts are necessary because the HHS budget has grown while American health has declined. 'If you want to Make America Healthy Again, you have to make HHS healthy again. You have to trim the bureaucratic fat,' said Severino, who is now vice president of domestic policy at the Heritage Foundation, a conservative policy group. 'We haven't seen chronic disease go down or obesity go down, while autism rates are up. If this were a private company, it would have gone bankrupt years ago.'
But many public health experts question how the federal government will be able to respond to existing problems, as well as new health issues, with fewer employees and resources. Infectious diseases are one area of concern. Trump, on the first day of his second term in office, withdrew the nation from the World Health Organization, which detects, monitors, and responds to emerging health threats. The US has been the largest financial contributor to the organization. Without membership, the US may remain in the dark if the WHO identifies an emerging threat that could ultimately spread and become global. Spillover can happen: In 2014, an Ebola outbreak in West Africa led to 11 reported cases in the US. The WHO played a central role in developing infection-prevention protocols and provided logistical support to affected countries. The evisceration of the US Agency for International Development could also leave the nation more vulnerable because the agency worked with countries such as Vietnam on early detection of diseases including bird flu. The agency typically would have aided in the response to a current Ebola outbreak in Uganda, providing support that doctors say helped prevent spread in past outbreaks.
The staffing reductions and frozen or canceled grants are having an immediate impact on the ability to respond to infectious outbreaks. Right now, for instance, Texas is in the throes of a measles outbreak, with more than 500 confirmed cases. But the administration's funding cuts forced the Dallas County health department to lay off 11 full-time workers and 10 part-time staffers responsible for responding to such outbreaks, Philip Huang, director and health authority for the Dallas County Health and Human Services Department, said at a press event. The administration has also imperiled ongoing research, including studies and trials related to chronic disease. Trump ended hundreds of research projects at the National Institutes of Health totaling more than $2 billion, including projects on HIV prevention drugs and Alzheimer's disease research. 'Patients enrolled in NIH studies led by Plaintiffs face abrupt cancellations of treatment in which they have invested months of time with no explanation or plan for how to mitigate the harm,' according to a federal lawsuit filed in Massachusetts by scientists and researchers. The research being cut could potentially have supported Trump's pledge, when he honored the boy with brain cancer, to drive down rates of the disease. In the weeks since, however, Trump's administration announced plans to weaken automobile tailpipe emission standards. Trump slashed more than 400 grants to Columbia University, including millions earmarked for a cancer center.
'It's making people sicker again. Now that would be a more honest bumper sticker,' said Leslie Dach, a former Obama administration official who is the executive chair of Protect Our Care, which advocates for the Affordable Care Act. 'They're stopping research on vaccines and gutting health care programs that keep 100 million Americans healthy. It's all show. It's a bunch of junk.'
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MAHA report's errors are just start of its problems
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White House Press Secretary Karoline Leavitt attributed the inclusion of phony publications to 'formatting issues' that would be corrected. An updated report that omits those studies and cleans up bizarre errors in several others has since been uploaded to the White House website. That version contained fresh errors, Notus reported. Many suspect that the fake citations are the product of AI. That alone should be disqualifying. Rather than the thoughtful, evidence-based assessment our kids deserve, the first major report on Kennedy's cornerstone initiative was a slapped-together treatise. But there's a bigger problem. If the MAHA team did rely on AI to generate supporting data — and it seems likely it did — it wasn't just cutting corners. It confirms this project was never a good faith effort to begin with. The team was assembling evidence to reinforce conclusions that supported Kennedy's well-known narrative. 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Something more insidious is at play with all of the half-baked or made-up statistics. He is using them to undermine the real experts, making it increasingly hard for Americans to understand whose advice to trust. And ultimately, his willfully misleading analysis provides cover while he dismantles longstanding norms for scientific research and health policy. In just a few short months, the secretary has wielded his authority in unprecedented and dangerous ways. For example, amid the largest measles outbreak in 30 years, instead of emphasising vaccines — which can prevent the disease — he asked the Centers for Disease Control and Prevention to develop guidelines for treatments. There are no proven treatments for measles. At least three people have died, and nearly 1,100 cases of the disease have been reported. In another disturbing move, Kennedy said he would unilaterally change the CDC's COVID vaccine guidelines to preclude pregnant women and children from receiving shots. That upended the longstanding process that relies on outside experts' careful analysis and open debate before making such decisions. Days later, the CDC amended its regulations to incorporate some, but not all of Kennedy's proposed changes, leaving many confused not only about the actual policy but who sets it. We should worry that his approach to measles and COVID is a preview of how he will treat the value of other routine shots. One of the most alarming sections of the report questions the evidence behind and safety of the childhood vaccine schedule and — without evidence — suggests it could be linked to chronic disease. Kennedy has also used his platform to push policy changes on the use of fluoride in drinking water, which he has repeatedly linked to lower IQs (a tenuous claim that experts say is based on fluoride levels not used in the US). Fluoridation is regulated by state and local municipalities, but Kennedy said he would direct the CDC to stop recommending the practice and the Food and Drug Administration — also under his purview — later banned fluoride supplements based on unsubstantiated claims that they harm gut health. His rhetoric on the topic appears to have emboldened the first two state bans on fluoride in public water. The MAHA report's agenda suggests more changes are to come. Meanwhile, new research in JAMA found that removing fluoride from drinking water would result in 25 million more cavities in children at a cost of $9.8 billion to the US healthcare system over five years. Kennedy's next move appears to be wresting control of health and science research altogether. 'We're probably going to stop publishing in the Lancet, New England Journal of Medicine, JAMA and those other journals because they're all corrupt,' he said on a recent podcast with wellness influencer Gary Brecka. Unless those top-tier journals 'change dramatically,' health agencies will 'create our own journals in-house,' he added. In other words, he'll have a ready-made platform to showcase data that justifies whatever policy he wants to roll out next. In another troubling sign of how data could be warped to fit a political agenda, President Donald Trump signed an executive order after the report was released directing a restoration of 'gold standard science.' The goal sounds reasonable enough: to ensure research is reproducible and reverse a decline in public trust in science and health agencies. But the language of the directive is concerning. It not only challenges the credibility of several agencies — including the CDC — but suggests someone like Kennedy could exploit the language of research integrity to crack down on findings that don't fit his personal agenda. Kennedy has called the MAHA report 'the diagnosis' and says he will 'deliver the prescription' in the next 60 days. 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At least seven sources cited in the report do not exist, as Emily Kennard and Margaret Manto of the journalism organisation NOTUS uncovered. HHS hastily reissued the report with some of those citations removed, but without disclosing the changes — an extremely unkosher action in the research community.
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Congress wants Medicaid recipients to work
Michelle Baruchman, Tribune News Service Georgia could soon become the poster child for administering Medicaid with work requirements — for better or worse. As Congressional Republicans seek to pass a budget bill enacting President Donald Trump's agenda, they're looking to require able-bodied Medicaid recipients to work in order to receive their health care coverage. Georgia is presently the only state in the nation with work requirements for its Medicaid population. Here, Medicaid provides government-funded health care for some low-income people, with about 30 categories of eligibility including certain pregnant women, older widows and primary caregivers. Instead of embracing traditional Medicaid expansion, Gov. Brian Kemp sought to grow the number of insured Georgians through a conservative framework; his program provides Medicaid to people earning up to 100% of the Federal Poverty Level — about $15,000 for a single person — if they work at least 80 hours per month or meet academic or other requirements. But rather than leading to more Medicaid recipients working, Georgia's experience has led to people who could be eligible for the program unable to receive Medicaid, mostly because of bureaucratic red tape. While experts say Kemp's program, called Georgia Pathways to Coverage, has different aims, it could still provide lessons in both politics and policy. Pathways is designed to use health care as an incentive to get able-bodied individuals into the workforce on a limited basis. Eventually, the thinking goes, those part-time workers would transfer into full-time employees and become eligible for company-sponsored private health care plans, moving them off the government's rolls. According to Kemp's Office, at least 1,025 Pathways members have been referred to 'better, private health care coverage' through Georgia Access, the state's health care exchange, because their income increased. 'With this success it's no surprise that others are starting to emulate our innovative approach to health care coverage,' said Garrison Douglas, a spokesperson for Kemp. Chris Denson, the director of policy and research at the Georgia Public Policy Foundation, said Pathways is a way to increase health care coverage that is in line with the governor's vision without expanding Medicaid under the Affordable Care Act. States that expand Medicaid for people earning up to 138% of the Federal Poverty Level, about $21,000 for an individual, have received additional federal funding to pay for it. About 40 states have expanded; Georgia has not. In Congress, lawmakers are looking for cuts that reduce the federal deficit, which is currently more than $1 trillion. Implementing work requirements nationwide among the existing able-bodied Medicaid population has been a Republican goal among those who believe there is waste and abuse in Medicaid. 'Medicaid has grown beyond its original intention to cover the aged, the blind, the disabled population, children, single mothers, and has grown to cover able-bodied individuals. That has long been an issue within conservative health circles,' Denson said. As part of discussions last year around easing regulations to establish new hospitals in Georgia, state Sen. Matt Brass, a Republican from Newnan, had voted for a form of Medicaid expansion. His thinking has shifted since then, and he supports work requirements and the Pathways programme. If you're going to use public money to pay for something, outside of those who are deaf, blind and disabled, you need to have some skin in the game,' he said. 'As long as you're working and a contributing member of society, then absolutely, I'm good with providing health care to help you do that.' Democrats understand that requiring Medicaid recipients to work for their benefits sounds like a good idea. A poll from the health research group KFF found that 62% of adults support work requirements. 'That actually makes sense to a lot of people. That sounds reasonable,' said state Rep. Michelle Au, a Democrat from Johns Creek. The problem, she said, is not with the work, it's with the administrative burden of reporting. 'There are people who actually are working and meet those hour eligibilities that still are not eligible for access through Pathways because of how onerous and difficult the reporting requirement is,' she said. 'It's building in a barrier to patients getting care.' KFF found that support for work requirements drops to 32% 'when those who initially support the proposal hear that most people on Medicaid are already working and many would risk losing coverage because of the burden of proving eligibility through paperwork.' Kemp's team initially expected fewer than 100,000 people to be enrolled in the program. As of earlier this year, there were about 6,500. Heather Payne is one of the patients struggling to get care. After she began having strokes a few years ago, she was no longer able to work her nursing job and has been waiting to get her disability application to be approved. She can't get Medicaid while her disability application is active, and she can't get Medicare without a disability status. Payne, 53, who lives in Dalton, recently decided to go back to school. Attending a public or private university of technical college is considered a qualifying activity for Pathways. But in addition to working clinical rotations, she's only taking nine credit hours right now, short of the 11.5 credit hours needed to be eligible for Pathways. 'I would have to take a full-time program at my school and work my clinical rotations to get the clinical experience I needed, to qualify to get Pathways,' she said. Other Georgians have said the portal to report work is a 'nightmare,' administrative support is lacking, and applicants are not given clear reasons why they are denied benefits.
