What Could Trump’s Second Term Mean for the Future of Public Health and Health Policy?

Trump and his allies made many claims about their plan for the nation’s healthcare on the campaign trail. What if they are true?

By Jaden Hayes

November 5, 2024: Election Day

Donald Trump’s 2024 reelection with 312 electoral votes firmly established Republican dominance over the Presidency, House, and the Senate for 2025. This unified control has intensified nationwide political tensions. A KFF poll released in February 2024 determined eight in ten American voters identified the economy and health care costs as leading public concerns. Trump’s attempt to undermine the Affordable Care Act (ACA), nominations for public health leadership, and proposed taxation of imported goods can exacerbate these concerns. His health initiatives have prompted debate among both health experts and the public regarding access and affordability of healthcare services nationwide. 

Dr. Ilana Graetz, an associate professor in Health Policy and Management at Emory University Rollins School of Public Health, expresses concern with Trump’s health agenda. “He’s going to keep doing everything that he can to undo the progress of the ACA and deregulate health insurance. I think, to the harm of people that need health insurance, which is all of us.” 

As the Trump Administration prepares to take office, the public braces for the impact of these initiatives on their personal healthcare and financial stability.  His administration will reshape the future of healthcare forever if his proposed initiatives are successfully passed through Congress.

Let’s Go Back to 2016…

In his first presidential term, Trump signed his very first executive order to repeal the Affordable Care Act on his inauguration day. His argument was to combat concerns over costs and market inefficiencies. 

According to KFF, 2024 enrollment in the ACA achieved an all-time record of over 21 million people enrolled, doubling the amount of enrollees from 2020. Trump stated how he does not intend on pursuing the repeal of the Affordable Care Act during the 2024 presidential debate against Vice President Kamala Harris, but, instead, might propose an alternative to lower healthcare costs for individuals who are unable to afford the ACA.

Due to the program’s popularity, critics claim it would be almost impossible to repeal ACA. Graetz disagrees.

Graetz claims that the ACA is very feasible to repeal. Even if he doesn’t repeal it, Graetz believes that he could still implement other health initiatives that could undermine the ACA.  She explains that implementing short-term insurance policies could incentivize healthy people to leave the marketplace, and resort to, as Graetz describes, plans that “they don’t know don’t cover essential health benefits.” Subsequently, this interruption could cause people to become sicker. 

Dr. David Howard, an adjunct professor in the department of Health Policy and Management at Emory University Rollins School of Public Health, adds that this push for individualized and private short-term plans could increase prices and rates for the uninsured. “If it pulls healthy people out of the regulated ACA Act market, then premiums in that market will go up, and some people may lose coverage”, Howard said.

Trump suggested in his previous administration that reforms that would streamline costs, expand health savings accounts, and increase competition among insurers, emphasizing his vision for a more accessible system for underserved Americans. Economists have proposed, however, that his promotion of individual and privatized insurance could actually harm the American people. 

Dr. David McMillon, an Assistant Professor of Economics at Emory University, issued a firm warning. “When healthcare systems are overly privatized, costs often increase, especially for people with pre-existing conditions or those who are economically disadvantaged” he said. “It’s a system where profit is prioritized, and the most vulnerable populations bear the brunt of the consequences.” 

Howard asserts that most people covered under the ACA are heavily subsidized– meaning that they are receiving financial support to cover the cost of the insurance. Subsidies of the ACA assist enrollees in two different ways. Enrollees can receive either a Premium Tax Credit or a Cost Sharing Reduction (CSR) based on eligibility. The premium tax credit assists with reducing the Monthly Payment for insurance coverage. The CSR, a payment made before you receive health care services, assists with reducing deductibles. Additionally, CSR also accommodates for out-of-pocket costs.  “It would take a large increase in premiums for people to want to drop out”, he said. 

Howard suggests that, unless the healthcare proposed under the privatized system is dramatically lower than an individual’s current premium under the ACA, current subscribers would not be incentivized to move away from the ACA.

How could the incoming administration implement policies that could have such a potentially devastating impact on the healthcare coverage of the American people? Trump plans on doing so by appointing “unqualified” personnel to senior positions within the Federal Departments including the Department of Health and Human Services and Centers for Medicare and Medicaid Services. 

Anti-Vaxx Activist for the Department of Health and Human Services? 

Trump nominated environmental lawyer  Robert F. Kennedy Jr. to serve as Secretary of the Department of Health and Human Services (HHS). HHS is an essential federal agency that ensures quality health services for the American people and for those that are “unable to help themselves.” His nomination has sparked significant debate due to his controversial views on vaccines and public health. 

Kennedy has been a vocal critic of vaccine safety, promoting debunked claims linking vaccines to autism. He has also expressed intentions, through various interviews and even an inflammatory tweet on X, to reform the Food and Drug Administration (FDA), suggesting that the “entire departments” may need to be overhauled. The FDA is responsible for protecting and ensuring security of resources that improve quality of life. These resources include drugs, medical products, and nutritional supplements.  His proposed changes range from revisiting federal vaccine recommendations to removing fluoride from public water supplies

 “He is against vaccines, so I think that would affect the FDA functioning and their priorities around approving new vaccines as well as CDC recommendations– who should be vaccinated, and mandates for them,” Graetz said. “Best case scenario–we have more research on fluoride and its effects on health. Worse case– he makes decisions that are not substantiated by evidence that really cause harm to kids, and everyone,” she added.

Howard noted, however, that due to his appointed position, Kennedy wouldn’t really have an influence to mandate such power. “The ability of the Secretary to affect policy is somewhat limited,” he said. “I think there could be some changes on the margins, but without congressional approval, it’s hard to make major changes.”

McMillon also expressed concern about the rise of conservative appointments, and how Trump’s appointments can be harmful to public initiatives. Kennedy’s nomination supports this ideal. “This looks like a very aggressive takeover, something that pushes away from the notion of cooperation to compromise,” he said, “hopefully, hopefully it slows down.” 

Kennedy’s appointment could create a regressive shift in health policy priorities, emphasizing alternative health approaches and skepticism toward traditional medical practices. His leadership could not only significantly influence the direction of federal health agencies and public health initiatives in the coming years, but experts and critics also suggest that these strides made in health policies will be setbacks.

Additionally, the broader shifts in health policy proposed during Trump’s 2024 campaign, including his administration’s imposition of tariffs could have widespread implications for pharmaceutical pricing.

Trump’s Proposed Foreign Tariffs and Effects on Drug Pricing

Donald Trump’s proposed tariffs on imports could also send shockwaves through the healthcare industry. Trump has said that he intends to enact a 20% tax on the majority of goods from China on the first day of office, including key raw materials and active pharmaceutical ingredients, which will significantly impact pharmaceutical pricing in the United States. 

 Healthcare leaders believe that Trump’s proposed tax on imported goods will severely jeopardize the effectiveness and efficiency of healthcare operations in the United States. Other experts claim that this tariff implementation will increase production costs for drug manufacturers reliant on China for essential components, leading to higher prices for generic drugs. 

 Graetz agrees: businesses will not take on these costs, which could increase taxes on the middle class. “The higher proportion of middle-class salary goes towards goods and services,” she said. “Depending on how he rolls them out, it could impact the cost of pharmaceuticals, medical devices, and, you know, access to care for a lot of people.”

Howard agrees with critics that it would impact generic drug pricing. “Generic drugs face a lot of competition where the current price is much more closely linked to the cost of production,” he said.

He does, however, believe that the prices of on-patent drugs, the ones that receive the most attention, will not be affected by Trump’s proposed tax on imported goods. “Their prices are kind of unrelated to what they cost to produce, as they are produced by monopolies.” 

Critics argue that Trump’s tariff will exacerbate drug affordability issues, particularly for middle class populations, though the incoming Administration justified the tariffs as a strategy to reduce dependency on foreign supply and increase domestic production. This enactment can only be implemented if Congress approves of its ruling. If Congress, currently occupied by majority conservative figures, implement these tariffs, it will come at the expense of the American people.

What are Trump’s Next Steps?

Health and economics experts emphasize that there is no predictability about how Trump’s second term will specifically reshape the form of healthcare due to his ambiguity on the campaign trail. Trump is, however, indicating plans to implement significant changes to the industry that could result in widespread chaos, confusion, and lasting damage.  

“I think that the health of people and our readiness to deal with public health challenges are going to suffer,” said Graetz. These actions will ultimately cause people to pay more and for businesses and hospital services to be disrupted, she suggests. 

To emphasize, these proposals, shrouded in conspiracy and lacking scientific evidence, are points he has discussed in interviews and campaign speeches as well as during the 2024 Presidential Debates. Therefore, it is not possible to conclude how exactly this plan will affect the landscape of healthcare, for now. 

Right now, the American people have the right to question how these plans would address the complex needs of the current healthcare system effectively. The stakes for public health and health policy are at an all-time high in the unpredictability of the Trump Administration’s upcoming second term.

[This story was written in December 2024 for the class HLTH 381W.]